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Health Improvements Sustained for Patients With Chronic Obstructive Pulmonary Disease Taking Salmeterol/fluticasone: Presented at ERS

By David Owen

STOCKHOLM, SWEDEN -- September 18, 2007 -- Salmeterol/fluticasone propionate sustains health improvements achieved in patients with chronic obstructive pulmonary disease (COPD), researchers reported here at the Annual Congress of the European Respiratory Society (ERS).

In addition, there are stark differences in COPD mortality across regions, with a markedly higher death rate in Eastern Europe, according to new data from the Towards a Revolution in COPD Health (TORCH) study.

Compared with placebo, treatment with salmeterol/fluticasone propionate (SFC) sustained beneficial effects on health-related quality of life throughout the three years of the TORCH study on all measures (symptoms, activity and impacts) of the St George's Respiratory Questionnaire (SGRQ), said professor Paul W. Jones, MD, Respiratory Medicine, St George's Hospital, London, United Kingdom.

"[The] TORCH [study] is unique because we know what happened to almost every patient; this can help us to understand the predictors of mortality in COPD," Dr. Jones added.

In addition, data from TORCH demonstrated that even patients who did not have a history of exacerbations -- a normal symptom of this progressive disease -- still benefited from a reduction in the rate of exacerbations during the three year study when on SFC.

The TORCH study was a multicentre, randomised, double-blind, parallel-group, placebo-controlled study that included over 6,100 patients from 28 countries, and compared the effects of SFC, salmeterol alone, fluticasone propionate alone and placebo in patients with moderate to severe COPD. The primary analysis was published in the New England Journal of Medicine (Calverley et al, 2007).

In a third new analysis presented here, it was demonstrated that both social factors (age and region of origin) and biological factors (lung function, exacerbation history, previous myocardial infarction and low body mass index) are associated with an increased risk of death.

An interesting finding, noted Dr. Jones, was the increased risk of death in Eastern Europeans with COPD compared with Western Europeans with COPD (Hazard ratio: 1.55, P <.001).

The reasons for this increased mortality risk remain unclear, but in another presentation, professor Peter M. Calverley, MD, Respiratory and Rehabilitation Medicine, University of Liverpool, Liverpool, United Kingdom, said he believed that factors in early childhood may play a role, especially air pollution and viral infections.

"These factors [have an] impact on the growth of lungs; consequently, patients in Eastern Europe have smaller more damaged lungs than patients in Western Europe. Cardiovascular factors are also very important, and we know that cardiovascular deaths are higher in Eastern Europe -- [the] level of alcohol intake plays a role here," he said.

Dr. Jones said that deaths due to COPD were likely contributing to the higher mortality in Eastern Europe and Russia. "It is scary that life expectancy in Russia and the former Soviet satellites is getting worse over time. Our data from [the] TORCH [study] indicate that COPD is likely…playing a part in this deterioration."

Dr. Calverley said that while social and geographical factors may not be amenable to change, biological factors remain potentially modifiable. "These results should remind health professionals of the importance of optimising interventions, such as smoking cessation and appropriate pharmacotherapy, in patients with COPD," he said.

This study is funded by a grant from GlaxoSmithKline.


[Presentation titles: Time Dependent Changes in the Individual Domains of the SGRQ. Results of the TORCH Trial. Abstract P3853. Factors Associated With Mortality in the TORCH Trial in COPD. Abstract 2144]

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