Update COPD 2011 – Was ist neu?

Im letzten Jahr waren im Bereich der COPD (chronisch obstruktive Lungenerkrankung) eine ganze Reihe interessanter Entwicklungen zu verzeichnen. Durch Weiterentwicklung von Klassifikationssystemen (BODE-Index) ist es gelungen, die Mortalität von COPD-Patienten wesentlich besser vorherzusagen als bisher. In der medikamentösen Therapie hat sich bei häufigen Exazerbationen, die oft zu Krankenhausaufenthalten führen, der erste 2010 zugelassene Vertreter der Substanzgruppe der Phosphodiesterase-4-Inhibitoren Roflumilast als interessant gezeigt. Das erste über 24 Stunden wirksame inhalierbare Beta-2-Mimetikum Indacaterol erweitert die medikamentösen Therapiemöglichkeiten zusätzlich. Zu den nicht-medikamentösen Therapieoptionen zählen die Lungenvolumenreduktion sowie moderne endoskopische Techniken zur Therapie des Lungenemphysems, ebenso wie die wichtige chronische nicht-invasive Beatmungstherapie. Eine weitere nicht-medikamentöse COPD-Therapie, die einen etwas ungewöhnlichen Ansatz verfolgt, ist die Implantation einer peripheren AV-Fistel, die letztlich wie ein Dialyse-Shunt funktioniert. Die Therapie ist in Deutschland bereits zugelassen, wird momentan jedoch ausschließlich im Rahmen von Studien angewendet.

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 phosphodiesterase-4-inhibitor 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, FEV₁ 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 endoscopic techniques, and noninvasive ventilation are described elsewhere in this issue. A unique new approach in COPD-therapy is the implantation of an arteriovenous 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.

Key words

COPD - BODE index - exacerbation - Roflumilast - Indacaterol - arteriovenous fistula

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