New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
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Transcript of New Therapies for COPD 2013 Edward Omron MD, MPH, FCCP
Edward Omron MD, MPH, FCCPPulmonary, Critical Care, and
Internal Medicine18525 Sutter Blvd, Suite 180Morgan Hill, CA [email protected]
Chronic, progressive shortness breath Symptoms
◦ Cough◦ Phlegm◦ Chest Pressure◦ Wheezing◦ Exercise limitation
Two irreversible lung diseases that frequently coexist together:◦ Chronic bronchitis: airways of the lung are
inflamed, swollen and narrowed resulting in “wheezing” HEAVY mucus or phlegm is coughed up Breeding ground for recurrent infections
◦ Emphysema: the scaffolding of the lung is destroyed resulting in multiple “holes”
Bronchitic Emphysematous
Third leading cause of death in America◦ 125,000 lives in 2007
Smoking is the primary risk factor for COPD
Female smokers are 13 times more likely to die from COPD than females who never smoked
13 million adults were estimated to have COPD in 2008
50 Billion in health care costs yearly
Tobacco Smoke!!!! Occupational Exposures
◦ Coal Miners◦ Smelters◦ Shipyards
Genetics is Very Important!
Pulmonary Physician Appropriate Symptoms Diagnostic Studies
◦ Chest X-Ray◦ Pulmonary Function Study◦ 6 minute walk test◦ Arterial Blood Gas◦ Alpha 1 antitrypsin deficiency
Congestive Heart Failure Asthma Bronchiectasis Interstitial Lung Disease
Patient Education◦ Early treatment for exacerbations◦ Appropriate treatment for symptoms◦ Reduce risk factors◦ How to treat an exacerbation ◦ Inhalers◦ Nebulizers◦ Pulmonary Rehabilitation
Bronchodilators◦ B Agonists◦ Anticholinergics◦ Xanthines
Pulmonary Specialist to determine which is best
Glucocorticoids (Steroids)◦ Oral prednisone for flair-up of disease◦ Intravenous usage in hospital◦ Inhaled usage for outpatient
Risks◦ Fractures◦ Diabetes◦ Infection
Vaccines◦ Influenza, pneumococcus
Antibiotics Flutter valve Supplemental Oxygen Mucolytics Pulmonary Rehab
Shortness of breath = inactivity Muscle Weakness = Fatigue Loss of independence = depression Isolation Weight Gain Immune system weakens
Builds Strength Less shortness of breath More independence Greater reserve to fight infection Less fatigue Weight control Quality of life
Under care of a health professional Physical Therapist guides training Stretches Aerobic Conditioning How to cough, breath, and train safely
Indacaterol (Arcapta Neohaler)◦ Once daily long acting (24 hours) bronchodilator
in COPD◦ Rapid onset with intense bronchodilation◦ Improvement in shortness of breath, exercise
performance, and quality of life.◦ Hopefully available later this year, excellent
safety profile
Phosphodiesterase inhibitors (similar to caffeine)
Decreases airway inflammation Not a bronchodilator Side effects: Headache, Nausea, Diarrhea Reduces COPD exacerbations Once daily oral dosing, cannot be used in
liver dysfunction
A genetic condition associated with early onset COPD and liver disease
Alpha 1-Antitrypsin is a enzyme that protects the lung from enzymes that break down lung tissue
About 1-3% of patients with COPD are predicted to have alpha1-antitrypsin deficiency.
Intravenous (IV) augmentation therapy with alpha1-antitrypsin benefits some patients
Identified in all populations All COPD patients are now screened for this
disorder
Inhaled long-term, once-daily maintenance treatment in patients with chronic obstructive pulmonary disease (COPD)
Combination of the inhaled corticosteroid (ICS), fluticasone furoate and the long-acting beta2 agonist (LABA), vilanterol
Will be available in the US during the third quarter of 2013
Should not be used as rescue therapy An increase in the incidence of pneumonia is
noted with this class of combination drugs
Lung Reduction Surgery◦ Improved exercise capacity, quality of life◦ Upper lobe emphysema best outcome◦ No survival advantage
Lung Transplantation◦ COPD, CF, IPF, Idiopathic Pulmonary
Hypertension◦ BODE Score 7-10◦ Median survival 6 years
Endobrobronchial Valves◦ Advanced emphysema◦ Modest improvement◦ Frequent COPD exacerbations and hemoptysis
Stem cells are derived from the bone marrow◦ Can regenerate normal lung tissue with
manipulation◦ Several studies in animal models show great
promise in COPD◦ Too early to comment
Vitamin D◦ Early enthusiasm ◦ Most recent study in severe COPD disappointing◦ No consensus
American Lung Association◦ http://www.lung.org/lung-disease/
http://www.onebreath.org/ NEJM 2003; 348:2059-2073 NEJM 2010; 363: 1233-1244 Am J Respir Crit Care Med 2013; 187:468-475 Am J Respir Crit Care Med 2013; 187: 228-
237 Am J Respir Crit Care Med 2011; 159-171
Edward M. Omron MD, MPH, FCCP
Pulmonary, Critical Care, and Internal Medicine
18525 Sutter Blvd, Suite 180 Morgan Hill, CA 95037 1-408-778-0022