Update COPD 2011, medication and non-medication therapeutic strategies, what's new?

摘要

The field of COPD has faced several new and interesting developments in the past year. Predictions based on the updated BODE index match observed mortality better than before. Several studies suggest a susceptibility phenotype: frequent inflammatory symptoms like chronic cough and sputum production are associated with more exacerbations per year. Since exacerbations frequently lead to hospitalization and increase mortality, there is a necessity to use all means to reduce exacerbation frequency in COPD patients. The phos-phodiesterase-4-inhibiror Romflumilast is a new medication to lower the frequency of exacerbations. Another expansion of therapeutic options in COPD is the first once-daily, long acting inhaled beta-2-agonist Indacaterol. After 12 weeks treatment, FEV, was significantly improved compared to placebo. New data show a strong association between adherence to inhaler-therapy and mortality. However, mortality was also decreased with adherence to placebo. This gives strong evidence for a "healthy adherer effect". Non-medication strategies such as lung volume reduction surgery, new endo-scopic techniques, and noninvasive ventilation are described elsewhere in this issue. A unique new approach in COPD-therapy is the implantation of an arte-riovenous fistula with left-to-right shunt. The shunt increases mixed venous oxygen content and cardiac output. The fistula is created in the iliofemoral region by a minimally invasive approach whereby an anastomotic vascular clip device is deployed. At this time, this therapy is exclusively available within controlled studies.