Combining the two most common COPD
drug therapies is a more effective treatment for patients
with a severe case of the disease than either of the
drugs alone, confirms a new Canadian study published
online in the Annals of Internal Medicine. "Our
outcome is relatively dramatic," beams lead author Dr
Shawn Aaron, a University of Ottawa respirologist.
The randomized, double-blind trial
followed 449 patients from across Canada for one year
and is the first trial to measure the safety and effectiveness
of a combination of tiotropium (Spiriva) and fluticasone/salmeterol
(Advair) for severe chronic obstructive pulmonary disease
(COPD), an incurable but manageable respiratory illness.
The disease, which affects about 5% of Canadian adults,
is caused primarily by smoking and can result in difficulty
breathing, bronchitis, pneumonia and lung cancer. It's
the fourth-leading cause of death in Canada.
SEVERITY
SLASHED
At first glance, Dr Aaron's findings don't even look
relatively dramatic. The study revealed that a tiotropium
and fluticasone/salmeterol combo only slightly improved
lung function in patients with severe COPD and it failed
to reduce the number of disease exacerbations experienced.
But, significantly, the drug combo did reduce the number
of hospitalizations over a year by a whopping 47%. This
indicates that although treatment-group patients still
had the same number of exacerbations as those on placebo
or tiotropium alone, those exacerbations were less serious,
requiring fewer emerg visits as well (down 19%).
Reducing hospitalizations for COPD
exacerbations is a boon both for patients and the healthcare
system; such hospitalizations last an average of 10.5
days and cost hospitals up to $11,000 per stay, so the
economic benefits of halving the number of hospital
stays (which will be published in a forthcoming evaluation
of the study's data) are enormous.
"Both drugs are used relatively
frequently in Canada for COPD. Generally one of the
two is chosen first and the other is added if the first
doesn't work," says Dr Aaron. "In the last few years,
more and more patients have been ending up on both."
A
BREATH OF FRESH AIR
"This is the first study to have looked at a combination
of these two agents for COPD treatment," says Queen's
University respirologist Dr Denis O'Donnell, Dr Aaron's
co-author and the man responsible for drafting the forthcoming
update of the Canadian Lung Association's best practice
guidelines on COPD treatment. "In the 2003 guidelines
we already advised that the combination therapy be reserved
for people with more advanced disease and exacerbations.
This study confirms the guidelines."
Dr O'Donnell admits that the combination
treatment did not result in much of an increase in lung
function: just a 5% improvement. "It's modest by any
standard," he says. "But it's nice to know that after
a year their breathing tests are better than when they
started. And the quality of life measurements were also
important — they came out positive."
Reducing the severity of exacerbations
is a major step forward for COPD treatment, notes Dr
Aaron.
Dr O'Donnell adds a word of caution:
"Family physicians shouldn't be extrapolating from this
study for their less severe patients," he stresses.
"The danger is that GPs will be using this as first-line
primary maintenance therapy, but the study only looked
at people with severe disease."
|
