Daliresp is a one-a-day pill. The results of a dozen clinical trials with thousands of patients with COPD due to cigarette smoking was summarized in 2016 by three famous pulmonary doctors (Wedzicha, Claverley, and Rabe) who were paid by Astra Zeneca to be investigators for several of these studies.
Roflumilast acts to reduce airway inflammation, but is not a corticosteroid like ICS inhalers or prednisone. It was no better than a placebo pill for patients with mild to moderate COPD (FEV1 more than 50% predicted), or for those with less than two exacerbations per year. However, it reduced by about 20% the average number of exacerbations for patients with severe to very severe COPD who had a chronic productive cough and a hospitalization for COPD during the previous 12 months. The effectiveness of roflumilast was not influenced by LABA, LAMA, ICS or combo inhaler therapy, which is also commonly prescribed to reduce COPD exacerbation rates. Note that a disadvantage of ICS therapy is an increase in the risk of pneumonia. An alternative to roflumilast is daily azithromycin, but a study called RELIANCE which will directly compare these two drugs will not be completed until 2023.
Side-effects which were more likely when compared to the placebo included nausea, diarrhea, weight loss (average 5 pounds), depression, and insomnia. However, the incidence of heart attacks and strokes was lower for those taking roflumilast. Daliresp costs more than $250 per month in the USA, but is covered by Medicare. Generic roflumilast may soon become available.