COPD8, Birmingham UK, 20-22 June 2012

The 8th International, multidisciplinary meeting dedicated to COPD was held in Birmingham, United Kingdom, in June 2012. The biennial meeting attracted over 650 delegates from 40 different countries showing a further increase in numbers from COPD7, especially in those attendees from Europe and Asia. Delegates came from a wide range of backgrounds, from basic scientists at the forefront of research to allied health care professionals delivering the front end of patient care. The meeting bought together leading experts from all over the world producing the unique opportunity to see and meet them face to face in a single venue where delegates and speakers mingle to discuss ongoing work and exchange ideas.

The UK Minister of State for Health, Simon Burns MP gave the opening address at COPD8 as clinicians, researchers and politicians consider the growing issue of COPD for healthcare systems and wider society. This year's programme again bought together all of the foremost academic researchers and clinical experts in the field, including contributions from Professor Christine Jenkins from University of Sydney, Australia, Professor Marc Decramer from University of Leuven, Belgium, Professor Peter Calverley from University Hospital Aintree, Liverpool, and Professor's Sonia Buist, Steve Rennard and Bart Celli from the Universities of Oregon, Omaha and Boston respectively, in the United States to name but a few. The patient voice was also featured strongly throughout with contributions from Dame Helena Shovelton from the British Lung Foundation and John Walsh, President of the COPD Foundation in the United States, who has COPD himself.

All 5 of the Plenary Sessions included an arbitration panel of leading experts, together with science writer and broadcaster Vivienne Parry posing key questions and facilitating discussion and interaction with the audience. Topics included The 21st century health care challenge of chronic non-communicable diseases, ‘COPD and co-morbidity’, Challenges of COPD diagnosis and integrated care, Infection and COPD’ and a debate entitled ‘Can COPD treatment be personalized?. There were 12 simultaneous sessions divided into clinical science, basic science and care delivery tracks. Meet the Experts sessions have always proved popular in previous years so an expanded programme was offered covering many aspects of COPD including: New treatments for COPD; The role of the nurse in optimizing patient care; 24 hours in the life of a COPD patient; Worldwide spirometry training; and Practical application of the updated GOLD guidance. All sessions were very well attended (often oversubscribed) and provided a valuable opportunity for delegates to discuss important issues with key opinion leaders.

The third Tim Griffiths Memorial Lecture was delivered by Professor Sally Singh on achieving consistent outcomes and standards in pulmonary rehabilitation, a topic that Dr. Griffiths championed.

The conference saw a transition from the COPD Lifetime Achievement awards to the introduction of the newly established ‘COPD Hall of Fame’ into which Professor Yoshinosuke Fukuchi from Japan, Professor Rodriguez-Roisin from Spain and Mr. John Walsh from the United States were inducted. They have all made an outstanding contribution to the field of COPD, and their work is summarized below.

A total of 44 posters were presented at COPD8 and authors were able to discuss their research with fellow delegates and faculty members during poster viewing sessions. The accompanying abstracts were those selected by the COPD8 Organising Committee for publication.

In conjunction with COPD8 the European COPD Coalition and several West Midlands NHS Foundation Trusts offered free lung tests to members of the public on 20 June in the ‘Healthy Lungs’ event. This was organized to mark World Spirometry Day on 27 June 2012, where healthcare professionals took to the streets across Europe to run public lung testing events to raise public awareness of COPD and spirometry testing. More than 180 individuals were tested in a 4-hour period by 6 trained clinical physiologists, and 13% of those tested showed abnormal lung function.

Figure 1.  Professor Steve Rennard announces the ‘COPD Hall of Fame’ award given to Professor Yoshi Fukuchi.

Figure 2.  Left to right: Professor Steve Rennard, who presented the award to Professor Roberto Rodriguez-Roisin, and Mr. John Walsh, who was presented with his award from Professor Bart Celli.

Since 1998, the conference series has steadily evolved and is now an important event in the COPD calendar. We had considered the idea of similar dedicated events worldwide as, although the science remains the same, it is clear that healthcare systems and the challenges faced by clinicians differ dramatically. Following a meeting of a group of key opinion leaders from the United States, this became a reality with COPD7usa taking place in Washington, DC, in December 2011. Through the dedication and hard work of The COPD Foundation, the event was also a great success, and COPD8usa will be held in Chicago on 14–15 June 2013.

At the end of the 3-day conference, there was a real feeling of anticipation and excitement for the future of COPD management and research. We are already making plans for COPD9, to be held in Birmingham from 25–27 June 2014, where we hope to deliver the next update on progress and challenges of COPD.

From a personal point of view, and that of my co-organiser Sue Hill, we would like to thank our sponsors who provided non-commercial input to the educational programme, our organizers Jackie Hutchinson and Executive Business Support and the legendary Anita Pye.

COPD Career Achievement Awards Presented at COPD8 in Birmingham, UK

Professor Yoshi Fukuchi

Professor Yoshi Fukuchi was recognized both for his long-standing and consistent effort to advance the science that underlies the understanding of COPD and for his efforts to foster international collaborations that have advanced COPD research and care. Professor Fukuchi was instrumental in assessing the key study of COPD epidemiology in Japan. He has been a leader in exploring several key areas, including hypoxemia pulmonary hypertension and the relationship between aging and COPD. Before his retirement, he led a group at Juntendo University that has become a world leader in this important area of research. Professor Fukuchi was a member of the original GOLD Guidelines Steering Committee and Scientific Committee. His participation in that effort was instrumental in making GOLD the key international organization it has become. Finally, Professor Fukuchi has mentored many young clinicians and researchers who are now becoming leaders in the COPD field in their own right.

Professor Roberto Rodriguez-Roisin

Professor Roberto Rodriguez-Roisin was recognized for his long-standing clinical and scientific contribution to COPD and international leadership in the field. He has contributed widely to the understanding and teaching of COPD publishing, not only on his own research on the pathobiology of COPD including many reviews and book chapters but by serving on the editorial boards of all the major respiratory journals. He was President of the European Respiratory Society (1992–1993) and served on the Board of Directors for the American Thoracic Society (1995–1997). He participated in the GOLD Initiative panel (1997–2000) and has remained active in this role being a member of the GOLD Scientific Committee and Executive, acting as Chair since 2007. In particular, his leadership in this latter role has enabled the reputation and independence of the GOLD strategy to remain central to its International reputation, furthering the diagnosis, management and research of COPD worldwide.

