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Effectiveness of Asthma and COPD Treatment in Patients with Comorbidities

This presentation by Leif Bjermer explores the real-life effectiveness of various treatment modalities for asthma and COPD in patients with significant comorbidities. Key comorbidities discussed include cardiovascular disease, cachexia, anemia, muscle weakness, depression, and osteoporosis. The session addresses the best treatment options, such as LAMA vs. ICS/LABA, and the potential bonus effects on comorbid conditions. Insights from clinical trials emphasize the importance of generalizability and add-on value for improved patient outcomes in complex cases.

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Effectiveness of Asthma and COPD Treatment in Patients with Comorbidities

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  1. Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20

  2. Real-life effectiveness of different treatment modalities ofasthma or COPD in patients with significant comorbidities

  3. Cardiovascular Disease Weight Loss (Cachexia) Anaemia COPD Muscle Weakness & Wasting Depression Osteoporosis Agustí A. PATS 2006

  4. COPD Co-morbidity in a population survey 97.7% of all 213 patients had ≥1 comorbidities and 53.5% had ≥4 comorbidities Vanfleteren et al. AJRCCM 2013

  5. Time to first hospitalisationwithin 5 years Deathwithin 5 years Co-morbidity and prognosis Three Two No co-morbidities One None Mannino et al, ERJ 2008

  6. Chest2006;129;285-291

  7. Questions • What is the best treatment option for COPD and CVD? • LAMA vs ICS/LABA • Bonus effects on Co-morbid conditions? • Statins • Roflimulast

  8. Rho signallingpathway Rho A ROCK (Rho kinase) Statins Actin polimerization P P MLCP Alpha-SMA MLCK Myosin II F-actin P P P P P P P P P P P P P P P P Stress fibre

  9. Lm(µm) Am J Physiol Lung Cell Mol Physiol 294: L882–L890, 2008

  10. *** Excluded *** * Excluded E.V. Ponte et al Allergy 2008;63:564

  11. Clinical Outcome of Montelukast as Partner Agent to Corticosteroid Therapy Price D et al. Thorax 2003;58:211–216 BUD Double dose BUD 400x2 add Montelukast

  12. Cigarette Smoking Impairs the Therapeutic response to Oral Corticosterods in Asthma. Chauduri et al. AJRCCM 2003;168:1308-11 Different inflammatoryendotype

  13. Questions • What is the best treatment option for Asthma and Rhinitis? • Optimal management of smoking asthmatics?

  14. REG Priorities (I) • Results from clinical trials should always be accomplished by comments on feasibility /generalizability to the target population. • These data will be provided by the company seeking for registration.

  15. REG Priorities (II) • In order to get a drug reimbursed, the company must commit itself to provide reasonably priced placebo to competitive or independent researchers. • This in order to facilitate company independent clinical trials.

  16. REG Priorities (III) • Add-on value of a treatment should be taken into consideration when a drug is launched for a specific treatment. Example 1 • A drug can have a small effect on lung function (FEV), but a fair effect on physical performance. Moreover, It has a good effect on a pathophysiological relevant biomarker. Example 2 • A drug have a minor effect on lung function (FEV) and on nasal symptoms and in obese asthmatics, weight is often reduced.

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