Early COPD Treatment Slows Disease

Aug. 27, 2009 - Early treatment of chronic obstructive pulmonary disease ( COPD) slows loss of lung function and likely extends survival, a large-scale clinical trial shows.

COPD is almost always caused by smoking. It includes two diseases: chronic bronchitis, in which the airways become inflamed; and emphysema, in which the air sacs in the lung are damaged.

Over time, COPD gets worse. Treatment does not reverse lung damage, but it can make patients feel better.

The enormous UPLIFT study enrolled nearly 6,000 COPD patients in 487 centers in 37 nations. UPLIFT tested the inhaled, long-acting bronchodilator Spiriva.

Last year, UPLIFT study investigators reported that Spiriva can safely help patients with severe COPD breathe more easily. But treatment did not slow the inexorable loss of lung function in COPD patients.

But what if Spiriva were begun earlier, in patients with more moderate, early disease? Few COPD studies have enrolled patients with early-stage disease.

Analysis of the subset of 2,739 UPLIFT patients with moderate COPD shows that Spiriva could actually slow COPD progression. Treatment also reduced COPD exacerbations and improved quality of life over the four-year study.

There was even a suggestion that Spiriva extended survival, although there were too few deaths among these patients for this finding to be statistically significant.

"Treatment of COPD should begin in symptomatic patients with moderate [COPD] disease," conclude UPLIFT investigators Marc Decramer, MD, PhD, and colleagues.

In an editorial accompanying the study, University of Liverpool researchers Lisa Davies and Peter Calverley note that the improvements seen with Spiriva treatment were greater in early-stage patients than in late-stage patients.

"Important gains in wellbeing can be produced and maintained in the earlier stages of COPD," they conclude.

The Decramer report, and the Davies/Calverley editorial, appear in the Aug. 28 online edition of The Lancet.