Mr. John Walsh

Mr. John Walsh was recognized for his efforts in promoting COPD disease awareness, in mobilizing the COPD patient community and for addressing the priority given to COPD by government agencies. He was a founder and remains the CEO of the COPD Foundation, USA. The Foundation has undertaken a number of activities, including development of educational materials, including the Big Fat Reference Guide, promoting case finding through development of COPD case screeners and advancing public awareness of COPD through activities including the Drive4COPD. The COPD Foundation has collaborated with the NIH and has provided key input into the management of the landmark COPDGene study. The Foundation is the overall organizing party for the COPD Biomarkers Qualification Consortium, a collaboration of industry, academia and government that is designed to obtain regulatory approval for new tools to develop treatments for COPD. Mr. Walsh is the first non-physician/researcher selected for a COPD Career Achievement Award.

DNA Damage in Blood of the COPD Patients by Comet Assay

H. T. da Rosa,¹ A. L. G. da Silva,^2,3 C. F. Charlier,³ M. Salvador,⁴ J. Saffi,^3,6 D. J. de Moura,^3,6 A. R. de Moura Valim,⁵ T. N. Guecheva,^3,6 and J. A. P.Henriques^{3, 4, 6}

¹Scientific Initiation of University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul/RS, Brazil

²Department of Health and Physical Education, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul/RS, Brazil

³Celullar and Molecular Biology Program, Federal University of Rio Grande do Sul - UFRGS, Porto Alegre/RS, Brazil

⁴Institute of Biotechnology, University of Caxias do Sul, Caxias do Sul/RS, Brazil

⁵Department of Biology and Pharmacy, University of Santa Cruz do Sul - UNISC, Santa Cruz do Sul/RS, Brazil

⁶Department of Biophysics, Federal University of Rio Grande do Sul-UFRGS, Porto Alegre/RS, Brazil

Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disorder with complex pathological features largely investigated. Our aims were to assess and quantify the level and the susceptibility of DNA damage and the concentration of thiobarbituric-reactive substances (TBARS) in COPD patients from southern of Brazil. A case-control study enrolling 51 COPD patients and 51 controls without pulmonary disease was done. Peripherical blood was used to perform the alkaline comet assay (pH > 13) and neutral (pH = 8.5). For susceptibility DNA damage, the cells were treated with alkylating agent methyl methanesulphonate (MMS) for 1 and 3 hours at 37°C and evaluated by alkaline comet assay. The lipid peroxidation by measurement of reaction between malondialdehyde and thiobarbuturuc acid (TBARS) as indexes of oxidative stress. The results of comet assay were significantly higher incases than control (Neutral: 47.53 ± 32.45 vs 37.49 ± 38.05, p = 0.047; Alkaline: 36.71 ± 25.41 vs 26.65 ± 27.96, p = 0.005). The susceptibility for DNA damage of MMS-induced lesions remained elevated for all the time in COPD and it was significantly higher after 3 hours of treatment (158.90 ± 103.50 vs 60.61 ± 61.60, p = 0.000) and also correlates positively with TBARS (p = 0.032). Our results demonstrate higher DNA damage and susceptibility, especially in moderate, severe and very severe COPD patients.

Inhalation of the Compatible Solute Ectoine Reduces Neutrophilic Lung Inflammation in Environmentally Exposed Individuals Suffering from Mild COPD

K. Unfried,¹ U. Krämer,¹ U. Sydlik,¹ M. Kroker,¹ A. Marini,¹ T. Jaenicke,¹ A. Paunel,² S. Keymel,³ C. Heiss,³ M. Kelm,³ J. Windolf,² A. Bilstein,⁴ and J. Krutmann¹

¹IUF Leibniz Research Institute of Environmental Health, Auf’m Hennekamp 50, 40225 Düsseldorf, Germany

²Department of Hand Surgery and Traumatology, Heinrich-Heine-University, Düsseldorf, Germany

³Department Of Cardiology, Pneumology, and Angiology, Heinrich-Heine-University, Düsseldorf, Germany

⁴bitop AG, Witten, Germany

Ectoine has been described to act preventive against lung inflammation induced by environmental nanoparticles (Sydlik et al., AJRCCM 2009; 180:29–35). Employing human in vitro and in vivo studies as well as animal studies, we now investigated the therapeutic value of this compound on pre-existing lung inflammation. Lung inflammation was first investigated in animals treated intra-tracheally with carbon particles. Mechanistic studies were performed using human neutrophils exposed to inflammatory stimuli. As human in vivo approach, a crossover study with elderly women [age 70–80] with mild airway obstruction and inflammation was performed. Besides other parameters, inflammation markers were determined in sputum and serum samples before and after both inhalation periods. A significant reduction of neutrophils in animals treated with ectoine after the stimulation of inflammation was observed. Neutrophil apoptosis rates in BAL, but also in experiments with human neutrophils, indicate a preventive effect of ectoine on anti-apoptotic cell reactions. In the human study, sputum parameters (IL-8, number of neutrophils, total nitrogen) showed a 20–30% stronger reduction after inhalation of ectoine compared to the effect after placebo. The studies identify ectoine as a well tolerated therapeutic approach to reduce neutrophilic lung inflammation by preventing anti-apoptotic cell reactions.

