The discovery of roflumilast for the treatment of chronic obstructive pulmonary disease (2016 Expert Opinion on Drug Discovery)

Dear Respiratory friends, we are happy to present you exciting story of  discovery of roflumilast for the treatment of COPD by great Italian team: Mario Cazzola, Luigino Calzetta, Paola Rogliani & Maria Gabriella Matera^.

Introduction: Cyclic adenosine monophosphate (cAMP) phosphodiesterase (PDE)4 is an intracellular target that can be exploited to the treat chronic obstructive pulmonary disease (COPD), given that it is expressed in all inflammatory cells implicated in this inflammatory airways disease. At the present time, roflumilast is the only PDE4 inhibitor that has received regulatory approval for use in patients with COPD.

Areas covered: The preclinical, clinical and post-marketing development of roflumilast is described. Furthermore, a critical analysis of the clinical data and positioning of this drug is undertaken in this review

 

Expert opinion: The identification of a subset of COPD patients, namely those suffering from severe airflow obstruction with symptoms of chronic cough and sputum and a history of previous exacerbations, as a specific target for roflumilast with the goal of reducing exacerbations, was entirely casual because the delineation of a “chronic bronchitis” responder group was clearly a post-hoc finding. However, it was useful to design prospective clinical trials that demonstrated reduced exacerbations in this specific subset of patients towards whom roflumilast therapy is now targeted. However, these pivotal trials still do not provide more accurate identification of the type of exacerbation to be treated by roflumilast. The identification of the right biological COPD exacerbation phenotype and/or the right clinical COPD phenotype are the only means that could justify the use of roflumilast as a first line anti-inflammatory therapeutic approach.

full text:

http://www.tandfonline.com/doi/abs/10.1080/17460441.2016.1184642

Indacaterol–Glycopyrronium versus Salmeterol–Fluticasone for COPD (full text article from NEJM 2016)

Dear Respiratory Friends great news come from NEJM about dual bronchodilators in COPD!

Most guidelines recommend either a long-acting beta-agonist (LABA) plus an inhaled glucocorticoid or a long-acting muscarinic antagonist (LAMA) as the first-choice treatment for patients with chronic obstructive pulmonary disease (COPD) who have a high risk of exacerbations. The role of treatment with a LABA–LAMA regimen in these patients is unclear.

 

Methods

We conducted a 52-week, randomized, double-blind, double-dummy, noninferiority trial. Patients who had COPD with a history of at least one exacerbation during the previous year were randomly assigned to receive, by inhalation, either the LABA indacaterol (110 μg) plus the LAMA glycopyrronium (50 μg) once daily or the LABA salmeterol (50 μg) plus the inhaled glucocorticoid fluticasone (500 μg) twice daily. The primary outcome was the annual rate of all COPD exacerbations.

Results

A total of 1680 patients were assigned to the indacaterol–glycopyrronium group, and 1682 to the salmeterol–fluticasone group. Indacaterol–glycopyrronium showed not only noninferiority but also superiority to salmeterol–fluticasone in reducing the annual rate of all COPD exacerbations; the rate was 11% lower in the indacaterol–glycopyrronium group than in the salmeterol–fluticasone group (3.59 vs. 4.03; rate ratio, 0.89; 95% confidence interval [CI], 0.83 to 0.96; P=0.003). The indacaterol–glycopyrronium group had a longer time to the first exacerbation than did the salmeterol–fluticasone group (71 days [95% CI, 60 to 82] vs. 51 days [95% CI, 46 to 57]; hazard ratio, 0.84 [95% CI, 0.78 to 0.91], representing a 16% lower risk; P<0.001). The annual rate of moderate or severe exacerbations was lower in the indacaterol–glycopyrronium group than in the salmeterol–fluticasone group (0.98 vs. 1.19; rate ratio, 0.83; 95% CI, 0.75 to 0.91; P<0.001), and the time to the first moderate or severe exacerbation was longer in the indacaterol–glycopyrronium group than in the salmeterol–fluticasone group (hazard ratio, 0.78; 95% CI, 0.70 to 0.86; P<0.001), as was the time to the first severe exacerbation (hazard ratio, 0.81; 95% CI, 0.66 to 1.00; P=0.046). The effect of indacaterol–glycopyrronium versus salmeterol–fluticasone on the rate of COPD exacerbations was independent of the baseline blood eosinophil count. The incidence of adverse events and deaths was similar in the two groups. The incidence of pneumonia was 3.2% in the indacaterol–glycopyrronium group and 4.8% in the salmeterol–fluticasone group (P=0.02). 

