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Treating COPD With Combination Therapy


Implications for treating chronic obstructive pulmonary disease with combination regimens based on clinical data and how the condition will likely be managed in the coming years.


Neil B. Minkoff, MD: We’ve been talking a lot today about all of these different things, but we had a significant section on combination therapy and triple therapy. I’m going to start with you, Maria, and ask, have you felt that there are enough data to support that combination or triple therapy improves health outcomes and has the potential to lessen cough?

Maria Lopes, MD, MS: I think there are. There’s no question that pharmacotherapy is having a major impact on not only symptoms but the reduction of exacerbations. We see this from a lot of the studies from when these first drugs even came out, much less than in the real world. I think many have proven themselves to have an impact on exacerbations and, ultimately, our visits as well as hospitalizations. That’s part of what we usually want to see at launch, as well as even in the real world—the ability to understand what that impact is on total cost of care.

Neil B. Minkoff, MD: What do you think the patient perspective is on the use of combination and triple therapy, and how it’s affecting them, and whether or not it’s lessening their healthcare utilization?

Frank C. Sciurba, MD, FCCP: There are 2 components. One is, if it makes them feel better, they love it. They’re happy. The other side is, if it reduces risk, they may not immediately perceive that. That’s like treating cholesterol or hypertension. That takes some education to get compliance. If you’re adding an inhaled corticosteroid to a dual bronchodilator, they may not perceive an immediate benefit from that. You need to tell them, “I believe this is going to reduce your flare-ups. It’s going to stabilize your disease.” There has to be an education piece. They have to understand why they’ve added that, including maybe that expense or the need to use a couple of inhalers at times.

Neil B. Minkoff, MD: I have to say, this has been a great conversation and a really outstanding dialogue. I think people are going to get a lot out of this. Before we conclude, I’d like to get a final thought, maybe just a couple of sentences—the major point you want to get across, or something like that, or something you found particularly interesting or newsworthy that came out of our conversation today. I’ll ask you to go first, Maria.

Maria Lopes, MD, MS: There is tremendous opportunity in COPD, on both the prevention side as well as treatment optimization. I have heard some great comments and feedback from thought leaders around how PROs [patient-reported outcomes] are being instrumental in understanding and assessing what the patient’s symptoms are. But also, how do you individualize goals? Hopefully that not only creates a meaningful impact but really optimizes care and the care delivery as well as impact on total cost.

Neil B. Minkoff, MD: Frank?

Frank C. Sciurba, MD, FCCP: It’s important to recognize that we can do something with this disease. Unfortunately, this disease has often been stigmatized to former smokers. It’s been defined as irreversible. But the reality is that many diseases in our society are based on just human errors, human activities. We should not stigmatize these patients.

The data show we can have impact on how they feel, and we can have impact on the cost of the healthcare system and the burden. We need to take them seriously, treat them, do evidence-based therapy, and not treat them as we did 30 years ago with just short-acting bronchodilators and steroids. Those are the wrong treatments.

Byron Thomashow, MD: I’ll say 1 good thing and 1 upsetting thing. The good thing is, this is a preventable and treatable disease. We’ve got treatments that work now. We need better treatments going forward. The second part is that despite its impact, COPD continues to receive a fraction of the research funding provided to all the other major diseases. There’s a reason we’ve made the progress we have with HIV and cardiovascular disease and cancer. It’s billions of dollars in research funding every year. COPD continues to struggle with a very little amount of funding. You get what you pay for. We can do better. We need to put more money into it.

Neil B. Minkoff, MD: I want to thank our panelists for a very robust discussion. And I want to thank all of you. And on behalf of our panel, we hope you found this Peer Exchange to be useful and informative. We’ll see you at the next one.

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