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Inhaled therapy, cardiovascular risk and benefit–risk considerations in COPD: innocent until proven guilty, or vice versa?

Lucile Regard, Pierre-Régis Burgel, Nicolas Roche
European Respiratory Journal 2023 61: 2202135; DOI: 10.1183/13993003.02135-2022
Lucile Regard
1Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
2Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France
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  • For correspondence: lucile.regard@aphp.fr
Pierre-Régis Burgel
1Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
2Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France
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Nicolas Roche
1Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
2Respiratory Medicine, Cochin Hospital; Assistance Publique Hôpitaux de Paris Centre, Paris, France
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Extract

COPD management mainly aims at relieving symptoms, and improving exercise tolerance and quality of life, as well as preventing exacerbations, disease progression and mortality, while providing adequate management of comorbidities. There is strong evidence showing that inhaled maintenance therapy has the capacity to target symptoms, exacerbations and quality of life; some evidence is now also available regarding mortality [1]. As always in the current era of personalised medicine, the choice of therapy needs to be based on a thorough benefit–risk assessment accounting for the characteristics of each individual patient [2]. This assessment can be somehow complexified by the fact that COPD is most often a component of a chronic complex multimorbid condition, rather than an isolated disease [3]. It can coexist with various comorbidities (or be a comorbidity for various diseases) including cardiovascular diseases, anxiety and depression, sarcopenia and peripheral muscle dysfunction, osteopenia and osteoporosis, lung cancer, anaemia or polycythaemia [4].

Abstract

Relationships between inhaled therapy, cardiovascular risk and prognosis in patients with COPD are complex. Globally, the benefit–risk ratio of inhaled bronchodilators and corticosteroids appears largely favourable. Studies in subgroups at risk are needed. https://bit.ly/3VS41Hq

Footnotes

  • Conflict of interest: L. Regard has nothing to disclose. P-R. Burgel reports grants and personal fees from GSK and Vertex, and personal fees from AstraZeneca, Chiesi, Insmed, Pfizer and Zambon. N. Roche reports grants and personal fees from Boehringer Ingelheim, Novartis, Pfizer and GSK, and personal fees from Austral, MSD, Teva, AstraZeneca, Chiesi, Sanofi and Zambon.

  • Received November 6, 2022.
  • Accepted December 6, 2022.
  • Copyright ©The authors 2023. For reproduction rights and permissions contact permissions{at}ersnet.org
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European Respiratory Journal: 61 (2)
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Inhaled therapy, cardiovascular risk and benefit–risk considerations in COPD: innocent until proven guilty, or vice versa?
Lucile Regard, Pierre-Régis Burgel, Nicolas Roche
European Respiratory Journal Feb 2023, 61 (2) 2202135; DOI: 10.1183/13993003.02135-2022

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Inhaled therapy, cardiovascular risk and benefit–risk considerations in COPD: innocent until proven guilty, or vice versa?
Lucile Regard, Pierre-Régis Burgel, Nicolas Roche
European Respiratory Journal Feb 2023, 61 (2) 2202135; DOI: 10.1183/13993003.02135-2022
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