Microfibril Associated Protein 4 (MFAP4) as a Biomarker 
of Emphysema

S. L. Johansson,¹ N. B. Roberts,² A. G. Schlosser,¹ H. Wulf Johansson,¹ I. Titlestad,³ I. Tornoe,¹ U. Holmskov,¹ J. Vestbo,^3,4 and G. L. Sørensen¹

¹Institute of Molecular Medicine, University of Southern Denmark,

²Department of Cardiology and Respiratory Medicine, Hvidovre Hospital,

³Department of Respiratory Medicine, Odense University Hospital,

⁴The University of Manchester, Manchester Academic Health Science Centre, South Manchester University Hospital NHS Foundation Trust,

Background: To enhance accuracy in evaluating prognosis and target therapy, there is a need for biomarkers in COPD. Yet, there are no reliable biomarkers that can differentiate between phenotypes of COPD. MFAP4 is a glycoprotein, co-localized with elastin and microfibrils in elastic fibres. We hypothesized that circulating MFAP4 reflects elastin degradation and thereby emphysema in COPD patients. Methods: Plasma levels of MFAP4 (pMFAP4) were determined by ELISA in 74 Danish COPD patients from the multicentre ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) study. Associations between log-transformed pMFAP4 levels and clinical outcomes were assessed by multiple regression analysis. Age, gender and current smoking were included as covariates. Results: Levels of pMFAP4 associated significantly with GOLD stages and were significantly higher in GOLD IV than in II. LogpMFAP4 was positively correlated to percentage of low attenuation area on HRCT (LAA%) (β: 0.007, p < 0.005). There was moreover a significant negative association between plasma logpMFAP4 and FEV1/FVC index (β: -0.007, p < 0.05), reversibility (β: -0.6, p < 0.05). There was a significant interaction between gender and BMI and Fat Free Mass Index respective (FFMI), showing a significant negative association between MFAP4 and BMI (β:-0.03, p < 0.01) and FFMI (β: -0.08, p < 0.005) among women. Conclusion: MFAP4 levels in plasma were associated with severity of COPD and were correlated to clinical characteristics of the emphysema phenotype.

Characterization and Localization of MFAP4 in Human Tissues

H. Wulf-Johansson, A. Schlosser, S. Lock Johansson, U. Holmskov, and G. Lykke Sorensen

Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark

Background: Emphysema and fibrosis are some of the features observed in COPD patients. Microfibril-associated protein 4 (MFAP4) plays an important role in the extracellular matrix by maintaining the structural integrity in lungs, arteries and skin. Systemic MFAP4 is significantly associated to% LAA (data not published) and MFAP4 has previously been associated to fibrotic disease (e.g., Mollenken et al., Hepatology 2009;49:1257–1261). Here we characterize the overall tissue distribution of the putative COPD biomarker. Methods: Quantitative real-time PCR (qPCR) was used to investigate the differential gene expression of MFAP4 mRNA transcripts in various human tissues. Immunohistochemical studies were used to localize the MFAP4 protein in human tissues obtained from the tissue bank at the Department of Pathology, Odense University Hospital. Results: MFAP4 was predominantly localized in elastic tissues such as the lung and arteries. Conclusion: MFAP4 was predominant in lungs and arteries and we suggest that systemic MFAP4 may reflect injury at these sites (see also abstract from Sofie Lock Johansson regarding sMFAP4 variation in COPD).

Association of CYPA1 Gene Polymorphism in COPD

A. Begum,¹ A. Venkateshwari,¹ Anjanamunshi,¹ S. V. Prasad,² and A. Jyothy¹

¹Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, India

²Andhrapradesh Government Chest Hospital, Irranuma, Hyderabad, India

Background: COPD remains to be a major and increasing global health problem and it is expected to continue to increase in the coming decades. Cigarette smoke are important xenobiotic substrate for CYP enzymes, which in its native form is relatively harmless in small doses but upon bioactivation by CYP enzymes, can become toxic for the lungs. Methods: We investigated the genetic polymorphisms of CYPA1 in COPD along with plasma nitric oxide levels. A cohort of 231 COPD patients along with 171 healthy controls were anaylsed. The genotypes were determined by PCR-RFLP and plasma nitric oxide levels were estimated by spectrophotometric (Lefoivre et al., 1982) method. Results: The CYPA1 genotypic frequencies among controls were found to be TT (46.1%), TC (47.95%), CC (5.84%) and allele frequencies are T (70.17%), C as (29.80%). In COPD subjects the genotypic frequencies were TT (36.3%), TC (52.81%), CC (10.8%) with allele frequencies as T (62.77%) and C as (37.22%).The frequency of CC genotype and C allele were significantly high in patients in comparison with COPD patients. (p = 0.03,) OR as 2.3, (CI-1.062–5.207) X2 = 4.6) indicating its possible association with the disease. The results were also analysed by DNA sequencing. The plasma nitric oxide levels were found to be significantly elevated in COPD (p < 0.001).

ALPHA1 Antitrypsin Deficient Monocyte-Derived Neohepatocytes and Their Correction

G. L. McNab,¹ and R. A. Stockley²

¹University of Birmingham, Birmingham, United Kingdom

²University Hospitals Birmingham, Birmingham, United Kingdom

Background: There is currently no cure for alpha1 antitrypsin deficiency (α1ATD). Basic understanding of the mechanisms involved and treatment of α1ATD have been hampered by the lack of a specific tissue and animal models. Aims: To reprogram monocytes from α1ATD patients into liver-like cells and to correct the Z defect using small DNA fragments (SDFs) for testing the potential efficacy of novel treatments. Methods: Monocytes from 3 PiZ α1ATD patients were de-differentiated with MCSF/IL3 and then differentiated into neohepatocytes with FGF-4. Albumin, urea and α1AT were measured. SDF enclosing the normal sequence at the PiZ mutation site was generated from genomic DNA of a healthy volunteer and then transfected into neohepatocytes. cDNA was checked for the M or Z message. Results: No albumin was detected from monocytes but it was secreted from neohepatocytes. Monocytes and neohepatocytes secreted both urea (5 ± 2 and 103 ± 30 μg/dL, respectively) and α1AT (272 ± 42 and 311 ± 34 μg/ml respectively) at 72 hours. Neohepatocytes produced PCR products from Z primers. M SDF treated neohepatocytes generated bands using M primers, indicating the generation of a corrected transcript. Control transfected neohepatocytes produced 322 μg/ml/24h α1AT and transfection with 20 μg M SDF significantly increased secretion (590 ± 104 μg/ml/24h, p = 0.026, n = 3). Moreover, increasing the concentration of M SDF to 50 μg increased α1AT production further (886 ± 298 μg/ml/24h). Conclusions: Neohepatocytes can be generated from α1ATD monocytes. The defective gene can be corrected and is associated with an increase in α1AT secretion. This would indicate that these liver-like cells provide a potential model for the study of α1ATD. Development of this technique could be beneficial and protect both the liver and lungs.

