- Email: [email protected]
18 Future drugs: emerging therapies in COPD
12 to state that NIV is not proven in these circumstances rather than that it is contraindicated. When NIV can be successfully applied there are clear advantages, particularly a reduction in infectious complications and length of ICU and hospital stay, with an attendant reduction in costs. There is no convincing evidence to date that a failed trial of NIV is harmful. NIV has a role for weaning some patients, particularly those with COPD. NIV should be available in all patients admitting patients with acute exacerbations of COPD. The role of domiciliary NIV for patients with COPD is more controversial. There is no robust randomised controlled trial evidence to support the use of NIV. It would however be generally accepted that there is a role in patients with hypercapnia who can not tolerate oxygen despite careful attempts to titrate the flow rate. It may also benefit patients with recurrent exacerbations requiring NIV acutely but this needs to be confirmed. On the basis of current evidence domiciliary NIV should be considered for no more than a minority of patients with COPD. 14 Palliative care workshop S. Prigmore. Chest Clinic, St George’s Healthcare NHS Trust, London, UK Patients with COPD can suffer disabling and distressing symptoms, while the interval from diagnosis to death can be protracted over many years. Prognosis in patients with COPD admitted to hospital with an exacerbation is poor. The burden on carers is high with limited access to appropriate social and nursing support. Palliative care affirms and regards death as a normal process, providing symptom relief, and integrates the psychological and spiritual aspects of patient care. It offers a support system to help patients live as actively as possible and helps the families and carers to cope. The management of severe COPD concentrates on symptom control and quality of life and therefore lends itself to the principles of palliative care. The workshop will be an interactive session, encouraging audience participation. Three case scenarios will be used to demonstrate the importance of palliative care in COPD management: 1. Managing symptom control in stable COPD. 2. Withdrawal of treatment including NIV. 3. Discussing End of Life wishes with patients with COPD. 15 Novel methods of assessing airway disease workshop I. Pavord. Institute for Lung Health, Department of Respiratory Medicine, Allergy, and Thoracic Surgery, Glenfield Hospital, Leicester, UK Traditional goals of airway disease management include control of symptoms, the maintenance of normal lung function, and the prevention of exacerbations. Symptoms and lung function do not relate closely to the extent and type of lower airway inflammation, and there has been recent interest in the possibility that extending the goal of management to include control of airway inflammation might result in improved outcome. I will present evidence showing that management strategies that use the induced sputum eosinophil count or the concentration of nitric oxide in exhaled breath as markers of eosinophilic airway inflammation result in better outcomes and more economical use of treatment in asthma and COPD. I will also discuss recent evidence that it might be possible to assess and monitor other aspects of the disease process, including inflammation of the distal airways and cough frequency.
Speaker abstracts, Friday 2 March 2007 Afternoon session: Therapeutic Approaches Plenary session 16 Therapies: the good, the bad and the ugly B. Celli. Tufts University, Boston, USA The prevalence of COPD is rising, not only in the western countries, but equally important and more rapidly, in the rest of the world. Deaths from COPD have risen 14% in men and 185% in women between 1984 and 2000. COPD is the 4th cause of death in the USA and the only major cause of death that continues to rise, as death from other causes (heart disease, cancer, strokes) are decreasing. Finally, in the USA there were more women than men dying from COPD since the year 2000. In addition, it remains an underdiagnosed disease so there is a need to increase awareness. Finally, the evidence indicates that COPD does respond to therapy and that there are many forms of effective therapy. Over the years, our knowledge about COPD and the capacity to treat it has increased significantly. Smoking cessation campaigns have resulted in a significant decrease in smoking prevalence in the USA. Similar efforts in the rest of the world should have the same impact. The fight against cigarette smoking should result in a drop in incidence of COPD in the years to come. The widespread application of long term oxygen therapy for hypoxemic patients has resulted in increased survival. During this time we have expanded our drug therapy armamentarium and have used them to effectively improve dyspnea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. Non invasive ventilation has offered new alternatives for the patient with acute or chronic failure. The revival of surgery for emphysema or in the immediate future, endobronchial lung volume reduction should provide an alternative to lung transplant for those patients with severe COPD who are still symptomatic on maximal medical therapy. With all these options a nihilistic attitude toward the patient with COPD is not justified. The evidence justifies a positive and constructive attitude. 