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Risk Factors and Comorbidities Impacting Patients With COPD


Jeffrey D. Dunn, PharmD, MBA, leads a panel discussion on disease and treatment landscapes for COPD.

Jeffrey D. Dunn, PharmD, MBA: Hello, and welcome to this AJMC® program titled “Medication Management Considerations in COPD.” My name is Jeff Dunn. I’m the chief clinical officer at Cooperative Benefits Group. We’re a transparent pass-through PBM [pharmacy benefit manager] in Salt Lake City, Utah. Joining me in this discussion are my colleagues Dr Courtney Crim, a clinical associate professor of medicine at the University of North Carolina at Chapel Hill School of Medicine [in Raleigh, North Carolina] and a pharmaceutical and biotech consultant; Dr Reynold Panettieri Jr., a vice chancellor for translational medicine and science director at Rutgers Institute for Translational Medicine and Science, a professor of medicine at Robert Wood Johnson Medical School, and emeritus professor of medicine at the University of Pennsylvania; and Mr Mike Hess, a respiratory therapist and a senior director of public outreach and education at the COPD Foundation.

Our panel of experts will provide an overview of COPD [chronic obstructive pulmonary disease] and its economic and clinical burden. We’ll discuss standards of care in COPD management, including triplet therapy in appropriate patient populations for intensive disease management, and review implications of drug therapy and patient perspectives that are important to consider in the management of COPD. Thank you. Let’s begin.

We’ll begin by providing a broad overview of COPD, including the economic and patient burden related to therapy. Courtney, let’s begin with you. Do you mind providing a high-level overview of COPD, staging, and treatment goals?

Courtney Crim, MD: There are 2 major goals that we like to achieve in patients who have COPD. One is to reduce their symptom burden and reduce their risk. This could be related to their risk for having exacerbations and impaired exercise tolerance. Likewise, we like to reduce the impact of their disease. This could be related to things like disease progression and mortality.

To address this as it relates to our treatment goals, we look upon this particularly as it relates to the GOLD [Global Initiative for Chronic Obstructive Lung Disease] strategy document to assess these patients in terms of the impact on lung function. That’s where we use the GOLD staging as it relates to the severity of airflow limitation, as well as the impact of their symptoms on their disease. This relates to their symptoms as relates to shortness of breath, their health status, and their risk for having exacerbations, so that when we consider how to treat these patients, we focus on the impact that the disease is having on their symptoms and their exacerbation risk. That’s how the various treatment strategies that the GOLD strategy document implements guides for physicians in terms of things to consider.

Jeffrey D. Dunn, PharmD, MBA: Rey, what are some of the biggest risk factors for COPD?

Reynold Panettieri Jr, MD: The greatest risk factors for the development of COPD in the United States is cigarette smoke or tobacco smoke in general. Globally, it’s biomass burning. But in the United States, cigarette smoke, pipe smoke, or any tobacco burning is going to be the greatest risk factor. There are hereditary risk factors for the development of COPD, such as antiprotease deficiencies. They’re very uncommon. That hereditary risk is even amplified with environmental smoke exposure. The bottom line is that if you’ve developed COPD in the United States, it’s likely because of tobacco smoke.

Jeffrey D. Dunn, PharmD, MBA: That will be super-important as we get into further discussions because that’s a modifiable risk factor.

Reynold Panettieri Jr, MD: Absolutely.

Jeffrey D. Dunn, PharmD, MBA: That will be important when we talk about interventions and other things, so thank you. Courtney, what are the most common comorbidities that may be present in patients with COPD?

Courtney Crim, MD: It’s important for us to recognize various comorbidities because oftentimes people look at COPD as solely a disease of the lung, whereas we recognize that a significant number of patients have various comorbidities. Of greatest concern is the cardiovascular disease that patients who have COPD are at greatest risk for. Other things that are important include osteoporosis. This can be related in part to the fact that because of their underlying lung disease, they aren’t as mobile. Mobility decreases the risk of osteoporosis. Osteoporosis is another big important comorbidity.

Skeletal muscle dysfunction can be related to a decrease of skeletal muscle cells or how well they function. Depression is also important in these patients with COPD because of the impact on their lung function and the inability for them to do things that are important in their lives. Anxiety is another significant comorbidity. Likewise, as we recognize that smoking leads to the development of COPD, smoking is also a risk factor for lung cancer. That’s another important comorbidity. Finally, things such as the metabolic syndrome is also a significant comorbidity in patients with COPD.

Jeffrey D. Dunn, PharmD, MBA: That’s interesting. We don’t often tie a lot of those to COPD, but a lot of those are modifiable as well. That’s also going to be important if we’re talking to patients with COPD about these other things. Can I ask you a naïve follow-up question? Some people will probably ask this question: what’s the relationship between COPD and asthma?

Courtney Crim, MD: They are 2 different diseases. Patients who develop asthma—particularly those who develop asthma at an early age—are still at risk for developing COPD, particularly if they’re a smoker. Having asthma doesn’t preclude the development of COPD. Likewise, having COPD doesn’t preclude the development of asthma. They’re 2 separate and distinct diseases. That’s why patients who have either [disease] need to be very cognizant of things that may increase their likelihood or risk for developing the other condition.

Jeffrey D. Dunn, PharmD, MBA: That’s superhelpful. The reason I ask is because from a payer perspective, a lot of the therapies are similar, but these aren’t the same patients. We have to look at these things from a different lens when we’re intervening and treating patients. That’s helpful. Thank you.

Transcript edited for clarity.

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