Roflumilast: systemic therapy for chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is characterized by chronic inflammation in both the pulmonary compartment and the rest of the body. Phosphodiesterase type 4 is expressed in inflammatory cells involved in COPD; and the phosphodiesterase 4 inhibitor roflumilast has been extensively evaluated in patients with this disease. Results from two large-scale, well-controlled clinical trials that included patients with moderate-to-very severe COPD have shown that once-daily administration of roflumilast significantly improves forced expiratory volume in 1 s and decreases exacerbations, particularly in patients with severe disease. Roflumilast is well tolerated with a low incidence of gastrointestinal adverse events that declines with continued treatment. In contrast to inhaled medications, which are the mainstay of COPD therapy, a systemic therapy is more likely to reach targets outside the lungs (e.g., the cardiovascular system) and may have the potential to decrease the severity of common comorbidities in COPD patients.
McIvor
R Andrew
RA
McMaster University, Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada. amcivor@stjosham.on.ca