Planning, COPD Hot Topics and CSA preparation

Ruth Gooch 11/1/12

Plan

• 14.00-14.45 Planning

• 14.45-15.15 COPD Hot Topics

• 15.15-15.30 Cakes and coffee

• 15.30-17.00 CSA Preparation

Planning

COPD Guidelines

COPD Treatment

• New moderate COPD, troubled by cough and some SOB...what’s your first treatment?

• That doesn’t relieve symptoms completely....what would you add in?

The POET trial

• Prevention of Exacerbations with Tiotropium trial

• One-year, multicentre, multinational, randomised, double blind, double-dummy, parallel group study

• 7363 male and female patients

The POET trial (2)

• End point was to compare the effect of (Spiriva) tiotropium inhalation capsule and salmeterol metered dose inhaler on COPD exacerbations

• Primary end point was time to first exacerbation of COPD

Results of POET trial

• Tiotropium was more effective at reducing exacerbations

• Over one year, the tiotropium group had a 17% RRR in exacerbations

• The time to their 1st exacerbation was increased by 42 days

• The % of patients having at least one exacerbation a year was reduced from 38.5% to 34.4%

So.....

• Tiotropium compared with salmeterol significantly increased time to first COPD exacerbation

• Also reduced annual rate of exacerbations

Is there a risk of using anticholinergics in COPD ?

• In 2008 a meta-analysis suggested an increase in the absolute risk of major adverse cardiovascular events in patients taking anticholinergics for COPD

UPLIFT Trial

• Understanding Potential Long-term Impacts on Function with Tiotropium

• Patients given either 18Ug of tiotropium or a matching placebo

• 4 year randomized double-blind, placebo controlled, parralel group trial

• Moderate to severe COPD

UPLIFT trial (2)

Primary end point was the yearly rate of decline in mean FEV1

Secondary outcome measures included rate of decline of FVC, QOL, exacerbations of COPD and rate of death

Results of UPLIFT trial

• Tiotropium reduces both respiratory and cardiac morbidity

• Over 4 years, patients consitently reported a better QOL

• Significantly delays time to first exacerbation

• Significantly reduces hospital admissions

Respimat

• Respimat is a mist inhaler

• It promised “improved delivery, with a 5mcg once daily dose of tiopropium

• BMJ paper found it was “associate with an increased risk of death”

• NNT for a year to cause one additional death was estimated at 121

• Currently awaiting further study comparing “inhaled” to “mist” tiotropium preparations.

• Until then => avoid!

COPD

Questions?

COFFEE

Learning Points from CSA Cases?

• Flu vaccs

• Erectile dysfunction, hypertension and obesity

• Osteoporosis

Summary

• COPD

– evidence basis to drug selection

– Diagnosis

– Pulmonary rehabilitation

– Respimat

Resources for today’s session

•Pennine VTS website

•Self assessment rating scale

–RCGP website

–Educational resources for GP training (and scroll to bottom of the page)

–Erectile Dysfunction resources:

–BASHH – erectile dysfunction

–40over40.co.uk

–Patient.co.uk