An estimated 15 million U.S. adults have been diagnosed with COPD, according to the CDC.More than half of these patients report significant impairment in the ordinary activities of daily living, with reduced productivity. Over 726,000 hospital admissions are due to COPD each year, resulting in $29.5 billion in direct healthcare medical expenditures and roughly $20 billion in indirect morbidity/mortality costs.

Once diagnosed, effective management of COPD should be based on an individualized assessment of current symptoms and future risks. One of the main goals of treatment of chronic obstructive pulmonary disease (COPD) is the prevention of exacerbations. Bronchodilators and anti-inflammatories are the first line therapy for treatment of COPD; however, these drugs are not effective in suppressing all infective exacerbations.

This lifelong condition requires customized treatment, and board certified pulmonologist Imtiaz Ahmad, MD with Allergy Sleep and Lung Care provides the latest advances in COPD treatment at two convenient locations in southwest florida.

DALIRESP® (roflumilast)
This once-daily oral prescription medicineis indicated as a treatment to reduce the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations. DALIRESP is the first and only selective PDE4 (phosphodiesterase-4) inhibitor for COPD.It is convenient for patients who are not good surgical candidates, or who have contraindications for other pharmaceutical treatments.

In clinical trials, DALIRESP significantly reduced the rate of moderate or severe exacerbations by 17% versus placebo in the indicated population. While the specific mechanism of action is not well defined, the therapeutic effect of DALIRESP may be related to the effects of increased intracellular cAMP in lung cells.

The most common side effects of DALIRESP include diarrhea, weight loss, nausea, headache, back pain, flu-like symptoms, and problems sleeping (insomnia), dizziness, and decreased appetite.

Antibiotic Prophylaxis
One strategy being used to prevent exacerbations of COPD, with some success, is long-term antibiotic prophylaxis.It is primarily aimed at reducing patient morbidity associated with COPD exacerbations and cutting down on hospitalizations.

Clinical studies have shown continuous macrolide antibiotic use for prophylaxis was associated with a clinically significant reduction in COPD exacerbations and hospitalizations. These effects may be achieved by reducing bacterial load in the airways in stable state and/or bronchial inflammation. The drugs more extensively studied are macrolides, followed by quinolones. 

The long-term use of antibiotics is associated with an increased risk of potentially serious adverse events and development of bacterial resistance. Therefore, the indication of long-term antibiotic therapy must be determined on a case by case basis taking into account the potential risks and benefits.

Lung Volume Reduction Surgery (LVRS)
LVRS is a surgical technique that may be beneficial for some patients with advanced emphysema who have poor control of their disease despite maximal medical therapy. LVRS entails reducing the lung volume by wedge excision of emphysematous tissue.

Benefits of LVRS include greater ability for the lungs to inflate and deflate properly, which improves breathing and reduced need for portable oxygen tanks. The goal for is to provide an improvement in overall quality of life.

It has been suggested that LVRS reduces the size mismatching between the hyper-inflated lungs and the chest cavity, thereby restoring the outward circumferential pull on the bronchioles (i.e., increasing elastic recoil) and improving expiratory airflow. In a study of 20 patients undergoing volume reduction surgery, 16 experienced an increase in elastic recoil. The patients with improved elastic recoil had a significantly greater increase in exercise capacity than the four without increased elastic recoil.

Optimal candidates for LVRS include patients with severe emphysema in the upper lobes of the lungs with decreased exercise capacity.

Endobronchial Valve Placement
This surgical procedure involves the use of synthetic devices that are deployed with bronchoscopy into ventilatory airways of the lung for the purpose of controlling airflow. An endobronchial valve is a device that permits one-way air movement. During inhalation the valve is closed preventing airflow to the diseased area of the lung.

The valve opens during exhalation to allow air to escape from the diseased area of the lung. They have been investigated for use in patients who have prolonged broncho-pleural air leaks, as well as an alternative to lung volume reduction surgery (LVRS) in patients with lobar hyperinflation from severe emphysema.

When used to treat persistent air leak from the lung into the pleural space, the endobronchial valve theoretically permits less airflow across the diseased portion of the lung during inhalation, aiding in air leak closure. The valve may be placed, and subsequently removed, by bronchoscopy.

Consideration for the use of endobronchial valves in COPD is based on the improvement observed in patients who have undergone lung volume reduction surgery. The procedure is designed to relieve dyspnea and improve functional lung capacity and quality of life; it is not curative.

Dr. Ahmad with Allergy Sleep and Lung Care works with physicians to provide a customized treatment plan for their patients. Call the office to discuss options available for your patients.