Highlights from European Respiratory Society Congress

September 26 – 30, 2015, in Amsterdam

One of the highlights of the International Congress was a session on improving outcomes in those with COPD. A major emphasis was on the current goals of treatment:
  1. Reduce shortness of breath – which can generally be measured in a few weeks of starting a new inhaled bronchodilator medication
  2. Reducing the risk of an exacerbation (worsening of symptoms usually due to a chest infection) – this requires at least six months to assess.
David Singh, M.D., from University of Manchester in UK

David Singh, M.D., from University of Manchester in UK

Dr. David Singh of Manchester, United Kingdom, spoke about optimizing bronchodilation (opening the airways). He quoted one study that showed that most patients with COPD were still short of breath with activities after being started on a single long-acting  bronchodilator (Primary Care Respiratory Journal, year 2011, volume 20, page 46). He then discussed the role of using two different bronchodilators in a single inhaler to get the greatest benefit. In the US, there are two approved dual bronchodilators in a single inhaler – Anoro Ellipta and Stiolto Respimat. The evidence suggests that two bronchodilator medications that work in different ways can provide better stability in keeping the breathing tubes open longer. This means that it should be easier to breathe for those with COPD and should have a better quality of life.   Dr. Marc Miravitlies of the University Hospital in Barcelona, Spain, discussed both daytime and nighttime shortness of breath (medical word is dyspnea) in those with COPD. Studies show that many
Marc Miravitlles, M.D., of University Hospital in Barcelona, Spain

Marc Miravitlles, M.D., of University Hospital in Barcelona, Spain

individuals who have COPD wake up due to breathing difficulty. Also, poor sleep is considered a risk factor for having an exacerbation (worsening of shortness of breath and/or coughing up yellow-green mucus). Bronchodilators that work throughout the night should help if the sleep problem is due to COPD, but will not help if there is another cause like sleep apnea. Dr. Neil Barnes, Medical Head of GlaxoSmithKline pharmaceutical company, spoke about the benefits and side effects of using inhaled corticosteroids (prednisone like medication). He emphasized that inhaled corticosteroids combined with long-acting beta-agonist bronchodilator (in US: brand names are Advair, Symbicort, and Breo) are widely prescribed, but should primarily be used in those who have had two or more exacerbations (worsening of symptoms) in the past year OR one exacerbation in the past year that required treatment in the hospital. A major concern about the use of
Neil Barnes, M.D., Medical Head of GalxoSmithKline pharmaceutical company

Neil Barnes, M.D., Medical Head of GlaxoSmithKline pharmaceutical company

inhaled corticosteroids is the risk of developing pneumonia.     My Comment: Each year at medical conferences there is growing research interest in helping those with COPD. Novel therapies are being evaluated in addition to improving inhaled bronchodilators. All of us need to promote greater public awareness of COPD and encourage the National Institute of Health, various professional organizations, and pharmaceutical companies to increase research funding.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.