What Does the Future Hold for COPD?

New COPD treatments in development

/ Author:  / Reviewed by: Chris Galloway, M.D.

Chronic Obstructive Pulmonary Disease is a lifelong disease with serious health and financial complications. Luckily, there is hope in new treatments for COPD.

COPD is a set of lung diseases which restrict airflow and lead to breathing difficulties. COPD patients are more prone to other respiratory diseases such as pneumonia or the flu. There is no cure for COPD but current treatments and future treatments could greatly improve the lives of COPD patients.

Dailyrx had the chance to talk about the current state of COPD with Zab Mosenifar, M.D., F.C.C.P., F.A.C.P., Professor and Executive Vice Chair, Department of Medicine, Director, Division of Pulmonary & Critical Care Medicine, Director, Women's Guild Lung Institute at Cedars Sinai Medical Center.

Previously, Dr. Mosenifar had discussed some of the causes of COPD. According to Dr. Mosenifar, nearly 80 percent of all COPD cases were caused by smoking and the death rates for COPD has increased.

Current Treatments for COPD

Around 14.8 million Americans, with up to 12 million undiagnosed cases, have COPD according to National Heart Lung and Blood Institute (NHLBI) and it is the third leading cause of death in America. Out of the 242,350 deaths associated with lung disease in 2008, COPD accounted for over 56 percent of lung disease-related deaths. Because of these numbers, doctors and researchers are trying to find new ways to help treat COPD.

Quitting smoking is the most important thing to do for COPD patients. This will help reduce future lung damage and won't cause symptoms to worsen. Since COPD patients are more prone to other lung diseases, vaccination is important. Dr. Mosenifar urges COPD patients to take the yearly flu shot as well as the pneumonia vaccination.

Common treatments for COPD include inhalers either a bronchodilator or inhaled corticosteroids such as Pulmicort. Other popular treatments combine a bronchodilator with an inhaled corticosteroid such as Advair, Spiriva and Symbicort.

For Dr. Mosenifar, in addition to inhalers, other forms of treatment could include exercise. Weight loss is important and exercise can improve cardiovascular health as well as lung function. Weight loss can reduce the strain on your body and improve daily quality of life.

In addition to these treatments, surgery is also an option for COPD patients. A bullectomy removes blockages in the bronchiole tubes. This allows more room for the air sacs and improves breathing. Another surgical procedure for COPD can remove up to 30 percent of damaged lung tissue so the health lung tissue can work better. Most drastically, COPD patients can also receive a lung transplant.

These treatments are based on symptoms and lung function tests, notes Dr. Mosenifar. Without factoring in hospitalizations, COPD can be quite costly. Dr. Mosenifar estimates the cost of COPD to be around $6,000 per patient. This number can be higher or lower based on symptoms and treatments.

Move Over Advair

Because of the number of people affected by COPD, new treatments and potential targets for treatment are constantly being developed. GlaxoSmithKline and Theravance, Inc. have announced the successor to Advair, called Relovair. Much like Adavair, Relovair is a combination therapy of a bronchodilator and an inhaled corticosteroid but is used once daily instead twice a day like Advair.

Relovair has been shown to be better than Advair when it comes to treating asthma and COPD symptoms. In two clinical trials, Relovair was shown to be an improvement over Advair although only one test had significant improvements. GlaxoSmithKline is investing heavily into Relovair and are planning to submit the drug for approval by the Food and Drug Administration by mid-2012.

While Relovair may be the new drug to replace Advair, generic versions of Advair may be available in the near future as well. Patents for Advair expired in 2010 in America and will expire in 2013 in Europe but a generic version has yet to be revealed.

Teva Pharmaceuticals, a leading manufacturer of generic drugs, has cited the regulation process for FDA approval as one reason why a generic version of Advair may not be possible in America. Teva was planning to submit a generic version for Advair in Europe by 2012 and available to the public by 2013 or 2014.

The Future of COPD

Another COPD drug is being developed by Novartis and has just passed its first three Phase III clinical trials. QVA149 is a different take on a combination treatment, this time combining two types of bronchodilator. QVA149 combines a long-acting beta2-agonist (LABA) indacaterol with a long-acting muscarinic antagonist (LAMA) glycopyrronium bromide and is used once daily. The dual bronchodilators help relax the muscles in the airway thus improving lung function.

QVA149 passed three clinical trials. The first trial showed that QVA149 was more effective than either the LABA or LAMA on its own when treating COPD symptoms. The second trial showed that QVA149 improved exercise endurance when compared to a placebo. The third trial determined that QVA149 was safe and well-tolerated.

For QVA149, this is just the first three out of seven steps before Novartis could seek FDA approval. No information about potential cost has been revealed but Novartis hopes to complete all clinical trials by the end of 2012. 

In addition to new drugs like Relovair or QVA149, Dr. Mosenifar believes that stem cells could play a role in COPD treatments. According to Dr. Mosenifar, studies involving stem cells used to grow new lung tissue are currently in the very early stages of research. 

For now, COPD patients have plenty of options for treatment. Quitting smoking is the best type of prevention and future studies can better understand how COPD works. New drugs like Relovair or QVA149 may further improve the quality of life for COPD patients and new studies are always finding new potential targets for COPD treatment.

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Review Date: 
April 5, 2012