TORCH: Towards a Revolution in COPD Health? Not really.
Last month, the long-awaited results of the TORCH study of Advair (aka Seretide outside the U.S.)(TM) for patients with moderate to severe COPD were published, but were no doubt disappointing to patients with COPD and investors who own GSK stock. Optimists spun the results as "positive" with a 17% relative reduction in death rates for those taking the combination inhaler for 3 years when compared to those taking the placebo inhaler. However, the absolute difference in deaths during the 3 years from any and all causes was only 2.6% (12.6% vs 15.2%) and this small difference was not statistically significant.An Advair Diskus 500/50mcg (the high dose used by the TORCH study) costs about $270 per month. The drug was associated with a lower hospitalization rate for COPD exacerbations, but 32 patients (or their insurers) would each have to pay about $3200 per year (over $100,000 total) to prevent just one of these hospitalizations.
But doesn't taking the combo inhaler make the patients feel better? Well, after taking Advair for one year, about half of them did generally feel noticably better than those taking the placebo inhaler, according to scores on a standardized COPD questionnaire (St. Georges). However, over the next two years, the disease progressed in all patients as their lung function fell further and they became more short of breath. Those taking the inhaled corticosteroid (fluticasone), either alone or in the combo inhaler, were also significantly more likely to get pneumonia (a serious side-effect). I'm personally not as optimistic (or biased) as my colleagues who were paid to participate in the study, one of whom said, "We clearly showed that the combined treatment helps prevent disease-related exacerbations and helps people feel better. But does it help them live longer? We can't say for sure; but we think it does."
About half of the patients had been taking a COPD inhaler before they entered the study, so it's not surprising that over six billion dollars was spent on Advair inhalers last year (for asthma or COPD), plus billions for Spiriva or Atrovent COPD inhalers.
But doesn't taking the combo inhaler make the patients feel better? Well, after taking Advair for one year, about half of them did generally feel noticably better than those taking the placebo inhaler, according to scores on a standardized COPD questionnaire (St. Georges). However, over the next two years, the disease progressed in all patients as their lung function fell further and they became more short of breath. Those taking the inhaled corticosteroid (fluticasone), either alone or in the combo inhaler, were also significantly more likely to get pneumonia (a serious side-effect). I'm personally not as optimistic (or biased) as my colleagues who were paid to participate in the study, one of whom said, "We clearly showed that the combined treatment helps prevent disease-related exacerbations and helps people feel better. But does it help them live longer? We can't say for sure; but we think it does."
About half of the patients had been taking a COPD inhaler before they entered the study, so it's not surprising that over six billion dollars was spent on Advair inhalers last year (for asthma or COPD), plus billions for Spiriva or Atrovent COPD inhalers.
I worry that patients believe that these inhalers are "curing" their lung disease and that they don't have to take the effort to stop smoking. Forty percent of the 6000 COPD patients in the TORCH study were still smoking, despite their advanced lung disease due to their habit. Sadly, I think that doctors are taking the easy ten second "solution" of writing a prescription for an expensive inhaler instead of the time-consuming counseling over several visits needed to help a nicotine addict to quit. Smoking cessation is the only intervention proven to slow the progression of COPD. It has been proven several times that inhalers are not the cure for COPD.
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Technorati Tags: COPD, chronic obstructive pulmonary disease, Advair, smoking cessation, healh-and-wellness
Labels: COPD
5 Comments:
This information is about as true as it gets. I no longer smoke and stopped immediately upon diagnosis with COPD. I used Atrovent and Flovent inhalers until about 2 years ago when I went on Advair 500/50. I am not better and never will be. Does it help? The nebulizer treatment is what helps and two times daily of Advair after the treatment seems to help.
My disease is progressing and nothling will stop that.
I agree that there are no known CURES for COPD, just a variety of "band aids." It does trouble me that smoking is such a powerful addiction and quitting si so tough (tho I've never smoked so have no personal experience).
So many health woes could be reduced or eliminated if smoking somehow just stopped (ah, if I had a magic wand). Smoking bans in many places, including HI have made it easier for some to quit. Some of the tobacco settlement funds in HI has gone toward tobacco cessation and prevention, tno NONE for COPD treatment or research.
Wish more was done toward figuring out what causes COPD & how to stop the progression (I know quit smoking, reduce exposure to irritants & use LTOT as needed, but what genetically/molecularly can be done to really make a difference).
Exercise has helped & taking Qvar (inhaled steroid) + Spiriva + Prilosec & allergy shots has really reduced my flares (frequency & severity), for which I'm very grateful & have stabilized my lung function, for which I'm also grateful. Now, how to fix those ruptured aveoli. Hmmmm
Starion
Listen!! If I can stop smoking after 43 years, anyone can. I, by no means, am not superman or special in anyway. I was dx with Pulmonary Fibrosis, COPD and Pulmonary Hypertension 01/07 and told,in no uncertain terms, "stop smoking now" You ask "why now?" I never took smoking seriously before I was told that I'm dying from 3 terminal ailments. That dx changed my entire outlook. I must have had that superman mentality or some other idiotic lack of thought at all. Whatever!! My time on this earth with my family just got shortened by a BUNCH and now I got a wake up call to the real life. I'm sure many are asking; What's the use"? Just one more day with my wife, kids and grandkids. Chantix helped too. I was told about the enhanced chance of quitting and used the "drug" for three months. Cheaper than cigarettes too. It worked for me.
I am 65. Both lungs full of emphysema. 12/06 to 2/08 hospitalized 7 times /exacerbation. next step? 20 steps to kitchen my o2 goes to 72/75 takes a good 3 min to bring up to 90 at 8 liters. albuterol nebulizer and rescue inhaler,singular 10mg, advair 500/50,spriva, flonaise nasel spray,fosamax,lisinopril70mg5mg,guaifenesin 1200mg,and now a maintenance of predisone at 10mg till doctor visit.have had about 7years.but the best help recently was a TTO (TRANS TREACHEL OXYGEN) FAST TRACT. a TREACH CATHETOR FOR ONLY OXYGEN. cleaning sometimes bothers me to do it, but I would rather have the treach. It delivers O2 right into the lungs so you get full benefit of O2.At rest now I am at 5 leiters insted of 8 and maby will go down more.NO nasel cannula (YEA)and I had to have an oxymiser pendant which delivers about twice the setting of O2.
I am a non-smoker, but have a history of exposure to mold and a fine dust in the workplace. I wonder if I do not already have COPD, but beleive I'm on the way. Have not been to a Pulmonologist yet, just an allergist/ENT. I was taking Sudex, but understand they've taken it off. I take the 100/50 Advair, Singulair, Mucinex-D, Zyrtec, and nasal spray. Any suggestions?
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