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COPD

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by

NINA ZHOU

on 5 August 2015

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Transcript of COPD

Chronic Obstructive Pulmonary Disease COPD
Emphysema
Chronic Bronchitis
Asthma
SYMPTOMS
Cough (chronic)
Chronic sputum production
Fatigue
Many respiratory infections
Shortness of breath = Dyspnea
Trouble catching one's breath
Wheezing
METHODS
"Simvastatin for the prevention of exacerbations in moderate-to-severe Chronic Obstructive Pulmonary Disease COPD"
Criner GJ and al. The New England journal of medicine, 2014; 370(23): 2201-10
Results
A daily dose of 40 mg of Simvastatin didn’t affect exacerbation rates ofpatients with COPD
Presentation ENGLISH WFARM1370
DUTU Alice
ZHOU Nina
Ishimwe Rosine
GNOFAM Magniba
SLOWLY !
Study design
STATCOPE study
40mg simvastatin
written informed consent
Study visits
Mesure
of
- spirometric variables : FVC & FEV1 ( at 12, 24 and 36 months)
- disease-specific quality of life SGRQ
-general quality of life SF-36

Clinic visits
every 3 months

contact
by
telephone

Questions
about
- interim development of exacerbations
- study-drug adherence
Participant population
patients from 45 sites of USA & Canada
40 to 80 years of age , with moderate-to-severe COPD
(ex)-smokers: 10 or more pack-years
At least one of the following criteria :
needed supplemental O2 for respiratory problems
taking glucocorticoids or AB
hospitalized for COPD exacerbation
Exclusion
of patients:
taking statins
with active liver disease, alcoholism or allergy
unable to take statins due to contraindications
Warning
: verapamil and amlopidine
Exclusion if diabetes or glycated Hb >6,5%
Outcomes
Secondary outcomes
time, severity of exacerbations
number of acute CV events
quality of life
changes in spirometric variables

Primary outcome
exacerbation rate person/year
Interim analysis, Stopping guidelines & Monitoring plan
Meeting
every 6 months to
-review recruitment
-follow-up :rates, study-drug adherence, safety and efficacy results.
March 2013 meeting
: no indication of a treatment effect
October 2013 meeting
: no change : the rates of exacerbations and the number of deaths :similar in the 2 groups
STATCOPE stopped for futility
Simvastatin
Hypercholesterolemia
Prevention of Cardiovascular disease + risk reduction (stroke + infarctus)
Anti-inflammatory
Causes or risk factor
control
placebo
Clinical Diagnosis & Assessment
tobacco smoking
air pollution
the latter from the burning of biomass fuels
allergy
Current Treatment of COPD
Based on the patient's symptoms
Risk of exacerbations
Severity of the spirometric abnormality
Identification of comorbidities
Family history of COPD
+ Comorbidities
Spirometry
FEV 1 / FVC < 0.70 = persistent airflow limitation and thus of COPD
Exacerbation severity
mild
moderate
severe
very severe
Anti-inflammatory effects of Simvastatin
Discussion
Why ?


- Simvastatin: the most powerful inhibitor of
HMG-CoA reductase
-The patients had moderate to severe airway obstruction
-No marker of systemic inflammation :serum CRP level
-Interaction with other drugs



nb: COPD is an inflammatory disease reflected in increased airway and circulating inflammatory markers.
Beta 2 - Agonists (oral +inhaler)
Anticholinergics (inhaler)
Combination
short or long action

MethylXanthines
Inhaled Corticosteroids
Combination long action beta 2 agonists + corticosteroids
Systemic corticosteroids

Phosphodiesterase- 4 inhibitors
Aortic stiffness
Experimental studies on animals: effect on lung tissue
Bronchodilators
Beneficial effects of simvastatin are in part due to inhibition of the epithelial production of key mediators of neutrophil chemotaxis, inflammation, and airway remodeling

Enrolling

Effect of Simvastatin on the time of the first exacerbation
There's no difference on the time of the first exacerbation between the two groups
Conclusion
Previous retrospective study
positive effect of Simvastatin
patients with CV diseases

STATCOPE: prospective study
no patients with CV diseases
no effect of Simvastatin

1) - What is COPD?
- What is SIMVASTATIN?
- Why a study on this subject?

2) - Methods
- Results

3) Effect or not?
We thank you for your attention.
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