Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.13 - Chronic Obstructive Pulmonary Disease (COPD)
(2013; 52 pages)


Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. COPD is the fourth leading cause of death worldwide and it is largely preventable. The main cause in developed countries is exposure to tobacco smoke. Other preventable causes include exposure to indoor and outdoor air pollution, such as occupational exposure (firefighters, farm workers) and the burning of biomass fuel for cooking and heating which impacts many women in Africa, China, and India.

In 2010, COPD was estimated to account for 2.7% of the disease burden and 3.2% of deaths in Europe, and for 3.1% of the global disease burden and 5.5% of deaths worldwide. 3,4 Worldwide prevalence of "moderate" COPD estimated by the Global Initiative on Obstructive Lung Disease (GOLD) in adults aged 40 years and older is 9–10%. Stage III COPD (generally considered as "severe") drives most of the costs of COPD. Its prevalence across 12 sites around the glove ranged from 0.8% (Hannover, Germany) to 6.7% (Cape Town, South Africa) The Burden of Obstructive Lung Disease initiative used standardized methods to investigate the prevalence of COPD around the world and showed important differences between countries. Prevalence ranged from 9% in Reykjavik, Iceland to 22% in Cape Town, South Africa, for men, and from 4% in Hannover, Germany to 17% in Cape Town for women.

Chronic obstructive pulmonary disease is associated with major morbidity and mortality such as cardiovascular disease, muscle wasting, type 2 diabetes, and asthma. Smoking cessation will probably have the most important effects on COPD as a public health problem in Europe and the world as it slows disease progression and lowers mortality.

None of the existing medications for COPD has been shown to modify the long-term disease progression such as decline in lung function in many patients or worsening of health status. Therefore, pharmacotherapy for COPD is used to alleviate symptoms and/or prevent complications. Inhaled bronchodilators are the mainstay treatment for COPD. Two large-scale, long-term, landmark studies have confirmed the efficacy of a fixed dose combination of a long-acting β2 agonist (salmeterol) and inhaled corticosteroid (fluticasone) and a long-acting anticholinergic agent (tiotropium).

Substantial unmet needs remain in COPD preventing the progression of COPD. Drug development for COPD is difficult owing to the chronic and slowly progressive nature of the disease. Not a single new therapy has come from information on pathogenic inflammatory processes. What is needed are surrogate markers of inflammation that may predict the clinical usefulness of new management and prevention strategies for COPD, new clinical end points to assess the impact of different COPD interventions and standardized methods for tracking trends in COPD prevalence, morbidity, and mortality over time.

New medicines for the treatment of COPD are greatly needed and there has been an enormous effort now invested by the pharmaceutical industry to find such treatments. While preventing and quitting smoking is the obvious preferred approach, this has proved to be very difficult. Not all COPD is due to cigarette smoking, especially in low- and middle-income countries (LMIC).

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