Medications under-used in treatment of COPD

Clinical Update: Asthma - Chronic obstructive pulmonary disease (COPD) is an under-diagnosed condition and medications are under-used, said Dr Tim McDonnell, Consultant Respiratory Physician at St Vincent’s University Hospital. In the UK, one million patients are known to have the disease. However, two million people who have COPD are thought to be undiagnosed.

Tiotropium (Spiriva), a long-acting, 24-hour, anticholinergic bronchodilator, is currently the first line of treatment for patients with COPD. Salmeterol too is a bronchodilator – of the β 2 agonist type.
Indacaterol, a long-acting bronchodilator, represents a new generation of drugs that could be accurately described as once-daily β 2 agonists.
Key indacaterol data presented at the European Respiratory Society (ERS) Annual Congress demonstrated 24-hour bronchodilator activity in COPD. Considered together, these results provided important insights into indacaterol’s future therapeutic potential.
“A study on indacaterol in COPD is about to start at a number of centres in Ireland and the drug has a future as a first line treatment for COPD,” said AMNCH Tallaght Consultant Respiratory Physician, Prof Stephen Lane. The INSURE study investigators, led by Dr Beatrix Balint, looked at the onset of bronchodilatory action, with indacaterol. A fast bronchodilator effect (within a few minutes of dosing) may aid patient adherence, the authors said. The bronchodilator effect of indacaterol at five minutes post-dose was similar to salbutamol, the short-acting agent that is widely used for its property of fast-onset bronchodilation.
In a 26-week trial, Mahler showed that indacaterol once-daily improved dyspnoea in COPD patients.
As part of the INVOLVE study, Dahl et al showed that once-daily administration of indacaterol 300μg or 600μg provided sustained 24-hour bronchodilation in patients with moderate-to-severe COPD, with clinically relevant bronchodilation at 24 hours post-dose, at week 12. Indacaterol demonstrated a fast onset of bronchodilation on day one of treatment.
As part of the INHANCE study, Fogarty et al showed indacaterol provided 24-hour bronchodilation efficacy in patients with COPD. This was maintained over the course of the six-month study – irrespective of patient age (over or under 65 years).