Early COPD Treatment Slows Disease
Spiriva Begun Early in Chronic Obstructive Pulmonary Disease Slows Lung-Function Loss
By
Daniel J. DeNoon
WebMD Health News
Reviewed By
Louise Chang, MD
Aug. 27, 2009 -- Early treatment of chronic obstructive pulmonary disease
(COPD) slows loss of lung function and likely extends survival, a large-scale
clinical trial shows.
COPD is almost always caused by smoking. It includes two diseases: chronic
bronchitis, in which the airways become inflamed; and emphysema, in which the
air sacs in the lung are damaged.
Over time, COPD gets worse. Treatment does not reverse lung damage, but
it can make patients feel better.
The enormous UPLIFT study enrolled nearly 6,000 COPD patients in 487 centers
in 37 nations. UPLIFT tested the inhaled, long-acting bronchodilator
Spiriva.
Last year, UPLIFT study investigators reported that Spiriva can safely help
patients with severe COPD breathe more easily. But treatment did not slow the
inexorable loss of lung function in COPD patients.
But what if Spiriva were begun earlier, in patients with more moderate,
early disease? Few COPD studies have enrolled patients with early-stage
disease.
Analysis of the subset of 2,739 UPLIFT patients with moderate COPD shows
that Spiriva could actually slow COPD progression. Treatment also reduced COPD
exacerbations and improved quality of life over the four-year study.
There was even a suggestion that Spiriva extended survival, although there
were too few deaths among these patients for this finding to be statistically
significant.
"Treatment of COPD should begin in symptomatic patients with moderate [COPD]
disease," conclude UPLIFT investigators Marc Decramer, MD, PhD, and
colleagues.
In an editorial accompanying the study, University of Liverpool researchers
Lisa Davies and Peter Calverley note that the improvements seen with Spiriva
treatment were greater in early-stage patients than in late-stage patients.
"Important gains in wellbeing can be produced and maintained in the earlier
stages of COPD," they conclude.
The Decramer report, and the Davies/Calverley editorial, appear in the Aug.
28 online edition of The Lancet.
SOURCES: Decramer, M. The Lancet, published online Aug. 28, 2009. Davies, L. and Calverley, P. The Lancet, published online Aug. 28,
2009. Tashkin, D.P. The New England Journal of Medicine, Oct. 9, 2008; vol 359: pp 1543-1554.
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