COPD: the silent killer

Although COPD is a devastating disease affecting an estimated one in 10 people aged 45 and older, up to 80% of sufferers are unaware they have it. Furthermore, even for patients who do receive treatment, current therapies do not stop the disease's progression. Until better treatments are available, then, efforts must focus on improving smoking cessation therapies and increasing awareness of COPD.

Chronic obstructive pulmonary disease (COPD) usually occurs in people aged 50 years and older. It is characterized by breathlessness on exertion, coughing and production of phlegm, which many people associate with 'just getting older', but actually reflects an underlying progressive loss of lung function.

The mechanisms involved with the development of COPD remain incompletely understood, although the main risk factor for COPD is cigarette smoking; 90% of COPD sufferers are current or ex-smokers.

'Silent killer'

In 2002, COPD was the fourth leading cause of death in the after heart disease, cancer and cerebrovascular diseases, accounting for 120,000 deaths. In addition, an estimated 28 million people in the seven major markets have COPD; a figure that will grow 14% by 2015.

Despite this, underdiagnosis remains a significant problem. Potentially 50-80% of COPD patients are not diagnosed due to the lack of awareness among the general public and physicians, the absence of any influential patient advocacy groups and the under-use of spirometers - the only instrument that can diagnose this disease.

Hence, patients often present with symptoms only in later stages of COPD, which has important implications for the economic burden of the disease and the patient's quality of life.

These worrying factors make it necessary to raise public awareness, educate general practitioners and drive up scientific and pharmaceutical interest in developing treatments for this killer disease.

Unstoppable progression

The two main drug classes used to treat COPD are bronchodilators and anti-inflammatories, with combined sales of $4.8 billion in 2004, according to IMS MIDAS sales audits.

Current therapies can reduce symptoms, increase exercise capacity, reduce the number and severity of exacerbations and improve health status and exercise tolerance in COPD sufferers. However, no pharmacological intervention has shown any major effects on the decline in lung function, which is the main characteristic of COPD.

The most important aspect of managing COPD in patients of all severities remains smoking cessation as it is the only treatment that has an effect on the decline in lung function.

Prescribing trends do not reflect best practice

According to Datamonitor research, while the prescription of inhaled corticosteroids and long-acting bronchodilators is most common in more severe COPD, a large proportion of patients with milder COPD receive these therapies, which is not recommended by treatment guidelines.

The role of inhaled corticosteroids, which remains controversial, should be clearer following the publication of GlaxoSmithKline's TORCH trial, which is investigating the role of Seretide/Advair in reducing mortality in patients with COPD.

Boehringer Ingelheim/Pfizer's Spiriva, a long-acting bronchodilator, was the fastest-growing COPD product in 2004, with sales forecast to climb from $415 million in 2004 to over $2 billion by 2014. While Spiriva is a first-line therapy for symptom relief in moderate to very severe COPD, its use in milder disease may increase following the release of results from a large scale clinical trial, known as UPLIFT, which are expected in 2008. If Spiriva demonstrates an effect on the decline in lung function, it may be readily prescribed to patients upon diagnosis.

Improved smoking cessation therapies

There remains a need for novel treatments that can prevent, stop or reverse the progression of COPD and prevent acute exacerbations. However, there are no revolutionary new drugs in the pipeline and, although novel combinations of existing classes of drugs may offer a step forward in patient compliance, they will not offer significant advances in treatment. Hence, in the near future, improvements in smoking cessation present the greatest hope to COPD patients.

It is essential to increase disease awareness among the general public in order to combat the under-diagnosis of COPD, which should be combined with nationwide screenings of high-risk groups to identify patients with early symptoms of the disease. Additionally, primary care physicians should be better educated about COPD symptoms and diagnosis to ensure patients are identified and treated accordingly.

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