Review of Role of Roflumilast in the Prevention of an Exacerbation Associated with the Chronic Obstructive Pulmonary Disease

COPD (Chronic Obstructive Pulmonary Disease), is a progressive disease that is characterized by persistent airflow limitation that leads to significant breathing problems in the patient. Sudden worsening of the symptoms of COPD is called as a COPD exacerbation. Usually COPD patients are categorised as mild, moderate and severe based on the symptoms, lung function and risk of exacerbation. The severe COPD is associated with frequent exacerbations which further deteriorates lung function of the patient. COPD exacerbations lead to frequent hospitalisation and are associated with high mortality. If COPD exacerbations result in hospitalization, they carry the same mortality as a heart attack: 22% die within the following 12 months and 50% who required ICU admission die during hospitalization. To prevent this exacerbation in COPD patients, active management with medications is necessary. Roflumilast, a selective phosphodiesterase-4 (PDE4) inhibitor, is a relatively newer option in the management of COPD. Roflumilast is used concomitantly with other available bronchodilators and also in the patients taking inhaled corticosteroids. In various clinical trials and real life studies, efficacy of roflumilast is well established in the prevention of COPD exacerbation and it also improves lung function. Because of novel mechanism of action and its efficacy in addition to current available therapy, roflumilast represents a valuable inclusion in the current armament for treating COPD patients. However, risk benefit ratio and long term safety profile of roflumilast needs further investigation particularly in the Indian patients.