For COPD Awareness Month, a top pulmonologist clears the air about chronic obstructive pulmonary disease as he shares new and emerging treatment options.
November is Chronic Obstructive Pulmonary Disease (COPD) Awareness Month—a chance to educate the public on this serious lung disease that affects 16.4 million adults in the U.S., according to the American Lung Association (ALA), and to provide resources for those diagnosed with the disease to help them live fuller, more active lives. Awareness is clearly needed: Despite being largely a preventable disease, rates of COPD are expected to grow 23% in the next 25 years, according to projections in a 2023 study in the Journal of the American Medical Association. Today, the ALA estimates that more than 300 million people worldwide could be living with COPD.
The good news? There are more effective therapies available for COPD today than even just a decade ago, offering hope for higher quality of life and breathing function for people living with this condition. To provide insight on the current COPD landscape—and share some promising developments that may be coming just around the corner—we spoke with Jordan Lee, M.D., a pulmonary critical care specialist at Queen’s Pulmonary and Critical Care Group in Honolulu, HI, and panelist for the ALA’s upcoming webinar on COPD management.
HealthCentral: How have COPD treatment options improved during the past 10 years?
Jordan Lee, M.D.: When I was first going through medical training in 2014, we would always treat COPD patients with just one or two inhalers: a long-acting muscarinic agent to relax airway muscles, as well as a long-acting beta agonist, like a bronchodilator, which also relaxes tightened muscles. Those are still very helpful but in general, we have a better understanding now when it comes to the pathophysiology of COPD and how it’s affected by chronic airway
Because of that, there’s been a shift toward triple therapy for COPD, which includes those two options, as well as inhaled corticosteroids. That’s become the gold standard because it’s hitting three different pathways in the respiratory system, leading to better breathing. This [approach] reduces symptoms and lowers the rate of COPD exacerbations in a year.
HC: What makes you most hopeful about emerging and experimental COPD therapies?
Dr. Lee: What’s fascinating right now is the use of biologic therapy, which are injectable medicines that can dampen the inflammatory process in the lungs. For example, Dupixent [dupilumab] was just approved by the FDA last year, and it’s already an exciting option, particularly for patients who have both asthma and COPD, or who have moderate-to-severe COPD alone. Biologics, in general, are showing good response rates, especially for those who don’t respond to triple therapy, so I expect this to be an area that expands with more usage and more data.
Another option that’s likely to be promising for the future is a procedure called an endobronchial valve, which is minimally invasive and addresses issues in the upper regions of the lungs. In the past, surgery would have required a more extensive, open-chest procedure—a lung volume reduction—in which damaged parts of the lungs are removed so the healthier parts can expand, and blood flow can be redistributed to those areas. While that’s still an option for some patients, use of the valve can have the same effect without being a major operation that requires much more recovery time.
HC: Is COPD reversible if you begin treatment in its earliest stages?
Dr. Lee: For the most part, those with COPD have had years of exposure to some type of damaging substance, usually cigarette smoke, which is the majority of COPD cases. But there can also be secondhand smoke or environmental toxins. Unfortunately, these patients have long-term damage that’s not reversible, although the symptoms can be managed. Unlike the liver, which has a degree of regenerative capacity, the lungs are not as resilient. Once they’re damaged, you’re kind of stuck. However, it’s true that beginning treatment as early as possible can have some effect, especially if it involves smoking cessation, so you’re not continuing to damage lung tissue.
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