While There Are More Inhalers to Treat COPD, The Class of Medications Offered by the Pharmaceutical Industry Have Not Changed For Decades
by Dr. Alan Moy, November 9, 2018
When I graduated from medical school 30 years ago, COPD patients were treated with 3 class of inhaled agents (inhaled corticosteroids, anti-cholinergic bronchodilators and beta agonist bronchodilators). The class of drug molecules have not changed for decades. What has changed is there are more of these inhalers from the same class to choose from. More inhalers now offer some small advantages like modest improved drug activity and longer duration of action. What has changed is that the pharmaceutical industry has focused more on the marketing of COPD drugs with increased competition among the industry to compete for the COPD market (i.e. combining multiple drugs in one inhaler device for better compliance and offering discount coupons for commercial insurances to cover patient costs). The inhalers may improve exercise tolerance and decrease COPD exacerbations, but there is no evidence that these inhalers increase patient survival (like how cancer drugs are required to demonstrate before being approved by the FDA). The only drug that has been shown to increase survival is supplemental oxygen, which was not developed by the pharmaceutical industry. These drugs do not reverse or repair the pathological and structural changes that occurs in COPD. Clinical trials are designed to be short-term because the cost of drug trials would be expensive. We do not know what are the long-term effects of these drugs. However, we know that corticosteroids impair wound healing. We do not know whether long-term treatment of inhaled corticosteroids could have adverse effects on lung structural architecture in COPD patients.
Inhalers have the greatest impact on mild-moderate COPD but they have very modest impact on patients with moderate-severe COPD. Also, inhalers have almost little to no activity in patients with emphysema.
I have never been able to predict which inhaler is superior or would work better in any particular patient. However, there are many non-pharmaceutical interventions that always help COPD patients which include:
1. Stop smoking.
2. Early detection for COPD with pulmonary function test (by far the most important but largely ignored (pulmonary specialists are often consulted too late).
3. Regular exercise, weight loss and proper diet.
So why has the pharmaceutical industry not introduced any life changing innovations for COPD patients? For that answer, see the next post from Dr. Moy.