New and emerging therapies for asthma and copd Edward Omron MD, MPH, FCCP


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Community presentation for new asthma and copd therapies

Edward Omron MD, MPH, FCCP
Pulmonary Medicine
Morgan Hill, CA 95037

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New and emerging therapies for asthma and copd Edward Omron MD, MPH, FCCP

  1. 1. New and Emerging Therapies for Asthma and COPD Edward Omron MD, MPH, FCCP Pulmonary and Critical Care Medicine Saint Louise Regional Medical Center
  2. 2. What is Asthma?• Reversible lung disease• The airways of the lung are inflamed, swollen and narrowed resulting in “wheezing”• Breathing problems occur in “attacks” but the disease is continuous• Recurrent cough, chest tightness / pain, or shortness of breath• Symptoms worsen with exercise, infection, changes in weather, or at night.
  3. 3. Asthma Airways
  4. 4. Asthma Facts• In 2009, 25 million Americans had asthma – Of these 13 million have had an asthma attack• In 2007 there were 3500 deaths from asthma – 63% of these deaths occurred in women• The prevalence of adult asthma in CA 2009 is 8%• Asthma accounts for 50 billion health care dollars yearly
  5. 5. Types of Asthma
  6. 6. Mainstays of TherapyInhaled Corticosteroids Remain the MAINSTAY of treatment in all asthmatic groups
  7. 7. Advances in Therapy• There is no cure of asthma thus far in 2012• CONFIRM the diagnosis before any augmentation of treatment of regimens – Rule out for example vocal cord dysfunction – Interstitial Lung Disease• Severe persistent asthma is a great challenge to both the patient and the physician
  8. 8. Xolair (Omalizumab)• Severe persistent asthmatics with allergies and an elevated IgE antibody level• IgE is an allergy antibody – It binds to allergens and causes the release of inflammatory mediators which makes asthma worse• Xolair binds to IgE antibody and turns it off• Reduced medication use, symptoms, and improved quality of life• Cost about $1500.00 monthly• Monthly subcutaneous injections
  9. 9. Xolair and IgE
  10. 10. Bronchial Thermoplasty (BT)• Severe asthmatics have excessive smooth muscle in the airways• BT is a non-drug procedure that reduces airway smooth muscle by applying heat to the airways – This reduces the frequency of asthma attacks• Three outpatient procedures performed three weeks apart under sedation• Benefits: – 32% reduction in asthma attacks – 84% reduction in ER visits – Improved asthma quality of life
  11. 11. Airway Lumen in Severe Asthma
  12. 12. Bronchial Thermoplasty
  13. 13. What is COPD?• Two irreversible lung diseases that frequently coexist together: – Chronic bronchitis: airways of the lung are inflamed, swollen and narrowed resulting in “wheezing” • HEAVY mucus or phlegm is coughed up • Breeding ground for recurrent infections – Emphysema: the scaffolding of the lung is destroyed resulting in multiple “holes”• Progressive Shortness of Breath associated with chest pressure and exercise limitation
  14. 14. COPD FormsBronchitic Emphysematous
  15. 15. COPD Pathology
  16. 16. COPD(Chronic Obstructive Lung Disease)
  17. 17. COPD Facts• Third leading cause of death in America – 125,000 lives in 2007• Smoking is the primary risk factor for COPD• Female smokers are 13 times more likely to die from COPD than females who never smoked• 13 million adults were estimated to have COPD in 2008• 50 Billion in health care costs yearly
  19. 19. COPD/Emphysema CT CHEST
  20. 20. Diagnosis of COPD• Pulmonary Physician• Appropriate Symptoms• Diagnostic Studies – Chest X-Ray and CT CHEST – Pulmonary Function Study – 6 minute walk test – Arterial Blood Gas – Alpha 1 antitrypsin deficiency
  21. 21. COPD Mimics• Congestive Heart Failure• Asthma• Bronchiectasis• Interstitial Lung Disease
  22. 22. Pharmacology• Bronchodilators – B Agonists – Anticholinergics – Xanthines• Steroids (intravenous inpatient and inhaled outpatient)• Vaccines(influenza and pneumococcus)• Antibiotics• Oxygen• Mucolytics and Flutter/Acapella Valves• Pulmonary rehabilitation
  23. 23. Pulmonary Rehabilitation
  24. 24. What effect does COPD have on my ability to be active?• Shortness of breath = inactivity• Muscle Weakness = Fatigue• Loss of independence = depression• Isolation• Weight Gain• Immune system weakens
  25. 25. Why should I exercise for COPD?• Builds Strength• Less shortness of breath• More independence• Greater reserve to fight infection• Less fatigue• Weight control• Quality of life
  26. 26. How do I exercise for COPD?• Under care of a health professional• Physical Therapist guides training• Stretches• Aerobic Conditioning• How to cough, breath, and train safely
  27. 27. Diaphragmatic Breathing
  28. 28. Elbow Breathing
  29. 29. Pursed Lip Breathing
  30. 30. Pursed Lip Breathing
  31. 31. Advances in Therapy• Indacaterol (Arcapta Neohaler) – Once daily long acting (24 hours) bronchodilator in COPD – Rapid onset with intense bronchodilation – Improvement in shortness of breath, exercise performance, and quality of life. – Hopefully available later this year, excellent safety profile
  32. 32. Roflumilast (Daliresp)• Phosphodiesterase inhibitors (similar to caffeine)• Decreases airway inflammation• Not a bronchodilator• Side effects: Headache, Nausea, Diarrhea• Reduces COPD exacerbations• Once daily oral dosing, cannot be used in liver dysfunction
  33. 33. Alpha-1 Antitrypsin Deficiency• A genetic condition associated with early onset COPD and liver disease• Alpha 1-Antitrypsin is a enzyme that protects the lung from enzymes that break down lung tissue• About 1-3% of patients with COPD are predicted to have alpha1-antitrypsin deficiency.• Intravenous (IV) augmentation therapy with alpha1- antitrypsin benefits some patients• Identified in all populations• All COPD patients are now screened for this disorder
  34. 34. Stem Cells in COPD• Stem cells are derived from the bone marrow – Can regenerate normal lung tissue with manipulation – Several studies in animal models show great promise in COPD – Too early to comment• Vitamin D – Early enthusiasm – Most recent study in severe COPD disappointing – No consensus
  35. 35. Resources• American Lung Association –•• -in-america/index.php