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COPD

BARRY MAKE, MD Co-Director, COPD Program. Director, Pulmonary Rehabilitation National Jewish Health, Denver, CO

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Which photo do you like?

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Question #1

1. COPD patient carrying oxygen on his bicycle

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2. Lilly pond at 9,000 feet elevation

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3. Lions, tigers and BEARS

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Disclosure Information

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Advisory board, consultant, multi-center trial, research funding or speaker in the last year for topics related to COPD: National Heart, Lung, and Blood Institute AstraZeneca Boehringer-Ingelheim CSL Bering Forest GlaxoSmithKline Novartis Spiration Sunovion Theravance January, 2015

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Objectives

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• Discuss a recent article on reducing therapy for Pr es e

COPD exacerbations – the Wisdom trial

• Understand the importance of COPD of

exacerbations

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• Know what therapies reduce COPD exacerbations

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Session Methodology

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• DISCUSSION

– Participation by all who are interested

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• Audience response system • Focus on a recent publication in New England pe

Journal of Medicine

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• Your feedback is encouraged

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Question #2

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Did you complete the assignment:

1. No

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Read New Engl J of Med WISDOM Trial?

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2. Yes

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3. Other

Question #3

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What percentage of your patients with COPD are on “triple therapy”?

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- long-acting antimuscarinic antagonist (tiotropium, aclidinium, etc),

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10% – 24% 25% - 50% 51% - 74% 75% - 100%

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1. 2. 3. 4.

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- long-acting beta-agonist / inhaled steroid (salmeterol / fluticasone, formoterol / budesonide, etc)

Question #4

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Why are MOST of YOUR COPD patients on “triple therapy”? 1. AECOPD are financially costly

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2. AECOPD reduce lung function

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3. Therapies can reduce AECOPD

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4. Self-management programs always reduce AECOPD 5. All (1 – 4) are correct

Question #5

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Which are NOT correct?

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COPD exacerbation importance:

1. AECOPD are financially costly

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2. AECOPD reduce lung function

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3. Therapies can reduce AECOPD

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4. Self-management programs always reduce AECOPD 5. All (1 – 4) are correct

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Reduce symptoms

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• Relieve symptoms (SOB) • Improve exercise tolerance • Improve health status

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Goals of COPD Management

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• Prevent disease progression • Prevent and treat exacerbations • Reduce mortality

Reduce risk

Global Initiative for Chronic Obstructive Lung Disease. Global strategy of the diagnosis, management, and prevention of COPD. 2014. http://www.goldcopd.org

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Reduce symptoms

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• Relieve symptoms (SOB) • Improve exercise tolerance • Improve health status

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Long-acting Bronchodilator Effects

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• Prevent disease progression • Prevent and treat exacerbations • Reduce mortality

Reduce risk

Global Initiative for Chronic Obstructive Lung Disease. Global strategy of the diagnosis, management, and prevention of COPD. 2014. http://www.goldcopd.org

Question #6

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Do these medications reduce COPD exacerbations?

combination

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1. YES

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• Long-acting muscarinic antagonists • Inhaled steroid / long-acting beta agonist

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2. NO

3. NOT SURE

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Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT)

Tiotropium Reduces Exacerbations

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Tiotropium

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Placebo

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14% reduction in exacerbation when added to usual therapy

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HR=0.86 (0.81, 0.91) P