NVA237 Provides Rapid and Sustained Bronchodilation IN COPD PATIENTS, with Efficacy Similar to Tiotropium: The GLOW2 Trial

E. Kerwin,¹ J. Hébert,² A. Pedinoff,³ N. Gallagher,⁴ C. Martin,⁴ D. Banerji,⁵ Y. Lu,⁵ and T. Overend,⁴

¹Clinical Research Institute of Southern Oregon, PC, Medford, Oregon, USA

²Centre de Recherche Appliquée en Allergie de Québec, Québec, Canada

³Princeton Center for Clinical Research, Princeton, New Jersey, USA

⁴Novartis Horsham Research Centre, West Sussex, United Kingdom

⁵Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA

Rationale: The GLOW2 study evaluated efficacy and safety of NVA237 (glycopyrronium bromide) compared to placebo and open-label tiotropium in COPD patients over 52 weeks. Methods: Patients randomized 2:1:1 to NVA237 50 μg once daily or placebo (via the Breezhaler® device) or open-label tiotropium 18 μg once daily (via the Handihaler®). The primary endpoint was trough FEV1 versus placebo after 12 weeks. Results: 1066 patients were randomized (mean age 63.6 years, mean post-bronchodilator FEV1 56% predicted). Trough FEV1 (Week 12) versus placebo was significantly superior versus placebo (p < 0.001) for NVA237 (97 mL) and tiotropium (83 m). Trough FEV1 for NVA237 (Day 1, Week 26 and 52) was significant (p < 0.001) versus placebo (91 mL, 134 mL and 108 mL, respectively) and comparable to tiotropium (83 mL, 84 mL and 89 mL, respectively). NVA237 provided rapid bronchodilation following the first dose on Day 1, with significantly higher FEV1 (p < 0.01) from 5 minutes to 2 hours post-dose versus tiotropium. On Day 1, the treatment difference in FEV1 for NVA237 versus placebo was 87mL at 5 minutes and 143 mL at 15 minutes. FEV1 AUC (Day1, Week 12, 26 and 52) for NVA237 was superior to placebo (p < 0.05) and numerically greater than tiotropium. Conclusion: NVA237 provided rapid and sustained bronchodilation over 52 weeks with similar efficacy to tiotropium.

THE QVA149 Ignite Program: Dual Bronchodilation as the Future 
of COPD Management

D. Banerji,¹ H. Chen,¹ and F. Patalano,²

¹Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA

²Novartis Pharma AG, Basel, Switzerland

Rationale: Combining bronchodilators of different pharmacological classes improves lung function versus individual components, thereby improving symptoms, breathlessness, and QoL. Here we provide an overview of the QVA149 (a once-daily fixed-dose combination of indacaterol and glycopyrronium bromide [NVA237] delivered via the Breezhaler® device). Studies using free-combination of LABA/LAMA have suggested the potential for the LABA/LAMA fixed-dose combination in COPD management. Methods: Review published LABA/LAMA combination data and provide an overview of the IGNITE program. Results: Several studies showed that lung function, breathlessness and QoL are improved with tiotropium once-daily plus formoterol/salmeterol twice-daily free combinations versus the component monotherapies. QVA149 is the most advanced fixed-dose LABA/LAMA combination in development. The efficacy and safety of QVA149 were demonstrated in two Phase II studies, which showed QVA149 optimises bronchodilation (trough FEV1: 226mL improvement versus placebo; p < 0.001), is well tolerated and demonstrates rapid and sustained bronchodilation. Phase III trials (IGNITE program), involving more than 5800 patients, will complete throughout 2012. Conclusions: Dual bronchodilators, such as QVA149, offer superior bronchodilation versus increasing the dose of a single bronchodilator. By combining two long-acting bronchodilators in a single inhaler, once-daily QVA149 may simplify COPD management for patients requiring additional bronchodilation.

NVA237 Improves Breathlessness and Health Status in Patients with COPD: The GLOW2 Trial

P. E. Korenblat,¹ J. Hébert,² N. Gallagher,³ C. Martin,³ D. Banerji,⁴ and Y. Lu,⁴

¹The Clinical Research Center, LLC, St. Louis, Missouri, United States

²Centre de Recherche Appliquée en Allergie de Québec, Québec, Canada

³Novartis Horsham Research Centre, Horsham, United Kingdom

⁴Novartis Pharmaceutical Corporation, East Hanover, New Jersey, USA

Rationale: The GLOW2 trial assessed efficacy of NVA237 (glycopyrronium bromide) compared to placebo and open-label tiotropium in COPD patients. Methods: Patients were randomized (2:1:1) to NVA237 50μg once daily or placebo (via the Breezhaler® device) or tiotropium 18μg once daily (via the Handihaler®) for 52 weeks. Here we report the symptoms (via transition dyspnea index [TDI]), health status (SGRQ), rescue medication use, and daytime symptoms. Results: 1066 patients were randomized (mean age 63.6 years; post-bronchodilator FEV1 56% predicted). LSM difference in TDI score versus placebo was significant for NVA237 at Weeks 12 and 52 (p < 0.05) and tiotropium at Week 52 (p < 0.05). Percentage of patients achieving minimal clinically important difference (≥1) in TDI score was significantly higher (p < 0.05) with NVA237 and tiotropium versus placebo. SGRQ at Weeks 12, 26 and 52 was significantly reduced with NVA237 (p < 0.001) and tiotropium (p < 0.05) versus placebo. NVA237 significantly reduced rescue medication use versus placebo over 52 weeks (p = 0.039). Percentage of days with no daytime symptoms was significantly higher for NVA237 and tiotropium versus placebo (p < 0.05). Conclusion: NVA237 provided significant improvement in dyspnea, health status and daytime symptoms versus placebo and was comparable with tiotropium over 52 weeks.

