Significant gas-exchange improvements reported after roflumilast in two cases of severe COPD

Two cases of 63-year-old men with severe chronic obstructive pulmonary disease (COPD) associated with respiratory failure are presented. Both patients were treated with long acting bronchodilators, inhaled corticosteroids, theophylline, diuretics, long term oxygen therapy, and nocturnal non invasive mechanical ventilation, without achieving any improvement or control of the disease course. We observed a clinical and functional improvement in both patients when we added roflumilast to the pharmacological treatment schedule. In this context, gas exchange parameters were greatly improved, leading us to speculate on the possible mechanisms causing such improvements in these COPD patients.