Roflumilast: a new agent for the treatment of COPD

Approximately three million people in the UK suffer from chronic obstructive pulmonary disease (COPD). Conventional therapies alleviate symptoms, improve lung function, reduce the risk of exacerbations and enhance quality of life, but COPD still commonly causes considerable morbidity and mortality. Roflumilast (Daxas®) is a recently launched maintenance treatment for adults with severe COPD associated with chronic bronchitis and frequent exacerbations. Roflumilast inhibits phosphodiesterase 4 (PDE4), a second messenger that downregulates many of the inflammatory cells contributing to COPD. In a year-long study that enrolled COPD patients with severe airflow limitation, bronchitic symptoms and a history of exacerbations, roflumilast (500 µg once daily) increased pre- and post-bronchodilator FEV1 and FVC, while reducing the number of, and increasing the time until, moderate or severe exacerbations. Nurses should remind patients that the full effects of roflumilast might take several weeks to emerge, and stress the importance of complying with treatment, even if the benefits are not immediately apparent. Common adverse events with roflumilast include diarrhoea, weight loss, nausea, abdominal pain and headache. While future studies need to resolve several outstanding issues, roflumilast seems to be an important new drug for adults with severe COPD associated with chronic bronchitis and frequent exacerbations.