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Leif Bjermer 10:00–10.20

Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities. Leif Bjermer 10:00–10.20. Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant comorbidities. Cardiovascular Disease.

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Leif Bjermer 10:00–10.20

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  1. Real-life effectiveness of different treatment modalities of asthma or COPD in patients with significant co-morbidities Leif Bjermer 10:00–10.20

  2. Real-life effectiveness of different treatment modalities ofasthma or COPD in patients with significant comorbidities

  3. Cardiovascular Disease Weight Loss (Cachexia) Anaemia COPD Muscle Weakness & Wasting Depression Osteoporosis Agustí A. PATS 2006

  4. COPD Co-morbidity in a population survey 97.7% of all 213 patients had ≥1 comorbidities and 53.5% had ≥4 comorbidities Vanfleteren et al. AJRCCM 2013

  5. Time to first hospitalisationwithin 5 years Deathwithin 5 years Co-morbidity and prognosis Three Two No co-morbidities One None Mannino et al, ERJ 2008

  6. Chest2006;129;285-291

  7. Questions • What is the best treatment option for COPD and CVD? • LAMA vs ICS/LABA • Bonus effects on Co-morbid conditions? • Statins • Roflimulast

  8. Rho signallingpathway Rho A ROCK (Rho kinase) Statins Actin polimerization P P MLCP Alpha-SMA MLCK Myosin II F-actin P P P P P P P P P P P P P P P P Stress fibre

  9. Lm(µm) Am J Physiol Lung Cell Mol Physiol 294: L882–L890, 2008

  10. *** Excluded *** * Excluded E.V. Ponte et al Allergy 2008;63:564

  11. Clinical Outcome of Montelukast as Partner Agent to Corticosteroid Therapy Price D et al. Thorax 2003;58:211–216 BUD Double dose BUD 400x2 add Montelukast

  12. Cigarette Smoking Impairs the Therapeutic response to Oral Corticosterods in Asthma. Chauduri et al. AJRCCM 2003;168:1308-11 Different inflammatoryendotype

  13. Questions • What is the best treatment option for Asthma and Rhinitis? • Optimal management of smoking asthmatics?

  14. REG Priorities (I) • Results from clinical trials should always be accomplished by comments on feasibility /generalizability to the target population. • These data will be provided by the company seeking for registration.

  15. REG Priorities (II) • In order to get a drug reimbursed, the company must commit itself to provide reasonably priced placebo to competitive or independent researchers. • This in order to facilitate company independent clinical trials.

  16. REG Priorities (III) • Add-on value of a treatment should be taken into consideration when a drug is launched for a specific treatment. Example 1 • A drug can have a small effect on lung function (FEV), but a fair effect on physical performance. Moreover, It has a good effect on a pathophysiological relevant biomarker. Example 2 • A drug have a minor effect on lung function (FEV) and on nasal symptoms and in obese asthmatics, weight is often reduced.

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