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Tiotropium may slow early lung disease damage
By Gene Emery
NEW YORK (Reuters Health) - Most people in the earliest stages of chronic obstructive pulmonary disease (COPD) have no symptoms, so they have no idea that their lungs are deteriorating rapidly.
A new study from China suggests that if COPD can be detected early, the drug tiotropium might be able to slow that deterioration if used in conjunction with standard inhaler therapy.
In 388 volunteers with the mildest forms of the disease who were treated with tiotropium, lung capacity declined by an average of 38 mL per year, compared with a 53-mL decline among 383 placebo recipients, researchers reported in The New England Journal of Medicine, online September 6.
Such people usually are given no medicine because they have no symptoms or few symptoms. Tiotropium (brand name Spiriva) costs about $13 per day for a standard dose, or roughly $4,700 per year. Boehringer Ingelheim, the manufacturer of the drug, paid for the study.
The findings need to be confirmed, but if they are, it could finally give doctors a treatment for the disease to delay late symptoms, Dr. MeiLan Han, a spokeswoman for the American Lung Association, told Reuters Health in a telephone interview.
"We know that lung function decline is probably greatest in the earlier stages," said Dr. Han, an associate professor of medicine at the University of Michigan. "What makes this study unique is it studied the mildest group that has ever been studied, the patients most likely to benefit, and the researchers actually showed a benefit."
Just over 6% of the U.S. population has been diagnosed with COPD, according to the Centers for Disease Control and Prevention. The vast majority are smokers or former smokers, but one quarter of its victims have never smoked.
"About half of the patients who have the disease are undiagnosed, yet it's the third leading cause of death in the United States," said Dr. Han, who was not connected with the research.
Doctors have not been more aggressive at diagnosing COPD because, until now, no treatment has been shown to be helpful in the early stages.
One of the coauthors, Dr. Pixin Ran of the Guangzhou Institute of Respiratory Diseases, told Reuters Health by email that 87% of patients with the earliest stage of COPD were still in stage 1 after 24 months, versus 76% in the placebo group.
"Once the diagnosis of COPD is confirmed," Dr. Ran said, "avoidance of the risk factors (e.g., smoking cessation) is imperative."
Long-term use of the drug would be necessary, but "maintenance therapy with medications such as tiotropium is reminiscent of the strategy for management of patients with diabetes and hypertension," he said.
But Dr. Ran also said, "Further study is needed for the development of less costly drugs that can help to improve lung function, slow down the decline in lung function, improve quality of life, and decrease the incidence of exacerbations among patients with early-stage COPD."
When the drug was tested on people with more-severe COPD in a 2007 study called UPLIFT, it didn't produce significant improvement in lung capacity. But there was a suggestion that it might help patients with moderate stage 2 disease.
"This is potentially game-changing," said Dr. Han of the Lung Association. "So instead of ignoring these people, the onus is getting them diagnosed because if the study is correct there's something we can do about it. It could lead us in a whole new direction."
SOURCE: https://bit.ly/2xbrImw
N Engl J Med 2017.
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