Influence of Statin Therapy on Exacerbation Frequency In Patients With COPD

1. Influence of Statin Therapy on Exacerbation Frequency In Patients With COPD • Şehnaz Olgun, Emel Eryüksel, Hatice Şenol, Sait Karakurt, Turgay Çelikel • Marmara University Hospital, Pulmonary and Critical Care

2. INTRODUCTION • Statins decrease the blood lipid levels and have an antiinflamatory effect. • It has been postulated that the chronic inflammation associated with COPD might be ameliorated by statins

3. INTRODUCTION • Recent studies from the laboratory have provided additional promise for the use of statins in COPD and Simvastatin ameliorated the structural and functional derangements of the lungs caused by cigarette smoking . • Simvastatin ameliorated the structural and functional derangements partly by suppressing inflammation and matrix metalloproteinase-9 induction and preventing pulmonary vascular abnormality. • Lee J-H, Lee D-S, Kim E-K et al. Simvastatin inhibits cigarette smoking-induced emphysema and pulmonary hypertension in rat lungs. Am J Respir Crit Care Med 2005; 172: 987–93.

4. INTRODUCTION • Statins enhance efferocytosis in vitro and in vivo, and suggest that they may play an important therapeutic role in diseases where efferocytosis is impaired and inflammation is dysregulated. • Morimoto K, Janssen WJ, Fessler MB et al. Lovastatin enhances clearance of apoptotic cells (eferocytosis) with implications for chronic obstructive pulmonary disease. J Immunol 2006; 176: 7657–65.

5. INTRODUCTION • Mancini et al. examined a number of important cardiovascular and pulmonary outcomes in an extensive retrospective study of COPD patients both with and without cardiovascular disease as a function of therapy and a better outcome associated with with statins, ACE inhibitors and ARB. • Mancini GBJ, et al. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol 2006; 47: 2554–60.

6. INTRODUCTION • Blamoun et al show that the statin group had fewer episodes of exacerbation and required intubation fewer times than the subjects not receiving statins .

7. EXACERBATİONS • 50 – 60 % of exacerbations are due to respiratory infections (mostly bacterial and viral) • 10 % are due to environmental pollution • 30 % are of unknown etiology

8. Reduced risk of COPD death and a significantly reduced risks of influenza death among moderate-dose statin users. Frost FJ, Petersen H, Tollestrup K, Skipper B.Chest. 2007 Apr;131(4):1006-12. • Statin use before CAP diagnosis is associated with improved outcome. Wunderink RG.Semin Respir Crit Care Med. 2009 Apr;30(2):146-53.

9. AIM • The aim of this study was to determine the frequency of antibiotic usage, emergency and out-patient clinic administration, hospitalization and COPD exacerbation in patients with COPD who were using statins.

10. METHOD • COPD patients who applied to our outpatient clinic for their routine check-up between October and December 2008 were included in the study and a detailed questioner form was recorded for each patient. • Enhancement of difficulty in breathing, coughing, sputum or change in sputum nature during the past 1 year was accepted as exacerbation criteria.

11. RESULTS

12. RESULTS

14. CONCLUSION • The lower frequency of exacerbation in COPD patients using statins may be explained by the antienflamatory effect of statins. • Studies including more patients using statins are warranted in determining their effects in COPD patients