Roflumilast for treating COPD?

The paper titled “Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomised clinical trials” was studying the effects of Roflumilast on a particular subset of COPD patients. Though the authors state this is a double blind study are honest about their conflict of interest, I feel that the selection criteria for patients may have been chosen based on who they thought would have the best outcome from treatment with this drug. The paper seemed to be a follow-up to their original study to try and prove significant results from the use of Roflumilast, which did not lend to its credibility. Overall, the authors had a large sample size showing that lung function tests were generally improved with the use of Roflumilast.

As they state in the paper, chronic obstructive pulmonary disease (COPD) is a lung disease. It is characterized by a shortness of breath, fatigue, chronic cough, and increased respiratory infections. There are two main forms: chronic bronchitis or emphysema. One of the leading risk factors is smoking, but there are other causes such as air pollution. There is not a cure, but people can treat the symptoms using an inhaler with either bronchodilators or steroids.

Roflumilast itself is a Phosphodiesterase-4 (PDE4) inhibitor. When PDE4 is inhibited, cyclic adenosine monophosphate (cAMP) is not broken down as readily in cells. Increased levels of intracellular cAMP help to suppress TNF-alpha, IL-2, and INF-gamma production. PDE4 inhibitors also lower cytokine production along with degranulation by neutrophils and inflammatory cell adhesion.

In this paper, they were studying the use of oral Roflumilast to treat COPD. However, most drugs currently in use to treat COPD are from inhalers, so as to directly contact the most affected area. Therefore, I think that in the future it would be really interesting to look at PDE4 inhibitors such as Roflumilast in an inhaler to treat COPD. In fact, some researchers are looking into non-steroidal anti-inflammatories that can be inhaled. A paper I found called “Inhaled non-steroidal anti-inflammatories for children and adults with bronchiectasis” looked at NSAIDs that can be inhaled. The results of this recent paper show a great deal of promise for using these inhaled NSAIDs in the treatment of different lung diseases such as bronchiectasis or COPD.