Examining the Evidence for Statin Use in Asthma and COPD

Recent research indicates that further study of the immunomodulatory effects of statins could lead to effective interventions for patients with chronic obstructive pulmonary disease (COPD). Neil Thomson, MD, of the Institute of Infection, Immunity & Inflammation at the University of Glasgow in the United Kingdom authored the review, and it was published recently in Current Molecular Pharmacology.

The author says that findings from random control trials (RCTs) “in patients with mild to moderate asthma suggest that short term treatment with statins has uncertain benefits on clinical outcomes,” adding that statins do not seem to improve lung function or symptom control except, perhaps, among smokers with asthma. He suggests that “the evidence for the clinical effectiveness of statins is not established due to limitation in study design of the clinical studies performed to date.”

Although there is currently little evidence that statins could be used to effectively treat asthma, two systematic reviews “concluded that statin use may reduce morbidity and/or mortality in COPD patients, although prospective interventional clinical trials are required to confirm these findings” according to the author.

One large, multicenter, randomized, placebo-controlled trial conducted over 12 to 36 months, the STATCOPE study examined whether or not simvastatin at a dose of 40 mg daily could prevent exacerbations in patients with COPD. The exclusion criteria included diabetes, cardiovascular disease, and those who were already taking statins. The author reports, “the results of the study suggest that simvastatin at a daily dose of 40 mg does not reduce exacerbation rates or the time to a first exacerbation in patients with COPD who were at high risk for exacerbations, but that had no cardiovascular indication for statin treatment.”

Additionally, the review includes a summary of 6 recently published observational studies regarding statin use and COPD. The results were mixed, with one showing no evidence that statins improve survival in COPD patients at one end of the spectrum and another showing that “statin use was associated with a 30% reduction in all-cause mortality at 3-4 years after first admission for COPD,” according to the author.

The author concludes by suggesting that “biases inherent in observational studies in COPD may explain the discrepancy with findings from the large RCT,” adding, “It is possible that a subgroup of COPD patients with cardiovascular indications for statins and/or systemic inflammation obtain clinical benefit in reduced exacerbation and mortality.” The author concludes “understanding the immunomodulatory effects of statins may lead to the development of novel targeted interventions for asthma and COPD.”