Roflumilast is a selective phosphodiesterase-4 inhibitor, introduced for the treatment of chronic obstructive pulmonary disease (COPD) patients with symptoms of chronic bronchitis and frequent exacerbations. Randomized clinical trials (RCT) found that roflumilast increases 9.5% the risk of adverse effects (AE), when compared with placebo [1]. However, 2 small real-life studies, which included 25 and 55 subjects, respectively, found a much higher incidence of AE (69 to 72%), which frequently lead to discontinuation of treatment [2–3].
