COPD Guidelines Step one SAMA / SABA Step twoeither: »LAMA »LABA (+/- ICS) Step threeLAMA & LABA & ICS
COPD Treatment New moderate COPD, troubled by cough and some SOB...what’s your first treatment? That doesn’t relieve symptoms completely....what would you add in?
The POET trial Prevention of Exacerbations with Tiotropium trial One-year, multicentre, multinational, randomised, double blind, double-dummy, parallel group study 7363 male and female patients
The POET trial (2) End point was to compare the effect of (Spiriva) tiotropium inhalation capsule and salmeterol metered dose inhaler on COPD exacerbations Primary end point was time to first exacerbation of COPD
Results of POET trial Tiotropium was more effective at reducing exacerbations Over one year, the tiotropium group had a 17% RRR in exacerbations The time to their 1 st exacerbation was increased by 42 days The % of patients having at least one exacerbation a year was reduced from 38.5% to 34.4%
So..... Tiotropium compared with salmeterol significantly increased time to first COPD exacerbation Also reduced annual rate of exacerbations
Is there a risk of using anticholinergics in COPD ? In 2008 a meta-analysis suggested an increase in the absolute risk of major adverse cardiovascular events in patients taking anticholinergics for COPD
UPLIFT Trial Understanding Potential Long-term Impacts on Function with Tiotropium Patients given either 18Ug of tiotropium or a matching placebo 4 year randomized double-blind, placebo controlled, parralel group trial Moderate to severe COPD
UPLIFT trial (2) Primary end point was the yearly rate of decline in mean FEV1 Secondary outcome measures included rate of decline of FVC, QOL, exacerbations of COPD and rate of death
Results of UPLIFT trial Tiotropium reduces both respiratory and cardiac morbidity Over 4 years, patients consitently reported a better QOL Significantly delays time to first exacerbation Significantly reduces hospital admissions
Respimat Respimat is a mist inhaler It promised “improved delivery, with a 5mcg once daily dose of tiopropium BMJ paper found it was “associate with an increased risk of death” NNT for a year to cause one additional death was estimated at 121 Currently awaiting further study comparing “inhaled” to “mist” tiotropium preparations. Until then => avoid!
Learning Points from CSA Cases? Flu vaccs Erectile dysfunction, hypertension and obesity Osteoporosis
Summary COPD – evidence basis to drug selection –Diagnosis –Pulmonary rehabilitation –Respimat
Resources for today’s session Pennine VTS website Self assessment rating scale –RCGP website –Educational resources for GP training (and scroll to bottom of the page) –Erectile Dysfunction resources: –BASHH – erectile dysfunction –40over40.co.uk –Patient.co.uk