Flovent

NEW YORK -- Chronic obstructive pulmonary disease is the fourth-leading cause of death in this country, yet many consumers don't even know what it is. A public opinion poll conducted by Opinion Research Corporation International and released in May found that only 22 percent of Americans could identify COPD as a respiratory disease.

Perhaps in part because of that lack of awareness, COPD is expected to leapfrog stroke as the third-leading cause of death in the United States by 2020.

It's a disease state so prevalent that more Americans are suffering from COPD than from diabetes--24 million versus 18.2 million. Of the five most deadly disease states in the United States--a list that also includes heart disease, cancer and diabetes--COPD is the only one in which mortality rates have continued to increase in the past 20 years. The overall death rate for COPD increased 67 percent between 1980 and 2000.

"COPD is a serious health threat with a debilitating impact on quality of life," stated Carl Wiezalis, director of the National Emphysema and COPD Association. The condition remains underrecognized, though awareness is improving, he said. "Given the low profile of the disease, many patients continue to go undiagnosed and don't receive the treatment that they need."

Even among doctors, relative awareness is low. While primary care physicians are certainly knowledgeable regarding COPD, the condition often is diagnosed as chronic bronchitis or emphysema--two upper respiratory conditions that frequently go hand-in-hand with COPD--or it is confused with asthma.

COPD represents a permanent loss of lung function as opposed to asthma, another breath-sapping disease that oftentimes is confused with COPD. Asthma, however, is typically associated with younger patients--children and teenagers--even though it can be diagnosed in adults. There are significant numbers of asthmatics who "outgrow" the disease because the inflammation of air passages becomes less bothersome as a child's lungs grow in size.

COPD is more an age-related disease regularly associated with a lifetime of smoking. Ninety percent of cases can be linked to the nicotine habit.

Raising the awareness bar

Nevertheless, many of the treatments for asthma also are effective for COPD patients. For example, GlaxoSmithKline's blockbuster asthma drug Advair Diskus, with $2.9 billion in 2004 sales, according to IMS Health, gained approval as a COPD treatment in November 2003. Analysts project sales of Advair will reach $5 billion by 2007.

New drugs specifically addressing COPD are expected to raise awareness surrounding the condition, as well. Examples include potential blockbuster drugs like Spiriva, a medicine from Pfizer and Boehringer Ingelheim that received Food and Drug Administration approval in June of last year. Those drugs are expected to help drive awareness among the professional community as Pfizer, Boehringer and other pharmaceutical powerhouses--GlaxoSmithKline, AstraZeneca and Sepracor among them--continue to detail doctors on the medications.

In March, Sepracor received approval for its line extension Xopenex HFA, a hydrofluoroalkane metered-dose inhaler for both asthma and COPD. The company, which plans to launch the inhaler toward the end of 2005, reported 2004 sales of $319.8 million for its short-acting bronchodilator Xopenex, which is administered through a nebulizer.

COPD medicines on the horizon include Edmond Pharma's erdosteine, which has been approved in Europe since 1995. In May, Edmond entered a license and supply agreement with Adams Respiratory to bring the drug to the United States. The two companies expect to file a new drug application later this year.

Nebulizers, devices that administer liquid drugs like albuterol as a mist inhalant, also are popular products among both asthmatics and people with COPD. They could represent a significant opportunity for chain drug operators as the Medicare population begins taking advantage of Medicare Part D drug benefits in January.

While most nebulizers are somewhat bulky and have to be plugged into a wall socket, Omron markets a battery-operated, portable nebulizer that can fit easily into a purse or fanny pack, representing a possible upsell for consumers. "Asthmatics or COPD patients, they want to travel, noted David Fahrner, Omron's general manager of marketing. "So to have a device that either is battery-operated or can be plugged into a car's [power] adaptor is important to their lifestyle."

It's not necessarily an incremental sale, though. Consumers who are aware of the portable devices gravitate toward them for the convenience, Fahrner said, if they are aware that the portable nebulizer, called MicroAir, is on the market. "What we need to do and what we're working harder on is to make people aware that [they have] options," Fahrner said. "We're really working hard with physicians right now ... making doctors aware that they can offer patients a better lifestyle choice with portable devices."

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