NVA237 Reduces COPD Exacerbations with Similar Rates to Tiotropium: The GLOW2 Trial

E. M. Kerwin,¹ A. Pedinoff,² T. B. Casale,³ N. Gallagher,⁴ C. Martin,⁴ D. Banerji,⁵ Y. Lu,⁵ and T. Overend,⁴

¹Clinical Research Institute of Southern Oregon, Medford, Oregon, USA

²Princeton Center for Clinical Research, Princeton, New Jersey, USA

³Division of Allergy & Immunology, Creighton University, Omaha, Nebraska, USA

⁴Novartis Horsham Research Centre, West Sussex, United Kingdom

⁵Novartis Pharmaceutical Corporation, East Hanover, New Jersey, USA

Rationale: The GLOW2 study assessed the efficacy and safety of NVA237 (glycopyrronium bromide) compared to placebo and open-label tiotropium in COPD patients. Methods: Patients were randomized (2:1:1) to once-daily NVA237 50 μg, placebo or open-label tiotropium 18μg for 52 weeks. Here we report the effects on COPD exacerbations, adverse events (AE) and serious AEs (SAEs). Results: 1066 patients were randomized (mean age 63.6 years, mean post-bronchodilator FEV1 56% predicted.); 76% completed. NVA237 significantly prolonged the time to first moderate/severe exacerbation versus placebo (HR = 0.66; p = 0.001; number needed to treat [NNT] = 13.27), which was comparable to tiotropium (HR = 0.61; p = 0.001; NNT = 10.04). The rate of moderate/severe exacerbations was significantly lower with NVA237 (RR = 0.66; p = 0.003), while tiotropium was similar to placebo (RR = 0.80; p = 0.179) over 52 weeks. NVA237 was superior to placebo in reducing moderate exacerbations requiring systemic corticosteroids (OR = 0.61; p = 0.006) and those requiring antibiotics (OR = 0.69; p = 0.026). The incidence of AEs was similar between treatment groups (NVA237 76.6%, placebo 76.5%, tiotropium 74.2%). SAEs were also similar with NVA237 (12.6%) versus placebo (15.4%) and tiotropium (15.0%). Conclusion: NVA237 significantly prolonged time to first COPD exacerbation and the rate of moderate/severe exacerbations versus placebo over 52 weeks. These effects were similar to tiotropium.

Efficacy of Indacaterol and Tiotropium as First Maintenance Treatment of COPD

M. Decramer,¹ A. Rossi,² D. Lawrence,³ and D. McBryan,⁴

¹Respiratory Division University Hospital, Katholieke Universiteit, Leuven, Belgium

²Pulmonary Unit, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy

³Novartis Horsham Research Centre, United Kingdom

⁴Novartis Pharma AG, Basel, Switzerland

Introduction: Outcomes data for initial maintenance treatment for COPD are limited. Aim: We evaluated efficacy of the long-acting inhaled bronchodilators indacaterol (IND) and tiotropium (TIO) as initial maintenance therapy. Methods. Data were pooled from studies of double-blind IND 150 μg od (n = 232), IND 300 μg od (n = 241) and placebo (PBO; n = 339) and open-label (o/l) TIO 18 μg od (n = 156) in pts with moderate-to-severe COPD; 77.6%, 81.3%, 73.2% and 78.2% pts completed 6 months’ treatment. Trough FEV1, rescue salbutamol use, transition dyspnoea index (TDI), St George's Respiratory Questionnaire (SGRQ) and odds ratios (OR) for clinically relevant response in TDI (≥1 point) and SGRQ (≥ −4 units) were evaluated at 6 months. Results. The table shows differences vs PBO (p < 0.05 vs *PBO, †TIO or ‡IND300).

Table

	IND150	IND300	TIO
Trough FEV1, mL§	170*	180*	140*
Change from baseline in rescue use, puffs/day	−0.48*	−0.59*	−0.19
TDI score§	1.27*	1.04*	0.69*
TDI responder OR	2.47*	2.50*	1.82*
SGRQ score§	−6.1*†‡	−2.5*	−1.6
SGRQ responder OR	2.77*†‡	1.61*	1.33


§Analysed using last observation carried forward.

A clinically important improvement in SGRQ score with placebo (−5.2) was possibly due to differential dropout. Conclusions: With best overall efficacy, IND 150 μg would be appropriate for initial maintenance treatment of COPD.

Achieving Clinically Relevant Improvements in Dyspnoea and Health Status: A Pooled Analysis of 3-Month Efficacy Data for Indacaterol and Tiotropium

P. W. Jones, D. A. Mahler, D. Lawrence, D. McBryan, and A. Radwan

St. George's, University of London. Division of Clinical Science, St. George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom

The effect of treatment on dyspnoea and health status can be expressed as likelihood (odds ratio, OR) of achieving the minimal clinically important difference (MCID) or number needed to treat (NNT) to reach the MCID, a measure that may be more readily appreciated by doctors. Pooling data from 9 studies in 5947 patients with moderate-to-severe COPD treated with once-daily indacaterol 150 μg (n = 2212), 300 μg (n = 935), tiotropium 18 μg (n = 1214, given open-label to n = 415) or placebo (n = 1586), outcomes were evaluated in terms of patients achieving the MCID in transition dyspnoea index (TDI) score (≥1 point) and St George's Respiratory Questionnaire (SGRQ) score (≥4 units) at 3 months. NNT to achieve MCID was calculated as 1/placebo−active event rates. Patient mean age = 63.6 years, post-bronchodilator FEV1 = 54.4% predicted. All treatments led to a greater likelihood of achieving MCID in TDI/SGRQ versus placebo (all p < 0.05). Versus tiotropium, patients were more likely to achieve MCID in TDI/SGRQ with indacaterol 150 μg (OR: 1.38/1.43) and 300 μg (OR 1.54/1.27) (all p < 0.05). NNTs to reach the MCID for TDI/SGRQ were 5/8 with indacaterol 150 μg, 4/8 with 300 μg and 8/26 for tiotropium. In COPD patients, clinically significant improvements in dyspnoea and health status were more likely with indacaterol than with tiotropium.

