Disclosures: Mario Cazzola has participated as a speaker, and adviser in scientific meetings and courses under sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Lallemand, Mundipharma, Novartis, Pfizer, Verona Pharma and Zambon, and is or has been a consultant to Chiesi Farmaceutici, Lallemand, Novartis, Ockham Biotech, Skyepharma, Verona Pharma and Zambon.
FILMED AT THE EUROPEAN RESPIRATORY SOCIETY (ERS) INTERNATIONAL CONGRESS, SEPTEMBER 2016
What do you consider to be the most significant advance in this field over the last year?
00:10 – This is a very interesting question. To be honest, in the therapy of COPD we have not a real advance, but we are understanding how to use better the drugs that we have in our hands. Now we know that likely COPD is not a disease, it’s a disorder, that include a lot of different diseases or phenotypes, as you prefer. We still not understand very well because we must put together phenotypes endotypes to understand of we have different diseases. But we know there are specific phenotypes such as frequent exacerbators, or such as emphysema, hyperinflation, or rapid decliners, or COPD with chronic bronchitis, that need specific treatment, and each of these phenotype need a tailored treatment. This is what we have understood. And we have also understood that we must not to look at the COPD as a disease and treat all patients in the same manner, but we must look at the treatable trait in each patient. And in this manner we can try to improve our patients’ quality of life in health condition, of course.
Many combination regimes are currently being investigated. In your opinion, which are the most promising?
01:29 – As physician, I’m using to combine drugs to treat COPD patients form a long time. Now what we have is the development of dual bronchodilation, that means to put together an antimuscarinic agent and a beta 2 agonist. Usually we try to put together once daily drugs or twice daily drugs. The combination is extremely useful because we have documented that there is a synergistic effect when you combine two bronchodilators. It means that potentially, you could start with lower dosage that we are using now to optimise bronchodilation interfering with the vagal system that is what regulates the bronchial tone, and adding the stimulation to adrenaline receptor that are extremely important to amplify the bronchodilation that we use with antimuscarinic agent. And this synergistic effect means that we can reduce the dosage and ideally, in my opinion, we should start to combine two drugs with the…combine two drugs with a low dosage than, as I said before, we are using now for treating patients. That’s extremely important point.
There have been significant advances in drug delivery devices. Can you say a little about this?
02:55 – There is an improvement, also, in devices. Technologies dramatically improved in these last five years and I can see, speaking with companies or attending meetings and so on, that there are new devices that are coming that will be even better than those we use. As clinical pharmacologist, I consider drugs extremely important, but I know that if we don’t have the…a good manner to deliver drugs, drugs will never reach the airways of our patients in the right manner and in the right amount. So, devices are extremely important, and I say fortunately we have improved devices and we will have even better in…I think in one or two years, you will see. That’s extremely useful thing.
Increased pharmacological options can complicate patient choice. What factors should be taken into account in patient selection?
03:53 – It depends if you are asking me this as a physician or as a specialist. As a general practitioner, well I can tell you that the general practitioner must follow guidelines and recommendations, must have a simple approach that can guarantee that the patient is at least treated. As a specialist I say it in my first answer, well, I must try to tailor the treatment according to the patient’s needs. That’s the problem. Yes, we have several new options now, new options in the sense that we have dual bronchodilation, we have triple therapy in development as well, we have different devices that can be adapted to the single patients. And I must always try to find the best treatment for each patient that I treat. I didn’t mention before that we cannot forget that COPD is followed…is often followed by comorbidities. And we must also always consider to treat these comorbidities in the better manner…in the best manner, because otherwise we can improve lung function, we can reduce exacerbation, but for example, we can have a big problem with the heart or with diabetes and so on. And at the end, the quality of life and health of our patient will never improve.