PracticeUpdate Conference Series: ERS 2018

used to treat COPD, also target this pathway. When combined with TLD, an additional beneficial effect is observed, even in patients treated heavily with other drugs. Patients in both parts of the trial received the anticholinergic bronchodi- lator tiotropium. Dr. Slebos presented results of 82 patients. Half were male, and the aver- age age was nearly 64 years. At 3 to 6 months after treatment, 71% of patients who had received the sham treatment had experienced an adverse respiratory event related to COPD versus 32% of those who underwent TLD. None of the patients died and no TLD- related adverse side effects needed to be treated. A total of 5 patients (12%) who underwent TLD experienced stomach problems such as nausea, abdominal bloating, and digestive discomfort. These

new, under investigation since 2008. Four clinical trials have taken place in the past 6 years (Innovative Pulmonary Solutions I and II, AIRFLOW-1, and AIRFLOW-2). According to Dr. Slebos, there is a great clinical need for more effective therapies. The effectiveness of treatment should be demonstrated through a double-blind, randomized, sham-controlled trial. Daiana Stolz, MD, of the University Hospital Basel in Switzerland, who was not involved in the study, emphasized the importance of these results based on the difficulty of treatment for patients with COPD. These results demonstrate that TLD can provide significant improvements to patient health, she said. She added the results of the AIRFLOW-3 trial are highly anticipated to confirm TLD as a safe and effective treatment for patients with severe COPD.

were temporary and subsided after 6 months. Dr. Slebos explained that these issues occurred based on the effect of radiof- requency energy on nearby nerves. The process and imaging are undergoing improvements in order to improve under- standing of the location of these gastric nerves, and additional measures have been implemented to avoid these nerves in future procedures. The larger, phase III, AIRFLOW-3 trial is being planned. It is likely to be launched in carefully chosen centers of excellence in Europe in 2019. Dr. Slebos noted that AIRFLOW-3 will have a similar design but will include more patients in order to gather more evidence for the procedure. Over 300 million patients worldwide suffer from COPD, including 4% to 10% of adults in European countries. TLD is relatively

www.practiceupdate.com/c/73940

" ...dietary nitrate in association with pulmonary rehabilitation

enhanced the gains in exercise capacity in patients with COPD and increased exercise endurance time... "

Estimated treatment effect of beetroot juice vs placebo 62 s (95% CI 33, 106), P < .0001. Nitrite and nitrate levels increased sig- nificantly (beetroot juice change in nitrite 0.31 ± 0.23 µM vs placebo change in nitrite 0.03 ± 0.09 µM, P < .0001; beetroot juice change in nitrate 567.8 ± 165.1 µM vs placebo change in nitrate –4.25 ± 25.07 µM, P < .0001). Dietary nitrate supplementation reduced the oxygen cost of exercise in COPD but not endurance time. Individuals using ambulatory oxygen may show a greater response. Dr. Pavitt concluded that administration of dietary nitrate in association with pulmonary rehabilitation enhanced the gains in exercise capacity in patients with COPD and increased exercise endurance time in this cohort of patients with COPD who required ambulatory oxygen.

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ERS 2018 • PRACTICEUPDATE CONFERENCE SERIES