The worldwide market for COPD treatments could reach as much as $7.5 billion by 2015, from $4.6 billion last year, according to new research from analysts at Datamonitor who say growth will be driven by new dual-acting and long-acting combination therapies.

There are currently more than 31 million COPD sufferers in the US, Europe and Japan – and the disease is expected to become the third biggest killer in the developed world by 2020. In 2002, COPD was the fourth leading cause of death in the US, with annual costs estimated to be $37 billion - double that for asthma.

Boehringer Ingelheim and Pfizer’s long-acting anticholinergic, Spiriva (tiotropium bromide), is currently the only once-daily inhaled bronchodilator approved for COPD and Datamonitor predicts it will record global sales of $1.5 billion by 2010. The development of a product combining Spiriva with a long-acting beta-2 agonist also looks promising, says analyst Shaun Falkingbridge, adding: “Although clinical trials with this combination product have not been performed, clinical experience with Combivent - a combination of a short-acting beta-2 agonist (salbutamol) and a short-acting anticholinergic (ipratropium)- in COPD is encouraging because the bronchodilation produced is of a magnitude greater than that of either component alone.”

The challenge for BI and Pfizer, however, is to get ahead in the race before competitors Novartis and GSK. The Swiss giant signed a deal with Vectura Group/Arakis in April 2005 for AD-237, a once-daily, long-acting antimuscarinic agent, and will develop it as a monotherapy and in combination with its own once-daily, beta-2 agonist currently in Phase II clinical trials (QAB-149). Meanwhile, GlaxoSmithKline also has numerous compounds in early clinical development to create a once-daily, dual-action combination product.