COPD: early diagnosis and treatment to slow disease progression

Abstract

Aims: Chronic obstructive pulmonary disease (COPD) is usually a progressive condition. Undiagnosed early-stage disease, particularly in symptomatic patients, is likely to become more severe with time. Hence, prevention or reduction in disease progression is highly relevant. We evaluated the published data and discussed the potential impact of early intervention on the course of COPD. Methods: We performed PubMed searches of studies in early or mild COPD, focusing on those relating to lung function decline. Results: Smoking cessation reduced lung function decline at all stages of COPD, and the earlier the intervention, the greater the impact on lung function. Accumulating data from placebo-controlled trials suggested that long-acting bronchodilators can slow the decline in lung function, as well as reduce exacerbation and mortality rates and improve health-related quality of life (HRQoL) in patients with mild-to-moderate COPD. Inhaled corticosteroids (ICS) do not impact lung function in early COPD, and further research is needed on the role of long-acting b 2 -agonist-ICS combination therapy in these patients. Conclusions: Initiating treatment early in the course of COPD is likely to slow disease progression and improve HRQoL. Current data support maintenance treatment with a long-acting bronchodilator in this patient group. However, many questions remain unanswered regarding the optimal treatment of mild COPD, and further research is required to develop evidence-based recommendations in this field.

Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in Maintenance-Naïve Patients with Moderate Symptomatic Chronic Obstructive Pulmonary Disease: A Post Hoc Analysis

“…Furthermore, demonstration of a statistically significant treatment difference on supplemental rescue medication use, a clinical endpoint reflecting an effect on symptoms [36], shows that the potential for better symptom control with improved bronchodilation in MN patients is also a realistic goal. Currently, data on the impact of initiating maintenance therapy with dual bronchodilators in MN patients are sparse and are largely obtained using post hoc analysis of prospectively collected data [16,17,24]. These analyses consistently indicate no diminished patient benefit or safety concern when opting to use dual therapy as a first-line treatment option.…”

“…While there is increasing evidence of an efficacy gradient within the LAMA and LAMA/LABA classes with respect to lung function [15,[21][22][23], the comparative efficacy of different dual bronchodilator combinations used as first-line therapy has not been studied in appropriately symptomatic patients [24]. The LAMA/LABA combinations umeclidinium/vilanterol (UMEC/ VI) 62.5/25 mcg, delivered via the ELLIPTA dry powder inhaler, and tiotropium/olodaterol (TIO/OLO) 5/5 mcg, delivered via the Respimat soft mist inhaler, are the only LAMA/LABA combinations approved in the USA, Europe and other parts of the world as once-daily maintenance therapies for COPD [25][26][27][28].…”

Diagnostic accuracy of a pocket screening spirometer in diagnosing chronic obstructive pulmonary disease in general practice: a cross sectional validation study using tertiary care as a reference

“…Existing prevalence data show variations due to survey methods reflecting also a widespread under-diagnosis of COPD, even in patients with developed respiratory symptoms [2–5]. On the other hand patients with a mild COPD already have substantial reduction in all parameters of health related QoL (HRQoL) [6]. Modern strategies for COPD management are stressing the importance of primary care physician’s office-based assessments of patients at risk, thus significantly increasing the number of timely diagnosed COPD patients [7].…”

Expanding The INSPIRED COPD Outreach Program^TM to the emergency department: a feasibility assessment

“…Policy makers and stakeholders within Departments of Health, Primary Care, Acute Care settings, and others within the health care system encourage a focus on initiatives for prevention and early disease self-management 17–20. Based on the number of patients coded as AECOPD in the local ED electronic coding system, projections from our successful prior recruitment strategy and outcomes of our original INSPIRED program,8,21 the referral rate to INSPIRED-ED was lower than anticipated.…”