Musts and no-go therapies for COPD and heart disease


By Nicola Garrett

11 Sep 2017

Delegates have been given a low-down on the therapies that should and should not be used in people with COPD and heart disease.

Taking ERS congress delegates through the evidence on the safety and efficacy of therapies in a session called “Musts and No-go’s” Professor Claus Vogelmeier, Head of the Department for Pulmonary Medicine at the Philipps-University of Marburg, Germany, said there was increasing evidence that beta-blockers were  “very beneficial” in patients with COPD.

“So far we say only use beta-blockers in patients with a cardiovascular indication but maybe this will change in light of new evidence,” he suggested.

Professor Vogelmeier told delegates that in his opinion the jury was still out on whether statins had a role to play in people with COPD and co-morbid heart disease. Studies had shown diverging results and more studies were needed, he said.

Evidence against the use of theophylline in COPD was quite convincing but the data was old.  

“It would be interesting to see if using lower doses would have different effects,” he told delegates.

Encouragingly the use of LABA and ICS had no effect on on cardiovascular mortality, with the SUMMIT trial that compared all cause mortality between patients on fluticasone furoate/vilanterol or placebo showing no difference in mortality between the groups.

Research also showed that bronchodilators had a positive effect on lung volume.

However regarding the treatment of COPD exacerbations Professor Vogelmeier said he could not offer delegates a drug “for the time being”.

He speculated that beta-blockers might be helpful in this situation but there were also compelling non-pharmacological interventions that could have an impact on inflammation.

For instance studies had shown that physical activity had anti-inflammatory properties on a molecular level and this was an area that we should be looked into.

“Something as simple as putting patients on a vibrating table may in the end be an anti-inflammatory treatment,” he told delegates.

The SUMMIT trial had shown patients in the first-month following an exacerbation were at particularly high risk for a cardiovascular event, he added.

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