Conclusions 

Indacaterol–glycopyrronium was more effective than salmeterol–fluticasone in preventing COPD exacerbations in patients with a history of exacerbation during the previous year.

 

full text from todays NEJM:

http://www.nejm.org/doi/full/10.1056/NEJMoa1516385#t=article

Why do so many elite athletes have asthma? (full text article from Austin Journal of Pulmonary & Respiratory Medicine)

British well known national daily newspaper the Guardian wrotes last week: "The idea of a supremely fit professional cyclist like Simon Yates having to occasionally reach for an inhaler to ward off a wheeze might seem anomalous. But asthma is surprisingly common among some elite athletes.

A handful have classic asthma, the usually allergy-triggered constriction of the bronchial tubes that tends to begin in childhood.

Much more common in sport is exercise-induced asthma, or EIA, in which rapid and heavy breathing causes the same symptoms. The effect can be exacerbated by atmospheric conditions, which means some sportspeople tend to suffer more than others.

John Dickinson from Kent University’s school of sport & exercise sciences, a world expert on asthma in sport, tested all 33 UK-based members of the British swimming squad and found 70% had some form of asthma, against a national asthma rate of about 8% to 10%. It is believed the chlorinated atmosphere of a pool could be a factor in this."

Read our article on Exercise-Induced Bronchoconstriction in Athletes (full text article from Austin Journal of Pulmonary & Respiratory Medicine):

https://www.researchgate.net/publication/297733949_Exercise-Induced_Bronchoconstriction_in_Athletes

 

5th International Congress of Georgian Respiratory Association, Batumi, 23-25 june 2016

Dear Respiratory friends we are happy to invite you on Great Respiratory event organized by our friends in Georgia!!!
On behalf of the Organizing Committee of the Georgian Respiratory Association 5^th International Congress, we would like to extend our warmest welcome to you all, to participate in this international event, which will be held in Sheraton Batumi Hotel, Batumi, Georgia, on 23-25June, 2016.

This is 5^th congress of the Georgian Respiratory Association, organizing with collaboration of the Government of Ajara Autonomous Republic, Tbilisi State Medical University, EVEX Medical Corporation, Georgian International Medical and Public Health Association(GIMPHA).

Georgian Respiratory Association with about 1000 members representing various disciplines of respiratory medicine together with world-renowned experts from Europe, America and Asia make this gathering a unique scientific event not only in Georgia but also in the region.

The Scientific Committee is planning a very comprehensive program catering for all specialties of respiratory medicine that will deliver state of the art lectures, update presentations, postgraduate courses, and abstract presentations. The program covers all fields related to respiratory medicine including Asthma and Allergy, RespiratoryCritical Care Medicine, Lung Cancer, Pulmonary Infections, Thoracic Imaging, Thoracic Surgery, Thoracic Oncology, Rare Lung Diseases, COPD, Interventional Bronchoscopy, and Pediatric Pulmonology.

The pharmaceutical industry is also committed in their support of our congress that will host a large exhibit area and many opportunities to share their products and current information with the attendees.

Like previous years, the Congress Organizing Committee is working hard to make this event a stimulating occasion both scientifically and socially. Undoubtedly, it will be a great opportunity to see other colleagues and friends and to benefit from the wide spectrum of medical topics to be discussed in this congress.

Besides our extensive scientific meetings, we will have the chance of meeting with friends old and new, with an enjoyable social program. We will meet you in the glamorous city of Batumi, a fast growing beautiful city with many attractions and rich heritage.

Please be prepared to meet the Georgian unique culture, which has evolved over the countrys long history, providing it with a unique national culture and a strong literary tradition based on the Georgian language and alphabet. Please get ready for the excitement and new different life that Georgia and Batumi can offer you. Please be ready for wonderful Georgian food and taste Georgian wine.

For these reasons, we look forward to seeing you in Georgia, so please mark your calendar and plan to join us.

