Download Planning, COPD Hot Topics and CSA Preparation

Ruth Gooch 11/1/12
Planning, COPD Hot Topics
and CSA preparation
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
• Step one
SAMA / SABA
• Step two
either:
» LAMA
» LABA (+/- ICS)
• Step three
LAMA & LABA & ICS
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