Two recent randomized trials support the use of roflumilast, a phosphodiesterase-4 inhibitor, in moderate to severe COPD. The first randomized patients on salmeterol or tiotropium to roflumilast or placebo for 24 weeks, and found a mean increase in FEV1 of 49cc (in the salmeterol group) and 80cc (in the tiotropium group) (abstract). The second study randomized severe COPD to roflumilast or placebo for a year, with a mean increase in FEV1 of 48cc. The roflumilast patients also had a 17% reduction in number of moderate to severe exacerbations (abstract). Roflumilast may become a standard addition to regimens in moderate and severe COPD.
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