April 17, 2014
A disease on the rise
Respiratory diseases impose a tremendous health burden on society. According to the World Health Organization (WHO), in 2000, the top five respiratory accounted for 17.4% of all deaths worldwide (1). Worryingly, death and disability due to chronic obstructive pulmonary disorder (COPD) was identified as being on the increase (1).
WHO defines COPD as encompassing two groups of lung disease, chronic bronchitis and emphysema. Chronic bronchitis refers to a productive cough for at least 3 months of each of 2 successive years for which other causes have been excluded. Emphysema describes destruction of the lung architecture with enlargement of the airspaces and loss of alveolar surface area (2). As the two conditions can coexist the terminology COPD is often used.
COPD effectively damages lung tissue over a prolonged period of time and impairs the flow of air in and out of the lungs and causes breathlessness (2). As the disease progresses it can cause sever limitations for the patient in their daily life. In some cases, they may require oxygen and could even eventually depend on mechanical respiratory assistance.
WHO is particularly concerned with the link between smoking and COPD. In the UK, smoking has been described as being responsible for over 95% of cases of COPD (3). Although the risk of COPD increases with age, there is a dramatic synergy with smoking. For example, cigar smokers are reported to have a 45% higher risk of COPD when compared to nonsmokers (2).
Unlike cardiovascular disease, quitting smoking does not lead to a substantial reversal of the COPD-related damage caused by tobacco, once the disease is established. As death rates due to cardiovascular conditions fall in industrialized regions of the world, the rates of COPD are increasing. Another area of concern is that smoking is becoming much more popular in developing regions of the world and thus COPD is on the rise.
As public awareness has been poor a variety of treatments have been used for COPD, such as those primarily for asthmatic conditions. Therefore, although the market has potential for growth it currently features a range of different types of products and is still considered to be a relatively new type of pharmaceutical market. According to IMS Health, the value of the COPD pharmaceutical market is currently around US$3 billion, but could increase to over US$9 billion by 2010 (3). A major driver of this market is the fact that COPD is receiving considerable attention in the United States, the world’s leading pharmaceutical market. Furthermore, as safer and more effective medicines become available and awareness of the disease grows patient demand will rise. A problem in Europe and Japan is how governments will approach the issue of paying for these new generation COPD medicines.
In 2002, Boehringer Ingelheim launched Spiriva (tiotropium bromide), which was the first COPD-specific drug (3). Co-marketed with Pfizer, Spiriva’s sales exceeded analysts’ expectations and this has led to optimistic expectations for the COPD pharmaceutical market as a whole (3). Spiriva has now been launched in more than 40 countries and further approvals are anticipated through 2005 (4). According to treatment guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), long-acting bronchodilators such as Spiriva are currently the preferred treatment option for COPD maintenance therapy (4).
A number of pharmaceutical companies are carrying out research in the field of COPD and considerable attention is being focused on the class of drugs known as phosphodiesterase-IV inhibitors. There are still a variety of safety issues to be resolved, but many companies have reported this class of drug as exhibiting great promise for the treatment of COPD (3). The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the United State’s leading research-based pharmaceutical and biotech companies found 17 compounds, being developed for the treatment of COPD, to be at various stages of clinical development (5).
COPD is a disease that will grow in importance in the future and it will have a major impact on society, particular amongst those that smoke. Unfortunately, awareness of the disease amongst patients is low and physicians often do not come into contact with such patients until their disease has advanced in severity, thus restricting treatment options. Governments and healthcare agencies must do more to increase knowledge of the disease so that suffers recognise the symptoms and seek medical advice early on. This is particularly important in order to counter the prevailing attitudes to smoking amongst some young people and the high profile that cigarettes continue to enjoy in the media.
At the moment, although new treatments are being developed for COPD the pharmaceutical market is undeveloped. Therefore it is difficult to determine which class of drugs will have the most success. What is clear though is that there will be a high demand for effective medicines and so COPD should be an area of interest for pharmaceutical companies who have an interest in the respiratory therapeutic field.