Various advances in management of Asthma & COPD (January - December 2016)

1. Recent Advances In
Asthma & COPD
Dr.Tinku Joseph
DM Resident
Pulmonary Medicine
AIMS, Kochi
Jan-Dec 2016

2. Contents
Asthma
COPD

4. Glycopyrronium + Indacetarol
 SPARK, BLAZE, ILLUMINATE , SHINE and ENLIGHTEN
(2012-2015)
 Increase in Lung function
 Improvement in health related QoL, and Dyspnea

5. Glycopyrronium + Indacaterol fixed dose
combination

6. FLAME TRIAL – June 2016

9. Fluticasone furoate –Vilanterol in COPD
September 2016

12. ROFLUMILAST
 PDE4 inhinbitor
 Reduce inflammation
 Inhibits breakdown of
intracellular cyclic AMP
 Not a bronchodilator – no use
in acute spasm
 Reduces exacerbations

13.  500mcg OD
 GI intolerence, headache and
sleep disturbances.
 AURA study
ROFLUMILAST

14. Endobronchial valves/coils

17. Endobronchial valves
 Significantly improved FEV1 , 6MWD
 Adverse events more
 Pneumothorax
 Valve replacement
 Conclusion –
 Effective in highly selected patients
 with out collateral ventilation
 who are ready to accept adverse events

20. Revolens study
 Coil treatment
 Homogeneous Emphysema
 The coil group had significant improvements in lung
function and quality of life at 6 and 12 months.
 Pneumonia
Endobronchial Coils

23. Endobronchial Coils

24. Endobronchial Coils

25.  Taken together, these studies show that
endobronchial valves or nitinol coils can:
 Improve lung function
 Exercise tolerance
 Quality of life in carefully selected patients with
severe emphysema who are willing to accept the
associated risks.
Endobronchial valves/coils

31. Smoking
 Varenicline -: first-line drug treatment
 Bupropion is a second-line therapy. It may be associated with
an increased risk of seizures and drug interactions
 Marginal evidence -: Electronic cigarettes might facilitate
smoking cessation.
 Quit rates are not yet comparable with those of the drugs
approved on the Pharmaceutical Benefits Scheme.

32.  Varenicline – 5 trials
 The first two were dose-finding studies with bupropion as an
active comparator in one
 Two large phase III studies with identical design compared
varenicline 1mg bid with placebo and bupropion 150 mg bid.
 At one year follow-up- varenicline was 2.4 times more effective
than placebo and significantly better than bupropion in one of the
studies and marginally superior in the other.
 The most common side effects were nausea and insomnia

33. New drugs
 Dianicline - 1 phase II trial - Promising results
 Rimonabant has shown some short term efficacy. However,
its effects do not seem to be significantly better than those for
the currently available treatments
 The current nicotine “vaccines” clearly do not give very long
lasting protection because the antibody titers do not remain
elevated for many months.

34. E-Cigarette

35. E-cigarette
 Vaping
 Regulation varies from country to country
 Achievement of abstinence was substantially lower
than the researchers anticipated for the power
calculations,
 They had insufficient statistical power to conclude
superiority of nicotine e-cigarettes to patches or to
placebo e-cigarettes.
 No significant differences in adverse events were
identified.

39. Reslizumab
 Monoclonal antibody to interleukin (IL)-5
 FDA approved
 Cinquair
 Add-on maintenance therapy of severe
asthma In patients >18 yrs or older
 Eosinophilic phenotype

41. Reslizumab: Description and
Production
 Sterile solution in single-use vial
 3 mg/kg IV q4wk infused over 20-50 minutes

42. Adverse Effects
 Elevated CPK (14%)
 Oropharyngeal pain (2.6%)
 Myalgias (1%)
 Anaphylaxis (0.3%)

44. Benralizumab
 Investigational molecule
 Anti-interleukin (IL)-5 receptor antibody.
 Two trials
 Reduced exacerbations in patients with moderate to
severe asthma who had elevated peripheral blood
eosinophil counts.
November 2016

45. Benralizumab

46. Benralizumab

48. Fluticasone + Salmeterol
 Small increase in asthma-related deaths associated with salmeterol
 Black box warning – FDA
 Combined with Fluticasone
 Safety of S+F – Multicentric trial 12000 patients
 Inhaled F vs. F + S
 No differences in SAE, no deaths, no asthma related
hospitalizations
 The AUSTRI trial
September 2016

49. September 2016

52. Omalizumab for allergic asthma in children 6 to 11
years of age
 Monoclonal antibody to immunoglobulin E (IgE)
 Indication-:
 patients with moderate to severe persistent asthma and
sensitization to perennial aeroallergens who are inadequately
controlled on inhaled glucocorticoids
 US-FDA has now lowered the approved age range from 12 to 6
years of age,
July 2016

53. Evaluation of recurrent wheezing in children <2
years of age
ATS recommendation
 unresponsive to bronchodilators or inhaled or systemic
glucocorticoids
 Suggested evaluation:
 videofluoroscopic swallowing study (modified barium
swallow) for possible swallowing dysfunction.
 24-hour esophageal pH monitoring for assessment of GERD.
 FOB- (BAL) to assess for lower airway bacterial infection
August 2016