The American Thoracic Society (ATS) held its annual meeting in Denver, Colorado on May 15-20 this year, where chronic obstructive pulmonary disease (COPD) was a topic that many physicians decided to head to the Rockies to discuss. The conference brings together clinicians, researchers and other allied health care professionals from throughout the world in one place to take a look at the current state of the art care in pulmonary, sleep and critical care medicine as well as the future to see what could be the next breakthrough. During the conference, innovative research and study results were presented, each of which help provide clues and pieces of the puzzle as to the cause, effects and treatment of COPD.
A popular symposium is always the “Year in Review", where thought leaders present what they consider important papers published during the previous year. In the COPD part of the lecture R. Graham Barr, MD, DrPH, from Columbia University, reviewed an article on “Withdrawal of Inhaled Glucocorticoids and Exacerbations in COPD” from the New England Journal of Medicine (NEJM). The findings indicated that in the group of people that were studied, withdrawing the inhaled steroid from long acting b2 agonist and long acting antimuscarinics did not shorten the time to an exacerbation. In other words, the addition of the anti inflammatory effect that inhaled steroid provides, did not provide "protective" effect on getting an acute deterioration of symptoms. However, in favor of steroids was that the results did showed those who were not on inhaled steroids had worse quality of life scores and lower FEV1. So the benefit from inhaled steroids was mixed.
In attendance at the conference was National Emphysema Foundation President, Laurence G. Nair, who provided his thoughts on this topic, stating, “the goal of pharmacotherapy is to take as much medicine as needed, but not more. Unnecessary medications increases the chance of side effects, unwanted drug interactions and is costly. However, many of our current go-to COPD medications (Advair, Symbicort, Dulera, etc.) already incorporate inhaled steroids in them. So, though from a pharmacology standpoint, removing inhaled steroids means you are taking one less medication, from a practical standpoint, it would not make you feel like you pared down your medication regimen. It would simply feel like you just replace one inhaler (a combination product) with another inhaler (a single agent without the steroid).”
A second study reviewed was “Simvistatin for the Prevention of Exacerbations in Moderate to Severe COPD" looked at the question did simvastatin have a role in preventing COPD exacerbations? This study was felt to be a well designed since it was a large multicenter, prospective, randomized trial. Why this topic was even considered was because it has been postulated that statin medication has some anti-inflammatory effect and some of the damage of COPD is imparted from inflammation. Nair stated that “this would be an interesting finding if it were true that statins actually had some protective effect on the lungs in addition to its known beneficial effect on the cardiovascular system, especially since these were two of the most important medical problems prevalent in our society." In fact, those who conducted the study actually terminated it early because there was no signal that there was any difference made by taking or not taking Simvistatin. No benefit was seen whatsoever.