Roflumilast could become a new therapeutic strategy for patients with chronic obstructive pulmonary disease

An anti-inflammatory drug called roflumilast could become a new therapeutic strategy for patients with chronic obstructive pulmonary disease (COPD), conclude the results of a randomised trial in this week’s issue of The Lancet.

COPD is the fifth leading cause of death worldwide, and its increasing prevalence and limited treatment options suggest that it will become the third leading cause of death by the year 2020. COPD is characterised by progressive airflow limitation associated with chronic inflammation and includes conditions like emphysema and chronic bronchitis. COPD is usually related to cigarette smoking, but other causative factors exist, such as exposure to air pollution.

Klaus Rabe (Leiden University, Leiden, Netherlands) and colleagues tested whether roflumilast, a phosphodiesterase-4 inhibitor, had an effect on lung function and healthrelated quality of life in patients with moderate to severe COPD. The investigators recruited 1157 patients with COPD from centres in eleven countries. Patients were randomly assigned to 250 mg of roflumilast, 500 mg of roflumilast or a placebo. The researchers found that roflumilast improved lung function and reduced worsening of respiratory symptoms when compared with placebo. They also found that patients on the drug had greater improvements in health-related quality of life than those assigned the placebo.

Dr Rabe concludes: “. . . roflumilast was effective in improving lung function and reducing exacerbations in a population of patients with moderate to severe COPD. The phosphodiesterase-4 inhibitor class shows promise as a new therapeutic strategy for patients with COPD.”