With my best regards,

 

Ivane Chkhaidze
Congress Chair

 

Vakhtang Katsarava
Congress co-chair 

Tamaz Maglakelidze
Congress co-chair

Kakha Vacharadze
Scientific committee chair

Program:
http://congress.georanet.org.ge/uploads/files/scientific_programm.pdf

World Pulmonary Hypertension Day 2016: 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Each year on May 5, pulmonary hypertension organizations and groups around the world participate in World Pulmonary Hypertension Day activities to raise awareness of this often-misdiagnosed disease and celebrate the lives of people living with PH. World PH Day brings global attention to the importance of improving the quality of life and life expectancy of the more than 25 million people living with PH worldwide.

Objectives

During the celebration of World PH Day, pulmonary hypertension organizations work to:

• Increase awareness and disseminate knowledge of the disease to facilitate early diagnosis. Early diagnosis is important in decreasing premature PH-related deaths.
• Promote access to specific healthcare and treatments that increase quality of life and life expectancy.
• Promote the concept of treating PH patients as a whole, which includes treating their physical, psychological and social issues.
• Unify international criteria for the recognition of Centers of Excellence in PH.
• Promote research that will help find the cure for pulmonary hypertension.

Members of the pulmonary hypertension community worldwide also organize and take part in a wide variety of awareness-raising events, actions and celebrations.

History 

In 2012, a program and a scientific symposium were held in Madrid, Spain as the first World PH Day celebration. The day was officially endorsed by 22 patient associations, 10 rare and affiliated disease organizations, and 8 scientific societies.

May 5 was originally chosen as World PH Day because it is the anniversary of the first child's death in Spain from pulmonary hypertension as a result of toxic rapeseed oil more than 30 years ago. This year, the May 5 date was upheld as World PH Day by popular consensus, and events are planned worldwide.

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Free full text of Guidelines:

http://erj.ersjournals.com/content/early/2015/08/30/13993003.01032-2015

Asthma 2016 Guidelines on World Asthma Day 2016: The 2016 update of the Global Strategy for Asthma Management and Prevention

World Asthma Day is a big event celebrated all over the world by the people to increase the awareness among public worldwide about the precautions and preventions of the asthma. This event is annually organized on international level by the GINA (Global Initiative for Asthma) in order to increase the asthma awareness all around the world. It is celebrated on annual basis at 1^st Tuesday of the May month. World Asthma Day celebration was first started celebrating in the year 1998 by the GINA in more than 35 countries after its first “World Asthma Meeting” in the Barcelona, Spain.

The 2016 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. This comprehensive and practical resource about one of the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.

Link for free download of the 2016 update of the Global Strategy for Asthma Management and Prevention:

http://ginasthma.org/2016-gina-report-global-strategy-for-asthma-management-and-prevention/

2016 Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults

Background: Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults; however, whether mild OSA has significant neurocognitive and cardiovascular complications is uncertain.

Objectives: The specific goals of this Research Statement are to appraise the evidence regarding whether long-term adverse neurocognitive and cardiovascular outcomes are attributable to mild OSA in adults, evaluate whether or not treatment of mild OSA is effective at preventing or reducing these adverse neurocognitive and cardiovascular outcomes, delineate the key research gaps, and provide direction for future research agendas.

Methods: Literature searches from multiple reference databases were performed using medical subject headings and text words for OSA in adults as well as by hand searches. Pragmatic systematic reviews of the relevant body of evidence were performed.

Results: Studies were incongruent in their definitions of “mild” OSA. Data were inconsistent regarding the relationship between mild OSA and daytime sleepiness. However, treatment of mild OSA may improve sleepiness in patients who are sleepy at baseline and improve quality of life. There is limited or inconsistent evidence pertaining to the impact of therapy of mild OSA on neurocognition, mood, vehicle accidents, cardiovascular events, stroke, and arrhythmias.

Conclusions: There is evidence that treatment of mild OSA in individuals who demonstrate subjective sleepiness may be beneficial. Treatment may also improve quality of life. Future research agendas should focus on clarifying the effect of mild OSA and impact of effective treatment on other neurocognitive and cardiovascular endpoints as detailed in the document.

Read More:

http://www.atsjournals.org/doi/suppl/10.1164/rccm.201602-0361ST