Researchers highlight need for more tailored approaches to treating chronic obstructive pulmonary disease

Speakers at the recent REG 2016 Summit highlighted the need for more research into the nature and effectiveness of treatment for COPD (Chronic Obstructive Pulmonary Disease) in a real-world environment.

Figures from the World Health Organisation[1] highlight that three million people died from COPD in 2012, accounting for six percent of all deaths globally. The research also shows that more than 65 million people have moderate to severe COPD and according to information compiled by the COPD Foundation[2], the quality of life of patients could be dramatically improved – and 40% of the resulting healthcare costs could be avoided - by preventing complications and hospitalisations.

Plenary speaker Dr Alan Kaplan (Ontario, Canada) spoke of the potential for precision medicine to achieve more effective patient management in COPD. Dr Kaplan proposed doctors need to interpret guidelines in conjunction with all available sources of evidence to treat the specifics of the patient in front of them. Several research abstracts presented at the summit echoed this call for more holistic approach to evidence appraisal to help guide more tailored approaches to COPD management.

Lies Lahousse presented data from the award winning abstract (awarded for implications for clinical practice) Effect of beta blockers on the Risk of COPD exacerbations[3]. The study suggests that beta blockers (primarily used to treat stress or heart problems, such as high blood pressure and angina) may also have potential benefit in managing patients with COPD.

COPD exacerbations involve a worsening of symptoms, in particular increased breathlessness, activity limitation and reduced quality of life. Although beta blockers are suspected to tighten the muscles in the airways, contributing to breathing problems, previous research has suggested beneficial effects of β-blocker use in patients with COPD. This study aimed to understand this link and to analyse if any potential benefit on exacerbations existed for COPD patients taking the drug.

The study drew on health records of 1,621 COPD patients from the Rotterdam Study, and explored the effect of beta blockers on time to COPD exacerbation in patients with/without heart failure. Cardio selective beta-blockers appeared to reduce the relative risk of COPD exacerbations by 21%. The benefits were substantially increased for patients with heart failure who saw a reduced risk of 55%.

A second prize-winning abstract (recipient of the best poster award at the summit) Comparative Effectiveness of Prescribing Similar versus Dissimilar Inhalers for COPD Therapy[4] (Bosnic-Anticevich, S et al.) explored the complex challenges that can face COPD patients when trying to take their inhaled medications effectively.  The historical cohort study considered the potential issues that arise when patients are prescribed more than one type of inhaler for different COPD medications, requiring them to master multiple, dissimilar inhalation and dose preparation manoeuvres.

The historical cohort study sought to characterise patients prescribed similar (multiple aerosol or multiple dry powder inhalers) or dissimilar inhalers (combinations of aerosol and dry powder devices) and potential clinical and/or demographic characteristics that may inform pragmatic prescribing decisions. The study included 52,817 patients from the UK Optimum Patient Care Research Database (OPCRD). The majority of patients (73%) were prescribed two different inhaler device types, particularly among those with more severe COPD. The largest contributor for the prescription of dissimilar inhalers was found to be the prescription of short-acting beta-agonists (SABA). The authors called for further work to now assess the implications of such prescribing behaviours on real-world clinical outcomes.

The research presented at the REG 2016 Annual Summit highlights the unanswered questions that remain in as to how best to manage COPD in the real world. It also highlights the value of organisations such as the Respiratory Effectiveness Group, which brings together international experts in real-life and comparative effectiveness research to utilise available real-world data sources to address these evidence gaps and assist clinicians in making more informed choices when considering the patient in front of them. Abstracts from the REG 2016 Summit will be published in a forthcoming issue of the Journal of Thoracic Disease.

[1] http://www.who.int/respiratory/copd/burden/en/
[2] http://www.copdfoundation.org/Portals/1/Factsheet.pdf
[3] Lahousse L, De Nocker P, Hofman A, Stricker B, Brusselle G, Verhamme K. Effect of Beta-Blockers on the Risk of COPD Exacerbations. J Thorac Dis 2016;8(Suppl 5):AB014. doi: 10.21037/jtd.2016.s014
[4] Bosnic-Anticevich S, Chrystyn H, Costello R, Dolovich M, Fletcher M, Lavorini F, Rodríguez-Roisin R, Ryan D, Yau S, Skinner D, Price D. Comparative Effectiveness of Prescribing Similar Versus Dissimilar Inhalers for COPD Therapy. J Thorac Dis 2016;8(Suppl 5):AB035. doi: 10.21037/jtd.2016.s035

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