Roflumilast is effective in reducing COPD related exacerbations and improving CAT score

Abstract

An 85-year-old male patient, former smoker (60 pack-years) and railway man, came to our clinic for the first time in 2005. Post bronchodilator (BD) forced expiratory volume in the first second (FEV 1 ) was 0.89 L (36% of predicted), residual volume (RV) was 172% of predicted, forced vital capacity (FVC) was 2.33 L (70% of predicted) and FEV 1 /FVC was 0.38. He was diagnosed with severe chronic obstructive pulmonary disease (COPD). At the time of the first visit, the patient was under daily treatment with tiotropium 18 μg/day, salmeterol 100 μg/day, fluticasone 1000 μg/day and theophylline Keywords: Roflumilast, COPD, Case report, Exacerbations, Steroid therapy. We present a case of a 85-year-old man who suffered from several chronic obstructive pulmonary disease (COPD) related exacerbations and hospitalizations. Traditional therapy, which also included intramuscular steroid therapy, did not help and caused several drug related adverse events. After yet another exacerbation followed by hospitalization at the intensive care unit, it was decided to start roflumilast treatment. In the year after beginning treatment, the patient did not experience any more exacerbations and his lung function also improved, as recorded by the COPD assessment test (CAT) score and improved forced expiratory volume in the first second (FEV 1 ) value. In this patient roflumilast seems to be effective in reducing exacerbations, an important goal to be achieved in COPD patients. Monaldi Arch Chest Dis 2013; 79: 3-4, Suppl., 41-44. This work originated from the Respiratory Physiopathology and Anti

Acute Exacerbation of Chronic Obstructive Pulmonary Disease – Clinical Presentation and Predictors of Outcome

“…The organisms were Streptococci species, Klebsiella, anaerobic organisms, Staphylococcus, Acinitobacter species. Fagon et al 32 , Monso et al 31 , Soler et al 30 in their studies isolated organisms in 50% of patients with AECOPD, with most common being Hemophilus, streptococci followed by Klebsiella Arora et al 36 studied 58 patients with AECOPD established etiology in 72% of cases. Ramkrishna et al 83 (2006) had a lower isolate of 25%.…”

Roflumilast: the fourth Mousquetaire in COPD pharmacological treatment

“…This issue of Monaldi Archives is dedicated to real life reports of the use of roflumilast in clinical practice. After a comprehensive review on the drug and its clinical data [15], six reports from different Hospitals and groups across Italy describe similar stories [16][17][18][19][20][21]. The reports deal with patients with recurrent AECOPD episodes causing multiple hospitalization (so called "revolving door patients"), patients not responding to conventional treatments, with accelerated decline of lung function, multiple comorbidities, developing disability.…”

The Role of Early Warning Scoring Systems NEWS and MEWS in the Acute Exacerbation of COPD

“…However, studies have shown more frequent isolation of pathogens during AECOPD than in patients with stable COPD, indicating a pathogenic role of bacteria at least in a proportion of AECOPD. 11,12 The rational for sputum collection is to identify respiratory tract infection and of course its sensitivities to antibiotics. The upper respiratory tract, especially the nasopharynx and the mouth, is densely colonized by a large variety of bacteria and a number of these bacteria have a potential pathogenic role when they move into the lower respiratory tract by micro-aspiration of secretions.…”