Last weekend saw the annual meeting of the Respiratory Effectiveness Group (REG) at the Sheraton Hotel, Heathrow, just outside London take place. For the uninitiated, the REG is one of the world’s leading academic respiratory organisations, dedicated to pushing the envelope of human knowledge in this vital area of patient care. In some ways, of more importance is their particular focus on the clinical impact of their research and findings (how it effects how we should treat and manage respiratory patients in the real world).
Below you can find a summary of our thoughts on some of the key topics of the summit.
Asthma COPD Overlap Syndrome (ACOS)
A particularly hot topic this year was ACOS (or ACO depending on your preference) with several presentations both for and against the condition. The key thrust of the arguments seem to hinge on whether ACOS is a discrete condition of its own, or whether it is a blanket term for a series of phenotypes that are actually significantly distinct from each other, in both presentation and treatment. One particular work of note was an Abstract presented on the prevalence of ACOS, no easy feat given there is little agreement over the definition of the condition. Their preliminary results suggest patients with the following diagnosis could/should be considered to have ACOS (of particular note given the current climate around Triple Therapy, see below).
- COPD only 20.5%
- Asthma and COPD (both) 14.4%
- Asthma only 14.4%
- Neither 8.0%
Biologics are widely considered one of the great new frontiers of respiratory medicine, providing whole suite of new drugs to help previously untreated or poorly treated patients. However, it was well noted that these treatments are incredibly precise (targeting particular triggers within the respiratory system) and are only shown to have an effect on very specific patients. This will inevitably lead to needing a greater precision in the diagnosis of patients to really see a benefit from this very expensive class of drugs. This is potentially not a bad thing for the patient, but expensive for the clinician/payer.
Triple Therapy has, in certain circles, been the ‘poster boy’ for the unnecessary over medication of COPD patients. In classic models of the disease, ICS (one of the components of Triple Therapy), should have little or no impact on the structural damage of the lungs usually associated with COPD. That being said, there are of course some COPD patients who would benefit from ICS treatment (those with ACOS being an obvious place to start). After a strong debate on both sides, it felt like the key take away point was to treat the patient in front of you. If ICS will benefit them, look to prescribe it at suitable doses, and if that is available in a single inhaler (as proposed by triple therapy), all the better.
Forced Oscillation Technique (FOT)
While not a new development, early publications on the subject date back to 2003, this year marked the authors first acquaintance with FOT as a replacement for Spirometry. An interesting abstract highlighting better correlation with patient outcomes within COPD than those shown by spirometry, coupled with the news that the newest models of the equipment are going to be priced competitively against mobile spirometry units, suggests their maybe a place for FOT in our clinical trials and (more importantly) clinical practice in the years to come. A much welcomed situation for anyone who has observed a severe COPD patient attempting to give a valid FEV1 value.
In short, the REG summit was once again an excellent crash course in the latest thinking around Respiratory Medicine, highlighting many of the key areas of debate and direction of movement for the year to come. I would highly recommend the summit to any members of academia, pharma or research services who have an interest in Respiratory Medicine.
Note: The thoughts outlined in the above article are those of the author, and may not reflect the position of CK Aspire on a given topic. They are also a top line interpretation of some of the topics discussed and may not reflect the intended viewpoint of the various speakers at the conference.
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