Indacaterol Once Daily Reduces the risk of COPD Exacerbations over 6 Months of Treatment: A Pooled Analysis

J. Wedzicha,¹ R. Buhl,² D. Lawrence,³ and D. McBryan,⁴

¹Academic Unit of Respiratory Medicine, UCL Medical School, Royal Free Campus, London, United Kingdom

²University Hospital Mainz, Mainz, Germany

³Novartis Horsham Research Centre, Horsham, United Kingdom

⁴Novartis Pharma AG, Basel, Switzerland

Introduction: Preventing exacerbations is an important treatment goal in COPD (GOLD 2011). Long-acting bronchodilators have been shown to reduce exacerbations. Indacaterol (IND) is a novel, inhaled once-daily β2-agonist (LABA). Methods: Data were pooled from three studies of ≥6 months duration including IND 150 μg (n = 746), IND 300 μg (n = 819) and placebo (PBO; n = 1151) given once daily in patients with moderate-to-severe COPD. We report the results for trough FEV1, time to first COPD exacerbation (analysed with Cox regression) and exacerbation rate over 6 months of treatment compared with placebo. Results: 77% patients completed 6 months’ treatment. Exacerbations occurred in 131 (17.8%), 149 (18.5%) and 247 (21.8%) patients in IND 150 μg, 300 μg and placebo groups respectively. The table shows differences vs placebo (**p ≤ 0.009; ***p < 0.001) (with 95% confidence intervals).

Table

	IND 150 μg	IND 300 μg
Change in trough FEV1, mL	160 (140–190)***	170 (150–200)***
Time to first COPD exacerbation, hazard ratio	0.74 (0.59–0.93)**	0.73 (0.59–0.90)**
Annualized COPD exacerbations, ratio of rates	0.69 (0.55–0.87)**	0.71 (0.57–0.88)**

Conclusion: IND 150 and 300 μg once daily provided clinically significant bronchodilation after 6 months’ treatment and significantly reduced the risk (and rate) of COPD exacerbations versus placebo.

Alpha 1 Antitrypsin Deficiency: Significance of the PiFZ Genotype

N. J. Sinden, and R. A. Stockley

Lung Function and Sleep Department, Queen Elizabeth Hospital, Birmingham, United Kingdom

Introduction: The F variant of alpha-1-antitrypsin (A1AT) has an allelic frequency of 0.002 in Caucasians and is associated with normal serum A1AT levels. However, an increased risk of emphysema in PiFZ heterozygotes has been reported, raising questions about the function of F A1AT. Aims: 1. To study the clinical phenotypes of 5 PiFZ individuals, 2. To compare the function of F A1AT with normal (M) and Z variants. Methods: Five PiFZ individuals were identified from the UK registry. Data was collected including demographics, pulmonary function and CT densitometry. To investigate function of F A1AT, its inhibitory activity against neutrophil elastase (NE) was compared with other A1AT variants. Association rate constants (Kass) for PiFZ, PiMM and PiZZ sera were determined. Results: All five PiFZ individuals had normal serum A1AT levels (>11 μM). They had a mean age of 65 and a mean 20 pack-year smoking history. Four individuals had airflow obstruction, three had impairment of gas transfer and four had emphysema on CT scan, which was in the lower zones in three individuals. The Kass values for M, FZ and Z A1AT were 1.4 × 107 M–1s–1, 7.2 × 106 M–1s–1 and 7.3 × 106 M–1s–1, respectively. Conclusion: F A1AT has reduced functional ability to inhibit NE similar to that of Z, and PiFZ heterozygotes seem to have an increased risk of emphysema despite normal A1AT levels.

A ‘Lung Census’ Activity for World Spirometry Day in Australia

P. A. Frith, T. Effing, D. Marshall, A. Vander Zypp, T. Reidy, and M. Ablett

Flinders University Faculty of Health Sciences, Bedford Park, South Australia

Aim: To extend to the community a case-finding initiative for COPD conducted in Australian primary care since 2007. Method: A respiratory questionnaire and spirometry using hand-held meters were administered at Universities, and in primary care practices, for World Spirometry Day 2010. Results: The population samples were Community (CS) [n = 1540; median age = 22.0 yrs; mean height = 172.0 cms; 56.6% male] and GP (GPS) [n = 4400; median age = 54.0 yrs; mean height = 168.2 cms; 42.1% male]. FEV1/FEV6 ratio<0.7 indicated airflow limitation (AL). In CS there were 14 (0.9%) with AL; in GPS there were 464 (10.5%) with AL. In GPS, those with AL were older than those without AL (n = 3930) (62.5 yrs vs 52.0 yrs; p < 0.001); were more likely to be current smokers (28.0% vs 18.1%; p < 0.001) or ever smokers (70.3% vs 50.9%; p < 0.01), and gave more positive questionnaire answers (mean score = 3.84 vs 2.52; p < 0.01). Previous respiratory diagnosis was recalled by 31.5% and 40.7% of those with AL vs 9.1% and 25.5% of those without AL (p < 0.01). Conclusion: In an Australian survey where 10% had airflow limitation half reported previous respiratory diagnosis, and 30% had never smoked. It is therefore important to expand case-finding initiatives for obstructive lung diseases through adult populations, using both questionnaires and spirometry.

Health Status of Carer-Patient Dyads Where Home Oxygen Therapy is Required for Chronic Respiratory Diseases

P. A. Frith, R. Sladek, R. Woodman, P. Cafarella, M. Luszcz, T. Effing, T. Jones, D. Rowett, and P.A. Phillips

Flinders University Faculty of Health Sciences, Bedford Park, South Australia

Introduction: Patients with disabling chronic disease often rely on family caregivers, with acknowledged carer burden. In some conditions carers and patients share elements of health impairment, but this is untested in patients receiving home oxygen therapy (HOT). Aims: In a large RCT of carer training for patients receiving HOT we hypothesised that patient [P] and Carers [C] would share emotional health but not physical health status. Methods: P and their primary C at randomisation completed Short Form 36 questionnaires [SF36]. P also completed Chronic Respiratory Questionnaire [CRQ] and Australian modified Karnovsky Performance Scale [AKPS], and C completed Carer Overload [CO], Mastery [MaS], Self Esteem [SE], Fatigue Scores [ICFS] and Anticipated & Received Social Support Scale [ARSS]. Results: P-C dyads (n = 197) provided data at baseline. There were weak correlations (p < 0.01) between C SF-role physical vs P SF-vitality (rho = 0.18), C SF-general health vs P SF-vitality (rho = 0.21) and P AKPS (rho = 0.18), and C SF-vitality vs P SF-vitality (rho = 0.17) and P AKPS (rho = 0.16). C OS correlated weakly (p < 0.01) with P SF-vitality (rho = -0.21) and P AKPS (rho = -0.25). No other dyad correlations were significant. Conclusions: Prediction of carer burden cannot be inferred from patient health status impairment where patients are receiving HOT for lung diseases.

