2. COPD? Where Are We Headed?
Dr. NAGHMAN BASHIR
FCPS, MRCP(UK)
Consultant Physician

4. Clinical Phenotypes
Macrolides to prevent Exacerbations
Role of Statins in COPD
Tobacco Cessation Tools

5. Clinical Phenotypes
Macrolides to prevent Exacerbations
Role of Statins in COPD
Tobacco Cessation Tools

7. (C) (D) (B) (A) Risk ≥ 2 or > 1 leading to hospital admission
(GOLD Classification of Airflow Limitation))
Risk
(Exacerbation history)
≥ 2 or
> 1 leading
to hospital
admission
1 (not leading
to hospital
admission)
Symptoms
(C)
(D)
(A)
(B)
CAT < 10 4 3 2 1
CAT > 10
Breathlessness
mMRC 0–1
mMRC > 2

8. CLINICAL PHENOTYPES
”…those attributes of the disease alone or in combination that describe the differences between individuals with COPD in relation to parameters that have clinical significance (symptoms, exacerbations, response to treatment, rate of progression disease, or death).
Am J Respir Crit Care Med 2010; 182:
…identify patients with different response to the treatments available and allow a more personalized approach to treatment…

9. RELEVANT PHENOTYPES A) Infrequent exacerbator, with either chronic
bronchitis or emphysema;
B) Overlap COPD-asthma;
C) Frequent exacerbator with predominant emphysema;
D) Frequent exacerbator with predominant
chronic bronchitis
Pharmacological treatment of stable COPD. Arch Bronconeumol 2012; 48:

10. Infrequent exacerbator, with either chronic bronchitis or emphysema
Any patient experiencing less than two exacerbations per year
Currently no anti-inflammatory treatment indicated or licensed for infrequent exacerbators,
Long-acting bronchodilators, alone or in combination,
and the possible addition of theophyllines in the more severe cases

11. Overlap COPD-Asthma History of previous asthma before the age of 40,
The demonstration of eosinophilic inflammation in sputum or increased peripheral eosinophilia,
Enhanced reversibility in airflow obstruction after the
bronchodilator test.
Inhaled corticosteroids together with long-acting bronchodilators irrespective of the severity of the airflow obstruction

12. Frequent exacerbator with predominant chronic bronchitis
Inflammation,
Hypersecretion,
Increased risk of Bacterial colonization and infections
Bronchodilators, inhaled corticosteroids, and respond to treatment with the PDE4 inhibitor roflumilast.
During exacerbations long-term treatment with macrolides , quinolones, and mucolytics.

13. Frequent exacerbator with predominant emphysema
Present NOT with chronic cough and sputum production but with typical clinical and radiological signs of emphysema
Longacting bronchodilators and, in some cases, inhaled corticosteroids.

14. Bacterial Viral Eosinophilic Pauci Inflammatory
PHENOTYPES
Bacterial
Viral
Eosinophilic
Pauci Inflammatory

16. Fast Decliner Inflammatory Systemic Pulmonary Hypertension-COPD
OTHER PHENOTYPES
Fast Decliner
Inflammatory
Systemic
Pulmonary Hypertension-COPD

17. Clinical Phenotypes
Macrolides to prevent Exacerbations
Role of Statins in COPD
Tobacco Cessation Tools

18. ERYTHROCIN Author (Year) Number Results Suzuki (Chest 2001) 109
Reduced number of exacerbations and common colds
Yamaya
(J AM Ger Soc 2008)
123
Reduced number of exacerbations and hospitalisation
Seemungal
(AJRCCM 2008)
Reduction in the frequency of exacerbations
Shorter duration of exacerbation
Longer time to the first exacerbation He
(Resp. 2010) 36
Reduction in the exacerbation rate
Delay in the time to the first exacerbation

19. CLARITHROCIN Author (Year) Number Results Banerjee
(Treat Res Med 2004) 67
No difference in the frequency of exacerbations
Yamaya
(J AM Ger Soc 2008)
123
Reduced number of exacerbations and hospitalisation

20. AZITHROCIN Author (Year) Number Results Blasi (Pulm Pharm Ther, 2010)22
Reduction in the number of exacerbations
Reduction in the number of hospitalisations
Improvement in quality of life
Albert
(NEJM 2011)
1142
Reduction in the frequency of exacerbations
Longer time to first exacerbation
Improvement in quality of food

22. Clinical Phenotypes
Macrolides to prevent Exacerbations
Role of Statins in COPD
Tobacco Cessation Tools

27. Clinical Phenotypes
Macrolides to prevent Exacerbations
Role of Statins in COPD
Tobacco Cessation Tools

28. The TOOL E CIAGARETTES People smoke for nicotine
but die from tar and smoke

29. Combustible Tobacco
…upto 98% of tobacco-related deaths are attributable to combustible products…
..Increasing interest in HARM REDUCTION and CHRONIC CARE APPROACHES…….
NEJM 370; 4: (JAN 23, 2014)

30. E Cigarettes On Line Survey
91% had attempted to quit.
Complete replacement (79%), partial replacement (17%)
Improvement in
general health (91%),
smokers cough (97%)
Ability to exercise (83%)
Sense of smell (80%), and taste (73%)
E cigarettes as potential harm reduction product. Nov tobaccoharmreduction.org/wpapers/011.htm

33. Lancet 2013; 382:
E cigarettes, with or without nicotine, were modestly effective at helping smokers to quit with similar achievement of of abstinence as with nicotine patches, and with fewer side effects.

34. THE MILLION DOLLAR QUESTION Will e cigarettes cause more or fewer people to smoke/quit?

35. Thank You Merci Grazie Gracias Danke