Currently, chronic obstructive pulmonary disease is an incurable condition that’s the third leading cause of death in the United States. The World Health Organization reports that in 2015, COPD claimed the lives of 3 million people worldwide, accounting for 5 percent of all deaths on the planet.
The burden of COPD is only expected to increase as heavy smokers who took up the habit in the 1960s and 1970s age. A 2016 Canadian study published in the American Journal of Respiratory and Critical Care Medicine estimates that within the next 15 years, COPD-related hospitalizations will increase 185 percent. Even though many people have gotten the message that quitting smoking is the best way to avoid developing COPD, the disease is also related to aging, and as the population in the U.S. and other industrialized nations continues to grow older, the rate of COPD incidence is likely to continue to offset the number of people who are quitting smoking.
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It becomes clear that treating COPD and finding better ways of managing the disease — estimated to affect nearly 30 million people in the U.S. today — will be critical to reducing incidence of COPD and helping patients live longer.
However, as the COPD Foundation reports, “COPD consistently gets the lowest levels of research funding. Simply put, without the research, cures and new treatments are slow in coming.” A 2003 review study in the European Respiratory Journal noted that COPD is “an orphan condition that overwhelmingly affects the poor and has been broadly ignored by scientists and by governments.”
That said, some researchers are continuing to look for new ways to diagnose and treat COPD, and the future of dealing with this disease likely lies in one of several areas, including earlier detection, new drug therapies and new surgical techniques.
Earlier Detection
For most patients, the onset of COPD is incremental, and you may have the disease without knowing it for many years. In some cases, you’ll only receive a formal diagnosis when you land in the hospital with an acute exacerbation, a worsening of the condition often from an infection. This is why the Centers for Disease Control and Prevention estimates that about twice as many people in the U.S. have COPD than are currently diagnosed. But because COPD is a manageable condition, the earlier you have a diagnosis, the sooner you can begin treatments that may slow progression of the disease.
A 2016 study in the American Journal of Respiratory and Critical Care Medicine reported that advancing the cause of diagnosing more COPD patients early could lie in the use of five simple questions and a peak expiratory flow meter test that could be administered by primary care physicians during a routine office visit. Dubbed CAPTURE, which stands for COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk, the five questions assess smoke and pollution exposure, breathing difficulties, exercise tolerance and patient history of respiratory illnesses. Depending on your score, you’ll either be referred for definitive diagnostic testing or offered a PEF test to measure how well your lungs expel air.
Other studies are looking into the underlying genetics of COPD to find better ways of identifying which smokers are more likely to develop COPD. Research into biomarkers — measurable substances that signal the presence of disease in the blood or tissues — are also gaining ground as a “hot topic” in the effort to identify COPD early or maybe even prevent it.
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New Drug Therapies
The two most commonly prescribed drug therapies for COPD are bronchodilators that help open up the airways and inhaled corticosteroids that help reduce inflammation in the lungs. Both treatments can alleviate symptoms, but neither can help repair the underlying damage that’s been done to the lungs. Currently, that damage is immutable, and drug treatments are left trying to slow the progression of the disease.
Recent studies and trials have looked at how the lungs accumulate this damage, and subsequently, how to address that damage before it becomes COPD. Oxidative stress — damage to cells casued by free radicals that haven’t been counteracted by antioxidants — and inflammation appear to be two big culprits, and clinical studies have looked at antioxidants like broccoli extract and certain genetic disruptors as new ways of treating COPD with mixed results.
In addition to new drugs that treat COPD itself, treatments that can help patients avoid the dangerous exacerbations that worsen prognosis and often land them in the hospital are also an area of active study. Currently, most doctors recommend you get a pneumonia vaccine and an annual influenza vaccine. You may also be instructed to take antibiotics or other medications to help prevent or treat infections that can lead to exacerbations.
New Surgical Procedures
Today there are three primary forms of surgery for COPD for which some patients may be eligible. The first is bullectomy, in which small, air-filled sacs called bullae are removed from the lung to ease airflow. Another is lung volume reduction surgery in which the most damaged part of the lung is removed to allow the healthier portion of the lung to work more efficiently. The last and most extreme surgery is lung transplant, which replaces the lung or lungs with a disease-free organ from a donor. All three have lots of potential complications and side effects and are aimed at improving quality of life.
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But surgeons at the Cleveland Clinic in Ohio are currently testing a new procedure called broncoscopic lung volume reduction in which “doctors insert special flexible scopes through the patient’s mouth to place metal coils into the damaged tissue of the patient’s lung. The coils return elasticity to the diseased tissue, allowing the lungs to work in a more normal way,” the hospital’s website reports. The procedure aims to help clear air that gets trapped in the lungs of many COPD patients, and in addition to coils, these less-invasive surgical procedures may also employ valves, plugs, thermal ablation (a type of scarring) and other means of getting the lungs to function more normally and release trapped air, a common problem in COPD.
BLVR procedures are not currently approved by the FDA, but they have been available in Europe since 2008 and are currently in trials at a few hospitals in the United States, so they may become a viable option soon.
Although the breakthrough that’s needed to cure COPD is likely still a long way off, researchers continue to seek ways to reverse the lung damage that leads to COPD. As their work continues, it’s not impossible to think that someday, COPD could become one of many other formerly incurable diseases that can be effectively eradicated from the body.
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What Research Advances May Offer New Treatments for COPD? originally appeared on usnews.com