COPD in Nepal

M. K. Piya

Kathmandu Hospital, Tripureswor, Nepal

Background: There is no national statistics available in Nepal, but the individual reports suggest that the disease is on the rise. Objective: To diagnose COPD in private settings by the history of Cough and SOB for more than 2 years duration and Pulmonary Function Test with FEV1% of predicted. Method and Results: One year retrospective analysis of 313 patients was done in Kathmandu Hospital with history of Cough and SOB from 13.08.2010-13.08.2011, (01.05.2066-01.05.2067). Patients with less than 2 years of Cough, SOB, Asthma, Pleural Effusions, Lung cancers and Heart diseases were excluded. After exclusion, only 183 patients (58.46%) were analysed. Male were 101 (55.19%) and Female of 82 (44.80%). Cough,SOB was highest in 2-5 yrs duration. Age of onset was in 51–60 yrs group. FEV1% predicted was 55.74% in severe cases followed by Severe 31.14% and Moderate 13.12%. Conclusion: COPD is still an ignored and neglected disease in Nepal. The above results show the maximum number and percentage in a category of very severe disease. FEV1 seems to be reliable and easy tool for the diagnosis as well.

Risk Factors Associated with Frequent Hospital Readmissions 
for Exacerbation of COPD

Y.-S. Kim, M.-H. Kim, H.-K. Park, M.-K. Lee, and S.-K. Park

Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan and Pusan National University Hospital, Busan, South Korea

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. Methods: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. Results: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <18.5 kg/m2, duration >36 months, forced expiratory volume in 1 second (FEV1) <50% predicted, arterial CO2 partial pressure (PaCO2) >40 mm Hg, and arterial oxygen saturation (SaO2) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <18.5 kg/m2, PaCO2 >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. Conclusion: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

Telemonitoring – An Early Warning System for Patients at Risk 
of COPD Exacerbations and Admission

S. Gompertz¹, C. Bhalla², S. McIldowie², H. Kemp³, and S. Pinnell⁴

¹ University Hospital Birmingham NHS Foundation Trust, QE Hospital Birmingham, United Kingdom

² Birmingham and Solihull NHS Cluster, Birmingham Community Healthcare Trust, Moseley Hall Hospital, Birmingham, United Kingdom

³ Solihull NHS Cluster, Birmingham Community Healthcare Trust, Moseley Hall Hospital, Birmingham, United Kingdom

⁴ Safe Patient Systems (SPS), Blythe Valley Park, West Midlands, United Kingdom

Introduction: COPD patients risk exacerbation and hospitalisation; delay in treatment lengthens recovery and may lead to admission. Aim: To promote earlier treatment of exacerbations in patients at risk of hospitalisation using remote telemonitoring. Methods: Patients with ≥2 COPD hospitalisations within 12-months entered their COPD symptoms daily onto a touch-sensitive mobile phone. When standard exacerbation criteria were fulfilled (Seemungal, TAR. et al. Am J Resp Crit Care Med 2000;161;1608–1613) an alert was generated, and a case manager phoned the patient to ensure appropriate clinical management. Primary outcome was the number of COPD admissions and costs in patients completing 12 months on the pilot service. Results: 33 patients completed the pilot (19 withdrew; 5 died); primary outcome data are summarised below:

Table

	Pre-pilot	Pilot
Total admissions	88	41	–53%
Admissions per patient	2(1–3)*	1 (0–2)*	2p = 0.006
Total admission costs	£194,066	£95,786	–51%
Admission costs per patient	£4859(£1718–£7355)*	£497(£0–£4221)*	2p = 0.002

*median(IQR).

Patients felt reassured their condition was being monitored(95%) and were good at entering data (mean(SD) monthly compliance 89(4.7)%). Conclusion: An appropriately-powered randomised-controlled trial is required to determine whether the significant reductions in COPD admissions/costs were related to the intervention, or to other changes in the patients or local healthcare system.

Impact of Morning Symptoms on the Working Lives of COPD Patients

V. Higgins, S. Broomfield, R. Pollard, and S. Fermer

Adelphi Real World, Macclesfield, United Kingdom

COPD increasingly affects persons of working age. Morning symptoms can affect COPD patients’ ability to attend work and have a sustained impact throughout their working day. The study aimed to quantify the prevalence and impact of morning symptoms experienced by working COPD patients receiving inhaled corticosteroid plus long-acting β2-agonist (ICS/LABA) therapy by association with days off work and impact during their working day. Patients in employment were drawn from a 2011 multinational real world study of COPD patients. Results were tested for significance (p < 0.05) using Mann–Whitney and negative binomial regressions. Confounders included were age, gender, BMI, co-morbidities, severity, smoking status and treatment adherence. Then, 131 patients were identified as receiving ICS/LABA-only therapy and in employment. Of these, 24.4% experienced one or more morning symptoms, most commonly cough and sputum. Compared with patients without morning symptoms, these patients are associated with significantly more days off work in the last 12 months (4.03 vs 2.27 p < 0.01). Notably no significant difference was shown for the impact while at work as reported by patients on a 7-point Likert scale, where 7 represents a constant impact (2.89 vs 2.41 p = 0.073). Presence of morning symptoms compromises the ability of COPD patients to go to work.

Symptoms, Consultations and Comorbidities in Real-World COPD Patients Classified by the GOLD 2011 Strategy

V. Higgins, S. Broomfield, and M. Small

Adelphi Real World, Macclesfield, United Kingdom

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 Strategy classifies COPD patients according to risk (by spirometry and/or exacerbation history) and symptoms (by COPD Assessment test [CAT] or modified Medical Research Council [mMRC] dyspnoea scale). In a real-world international COPD population sampled from the Adelphi Respiratory Disease Specific Programme, we examined the proportion of patients in each GOLD category (classified by CAT), and patterns of symptoms, consultations and comorbidities. Of 2392 patients completing a questionnaire, 1508 with data for all 4 GOLD classification parameters were analysed. The proportions of patients in categories A, B, C and D (by CAT) were 10, 49, 1 and 40%, respectively. There were no major demographic differences across categories except age (mean age in A, B, C and D, respectively): 62.0, 63.5, 60.2, 67.3). Category D patients had a greater range of symptoms (mean number over last 4 weeks: 1.5, 2.5, 1.4, 4.1), more consultations (mean over last 12 months: 2.3, 3.1, 2.7, 4.4) and a higher incidence of comorbiditiy (cardiovascular disease, diabetes, anxiety, depression and gastroesophageal reflux disease). In GOLD category D patients, there is a higher burden of progressive disease than other categories.