17 Mortality: making sense of therapeutic outcomes P. Calverley. Department of Medicine, University Hospital Aintree, Liverpool, UK Abstract not available at time of going to press. 18 Future drugs: emerging therapies in COPD B. O’Connor. University Hospital Birmingham Foundation NHS Trust, UK Abstract not available at time of going to press. Track 1
Primary Care Focus
19 Rehabilitation
factors that make it possible
S. Singh. Cardiac & Pulmonary Rehabilitation, Glenfield Hospital, Leicester, UK Pulmonary rehabilitation is an established intervention for patients with COPD, acknowledged in all recent guidelines for the management of the disease. Rehabilitation focuses on the individual patient and the disability associated with the disease. Rehabilitation adopts a multidisciplinary approach that offers a package of exercise, education, nutritional and psychosocial support. This session will help identify suitable patients for rehabilitation, discuss optimal training regimes and explore adjuncts to rehabilitation that may enhance the benefit for the patient.
Speaker abstracts, Friday 2 March 2007 Afternoon session: Therapeutic Approaches Plenary session 16 Therapies: the good, the bad and the ugly B. Celli. Tufts University, Boston, USA The prevalence of COPD is rising, not only in the western countries, but equally important and more rapidly, in the rest of the world. Deaths from COPD have risen 14% in men and 185% in women between 1984 and 2000. COPD is the 4th cause of death in the USA and the only major cause of death that continues to rise, as death from other causes (heart disease, cancer, strokes) are decreasing. Finally, in the USA there were more women than men dying from COPD since the year 2000. In addition, it remains an underdiagnosed disease so there is a need to increase awareness. Finally, the evidence indicates that COPD does respond to therapy and that there are many forms of effective therapy. Over the years, our knowledge about COPD and the capacity to treat it has increased significantly. Smoking cessation campaigns have resulted in a significant decrease in smoking prevalence in the USA. Similar efforts in the rest of the world should have the same impact. The fight against cigarette smoking should result in a drop in incidence of COPD in the years to come. The widespread application of long term oxygen therapy for hypoxemic patients has resulted in increased survival. During this time we have expanded our drug therapy armamentarium and have used them to effectively improve dyspnea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. Non invasive ventilation has offered new alternatives for the patient with acute or chronic failure. The revival of surgery for emphysema or in the immediate future, endobronchial lung volume reduction should provide an alternative to lung transplant for those patients with severe COPD who are still symptomatic on maximal medical therapy. With all these options a nihilistic attitude toward the patient with COPD is not justified. The evidence justifies a positive and constructive attitude. 17 Mortality: making sense of therapeutic outcomes P. Calverley. Department of Medicine, University Hospital Aintree, Liverpool, UK Abstract not available at time of going to press. 18 Future drugs: emerging therapies in COPD B. O’Connor. University Hospital Birmingham Foundation NHS Trust, UK Abstract not available at time of going to press. Track 1
Primary Care Focus
19 Rehabilitation
factors that make it possible
S. Singh. Cardiac & Pulmonary Rehabilitation, Glenfield Hospital, Leicester, UK Pulmonary rehabilitation is an established intervention for patients with COPD, acknowledged in all recent guidelines for the management of the disease. Rehabilitation focuses on the individual patient and the disability associated with the disease. Rehabilitation adopts a multidisciplinary approach that offers a package of exercise, education, nutritional and psychosocial support. This session will help identify suitable patients for rehabilitation, discuss optimal training regimes and explore adjuncts to rehabilitation that may enhance the benefit for the patient.