GM Journal editor Alison Bloomer explores the range of conditions which exist in the chronic obstructive pulmonary disease spectrum and why it remains undertreated in the UK:
Approximately 900,000 people are currently diagnosed with COPD and it is the fifth biggest killer in the UK.1 It is also the second largest cause of emergency admissions. COPD is a complex condition, which is hard to identify in its early stages where systems do not exist.2 The elderly are especially prone to the adverse health effects of COPD, which is a common disorder in that population. While the prevalence and morbidity of COPD in the elderly are high, it is often undiagnosed and thus undertreated.3
COPD leads to damaged airways in the lungs, causing them to become narrower and making it harder for air to get in and out of the lungs. The word “chronic” means that the problem is long-term.
Long-term exposure to lung irritants that damage the lungs and the airways are usually the cause of COPD.4 Cigarette smoke, breathing in second hand smoke, air pollution, chemical fumes or dust from the environment or workplace can all contribute to COPD. Most people who have COPD are at least 40 years old when symptoms begin.4
Many nonpharmcological and pharmacological interventions are available for managing COPD. However, management of COPD in the elderly population may be challenged by the “polypharmacy” of medications that these patients often take, which can interfere with compliance with therapy.
Additionally, the elderly often suffer from physical or cognitive disabilities that can prevent compliance with prescribed medications. Lastly, adverse effects from medications prescribed for treatment of COPD may be more pervasive in elderly patients.3
That is why the news of different combination treatments coming to the market this year might be welcomed by respiratory physicians. These could offer a potential advantage in terms of improved adherence for some patients with COPD.
GlaxoSmithKline recently launched Relvar ellipta in the UK, which is the first inhaled corticosteroid/long acting beta2-agonist (ICS/LABA) combination to provide continuous 24-hour efficacy for the treatment of COPD in a once-daily dose.
Relvar is a combination of the inhaled corticosteroid (ICS), fluticasone furoate, and the long-acting beta2-agonist (LABA), vilanterol and is the first ICS/LABA to launch with both an asthma and COPD indication at the same time.
More combination treatment is in the pipeline from other companies, which should help with compliance and management of this disease which costs the NHS over £800 million a year.5
1. British Lung Foundation. http://www.blf.org.uk/Files/94ff4ae1-1858-485f-ae85-a06200ded618/Invisible-Lives-report.pdf Last accessed: January 2014
2. Department of Health. Facts about COPD. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Longtermconditions/COPD/DH_113006 Last accessed: January 2014
3. Hanania NA, et al. COPD in the Elderly Patient Semin Respir Crit Care Med 2010; 31(5): 596–606
4. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket guide to COPD diagnosis, management and prevention
5. NHS. COPD Commissioning Toolkit. 2012 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212876/chronic-obstructive-pulmonary-disease-COPD-commissioning-toolkit.pdf Last accessed: January 2014