Psychometric Properties of the Clinical COPD Questionnaire (CCQ)

A. Pommer

Tilberg University, Tilburg, The Netherlands

Background: The Clinical COPD Questionnaire (CCQ) was designed to measure symptoms and functional status. Although its concurrent validity has been studied extensively, research methods that were used are questionable; moreover the latent structure has never been investigated. Design/Methods: 340 COPD-patients completed the CCQ and were randomly divided in two groups (group I N = 161, group II N = 179, study 1). The latent structure of the CCQ was analyzed by explorative (EFA) and confirmatory factor analyses (CFA) in group I and II. In study 2 (N = 68) the concurrent validity of the latent structure was investigated by correlating the CCQ with the Patient Health Questionnaire (PHQ9, depression)), and General Anxiety Disorder, (GAD7, anxiety). Results: EFA revealed (group I) a 7-item scale with three dimensions: ‘functional limitations’ (3-items), ‘coughing’ (2-items) and ‘emotional distress’ (2-items), that was confirmed with CFA in group II (CFI: 0.99, NFI: 0.99, RMSEA: 0.02). The functional and emotional distress subscale showed significant and clinically relevant correlations with the PHQ9 (r = 0.43, p < 0.01, r = 0.54, p < 0.01), and the GAD7 (r = 0.41, p < 0.01, r = 0.65, p < 0.01). Conclusion: Factor analysis of the CCQ revealed only 7 suitable items that form three sub dimensions which assess general aspects of wellbeing rather than COPD specific symptoms and functional limitations.

Preventing COPD Admissions in Earthquake Ravaged Cities – The Christchurch Experience 2011–2012

M. Epton and R. Laing

Canterbury Initiative Integrated Respiratory Service, Pegasus Health, Bealey Avenue and Respiratory Services, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand

The Christchurch earthquake of February 2011 killed 185 people, devastated communities, ruined primary care facilities, destroyed hundreds of rest home beds and reduced tertiary beds by 106 from 760 pre-quake. A number of projects were initiated to optimize well-being of patients with COPD, aiming to reduce winter admissions. These included phone contacts of vulnerable patients, with check-lists including information about home heating, influenza vaccination, Red Cross support, availability of medications, and self-management. Frequent hospital attenders underwent a case-management process in primary care, to identify patient or health system behaviours which might lead to avoidable admission. A linked database of ambulance calls, emergency department attendance, and admissions was generated giving information about patient and health system responses leading to admission. Overall, patients contacted by phone showed high levels of self-reliance, forward planning, and vaccination uptake. Respiratory admissions to Christchurch Hospital were no higher than previous years, and lower in the immediate post-earthquake weeks. The winter admissions of 55 frequent attenders undergoing case management dropped from 156 (2010) to 84 (2011). Lessons learned in a crisis, about how patients and health systems respond in COPD exacerbations, and how system responses might affect likelihood of admission, are invaluable in planning COPD management strategies.

Palliative Care and COPD – A Perspective from an Australian Palliative Care Service

I. Grant

Barwon Health Palliative Care, North Geelong, Victoria, Australia

COPD is one of the 10 most common causes of death in Australia. Many patients experience unrelieved symptoms for months before death, and respiratory failure can be extremely distressing for patients, and traumatic for families and health professionals. Palliative Care has historically provided the majority of its resources to the care of people with malignant neoplasia. Increasingly, there is recognition that people with advanced non-malignant conditions such as COPD can potentially benefit from specialised Palliative Care. The Barwon Health Palliative Care Service serves a mixed urban and rural region with a population over 350,000, centred in Geelong, Victoria. The service has a 16-bed inpatient hospice unit, an inpatient consultative service for the regional general hospital, and a community-based program. With improving links to the Thoracic Medicine department, numbers of COPD patients being treated by the Palliative Care service are increasing. This has led to improved management of dyspnoea and end-stage respiratory failure, but it has also revealed challenges in adapting a care model primarily designed for malignant neoplasia to management of a chronic relapsing disease. The presentation will detail the experience of this service, and, using a case study, explore dilemmas of the interface between COPD and Palliative Care.

Nintendo Wii Therapy in the Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease

L. L. Carvalho, L. K. Dias, C. Classen, G. G. Baldissera, D. F. Cruz, T. C. M. Fleig, T. G. Carvalho, and A. L. G. Silva

Physiotherapy Santa Cruz Hospital and Pulmonary Rehabilitation, Santa Cruz do Sul/RS, Brasil and Departament of Physical Education and Health, Santa Cruz do Sul University- UNISC, Santa Cruz do Sul/RS, Brasil

The Nintendo Wii video game system has many potential uses in therapy practice. The Wii is able to blend exercise and physical activity with video games. In addition, to using the Wii in therapy sessions include an increase in patient compliance, anticipation for the next treatment session, and a boost in patients’ socialization and self-esteem. Our aim were to assess the cardiorespiratory changes of COPD patients.We checked the vital signs (systolic and diastolic blood pressure -BP, heart rate- HR, respiratory rate- RR and peripheral oxygen saturation- OS) and dyspnea level of 10 COPD patients, both gender, at rest and after therapy and every minute until values returned to resting. The disease level varies from mild to very severe. The BP (122/77 mmHg vs 123/78 mmHg), HR rate (88.40 ± 10.49 vs 86.10 ± 12.46), RR rate (21 ± 4 vs 22 ± 4),%OS (95.40 ± 4.14 vs 95.40 ± 4.16) and dyspnea variables not significantly changed, at rest and after Wii therapy. The%OS was lower in female than male at rest (90.00 ± 3.46 vs 97.71 ± 0.75; p = 0.000) and after Wii therapy (90.33 ± 4.50 vs 97.57 ± 0.97; p = 0.002). The data showed few differences in the cardiorespiratory system in COPD patients and reinforce the need to understand the mechanisms by which this happens in the disease process.