A drug that combines two types of medicines for chronic lung disease showed positive results in four studies, drug maker GlaxoSmithKline (GSK) said. The drug is a dry powder inhaler for treatment of chronic obstructive pulmonary disease (COPD). It contains two types of drugs that often are used for COPD. One is an anticholinergic called umeclidinium bromide. The other is a beta agonist, vilanterol. These two types of drugs relax airways, but in different ways. The new combination drug is long-acting. It is taken once a day. In a 24-week study, the inhaler showed better results than its two component drugs given separately, GSK said. A separate study compared the new inhaler with tiotropium (Spiriva), a rival anticholinergic drug. The new inhaler also provided better results in this study, GSK said. GSK is developing the new drug along with the British drug maker Theravance. Reuters wrote about the study results July 2.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

The ingredients are different. But even if this new combo drug for COPD does get approved, don't consider this a huge advance in treatment. It combines two drug types already in common use.

COPD is short for chronic obstructive pulmonary disease. It includes chronic bronchitis and emphysema.

The main features of COPD:

• Less flow of air into and out of the lungs
• Permanent damage to the lungs and bronchial tubes
• Symptoms that usually get worse over time

COPD is one of the leading causes of death in the United States. About 1 in 20 deaths is directly related to COPD.

Smoking is the major cause of COPD. More than 80% of people with the disease are current or past smokers.

Drugs for COPD cannot slow down the eventual decline in lung function. But they can allow people to breathe a little easier, with less coughing. Commonly used drugs for COPD help people feel better in different ways.

• Corticosteroid inhalers can reduce inflammation.
• Beta agonist inhalers can improve air flow by relaxing the airways. Some inhalers combine a long-acting beta agonist with a corticosteroid. These include Advair and Symbicort.
• Anticholinergic inhalers can improve air flow. They have a different way of relaxing bronchial tubes. One of the most popular inhaled drugs used to treat COPD is tiotropium (Spiriva).

Glaxo's new drug just combines a long-acting beta agonist with an anticholinergic inhaler. But most people with COPD already take both of these. They just use them separately.

It might possibly be a little more convenient to combine the drugs. But I suspect that's it. And how much this new combo drug will cost has yet to be determined.

What Changes Can I Make Now?

Quit smoking. This is the only proven way to prevent COPD. If you already have COPD, it is the only chance you have to prevent it from getting worse.

Smokers who want to quit face a difficult challenge. Tobacco use may be the toughest unhealthy habit to break. But don't get discouraged. You can quit. In fact, in the United States today, there are more ex-smokers than smokers.

Trying to quit cold turkey can't hurt you. But it can be unpleasant. If it doesn't work, don't look at this as failure. It is actually your first step in quitting forever.

Most people need help to quit smoking for good. Take advantage of stop-smoking programs. Free ones are usually available. Accept support from your family and friends.

Nicotine replacement therapy can help you get through the cravings. You have several choices. Nicotine is available as patches, gum, nasal sprays, inhalers and lozenges. Using the nicotine patch or gum doubles your chances of quitting successfully. The other methods are newer, so less is known about them. However, they appear to be about as effective as the patch and gum.

Get help from your doctor. Medicines also can help you quit for good. The two that work the best are bupropion (Zyban, Wellbutrin and generic versions) and varenicline (Chantix).

What Can I Expect Looking to the Future?

I suspect the combo drug will pass through testing and get approved. How popular it becomes will likely depend more on its cost rather than anything else.