In-dacaterol we TRUST
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Respiratory medicine
In-dacaterol we TRUST
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This month's Thorax has some new data on the utility of indacaterol in addition to tiotropium on bronchodilatation in COPD. The INTRUST-1 and INTRUST-2 study investigators suggest that bronchodi
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Cat:OpenClinicalForum:8114d353-b41b-4a03-b052-dc009589d5cfDiscussion:09e05621-215b-4424-9a26-136be190e84b
Forums » Open clinical » Respiratory medicine » In-dacaterol we TRUST
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In-dacaterol we TRUST
posted at 12/9/2012 11:06 PM BST
on bmj.com
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Posts: 1220
First: 19/4/2010 Last: 20/6/2013 |
This month's Thorax has some new data on the utility of indacaterol in addition to tiotropium on bronchodilatation in COPD. The INTRUST-1 and INTRUST-2 study investigators suggest that bronchodilatation should be maximised by using both kinds of bronchodilator - beta agonists, and anti-cholinergics. Is this news? Should we be surprised? Part of my doctorate showed that there is a benefit from dual-bronchodilatation in terms of airways measures, but does it make a difference in terms of quality of life, or exercise tolerance, exacerbation rate, or even mortality? Is this a return to dual bronchodilators, rather than LABA/steroid? Should we be giving every one LABA/LAMA, or should we wait for the inevitable LABA/LAMA/steroid? |
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Re: In-dacaterol we TRUST
posted at 13/9/2012 3:37 AM BST
on bmj.com
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Posts: 3011
First: 10/3/2009 Last: 20/6/2013 |
I find it interesting how we use LABA's in COAD when they show no improvement in lung function with short acting beta-agonists in the respiratory lab. Something mystical happens when they get home. Imagine a cardiologist using a long-acting bla-bla drug for the heart which is shown not to be efficacious in a cat experiment. Respiratory medicine is the last domain of the hopeless, governed by the hopeful prescribing drugs which are shown to be hopeless. Our advances are at a glacial pace. Yes, the FEV1 improved by 40 mls after 10,000 patients and two thousand man hours of studies. Watching respiratory medicine advancing is like watching the Mona Lisa for a smile. |
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Re: In-dacaterol we TRUST
posted at 13/9/2012 9:33 AM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
We should use the combination of beta agonists & anticholinergics, & avoid long term usage of steroids, either inhaled or oral. Indacaterol inhalation powder is a long-acting, selective β(2)-adrenoceptor agonist that is indicated for the maintenance bronchodilator treatment of airflow obstruction in adults with chronic obstructive pulmonary disease (COPD). Combination therapy with indacaterol plus tiotropium bromide improved lung function, dyspnoea, rescue medication use and general health status significantly more than tiotropium bromide alone in patients with moderate to severe COPD. Indacaterol was not associated with an increased risk of cardiovascular adverse events. Indacaterol provides a valuable option for the maintenance treatment of adults with COPD. |
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Re: In-dacaterol we TRUST
posted at 13/9/2012 1:03 PM BST
on bmj.com
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Posts: 347
First: 17/12/2011 Last: 18/6/2013 |
Indacterol much more expensive that salbutamol. Is it really clinically that much better? Tiotropium very popular with respiratory physician and respiratory nurses, but I have not been fully convinced that it significantly better than ipratropium [atrovent]. But I do go along with the general consensus and prescribe both. Also lots of inhaler steroids , although again I worry about the long term consequences of even inhaler steroids. |
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Re: In-dacaterol we TRUST
posted at 20/9/2012 10:19 PM BST
on bmj.com
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Posts: 1220
First: 19/4/2010 Last: 20/6/2013 |
@Pat - there's no doubt at all that Tiotropium is significantly superior to ipratropium. FEV1 data is compelling enough, but add into that the quality of life data, the exacerbation data, and the mortality trends with Spriva (From the UPLIFT study, and more). @Steve - yes triple therapy is the final step, but where does Indacaterol fit into this? Monotherapy steroids are not licenced in COPD, the only combinations are LABA/ICS, so to get to triple therapy it's LAMA + LABA/ICS. So what's the role for an Ultra-LABA, like Indacaterol? There's a lot of general feeling to avoid steroids in COPD, but the current evidence base shows us that mortality is significantly improved by being on ICS/LABA combinations. Being on a LABA confers some benefit, but not as much as ICS/LABA. No-one should be on an unapposed steroid for COPD. This leads us to the question of whether there should be an extra step in the NICE guidelines? LABA/LAMA without the steroid???
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Forums » Open clinical » Respiratory medicine » In-dacaterol we TRUST
