Treatment of COPD and advancements

COPD is Chronic Obstructive Pulmonary disease which occurs due to exposure to smoke (especially cigarette smoke) over a long period of time which causes swelling of airways and damage to the alveoli and thus difficulty in airflow and oxygenation. It is characterized by a persistent cough, gradual onset and progressive shortness of breath. Severe COPD can lead to respiratory failure and repeated hospitalisation leading to poor quality of life and even death. There is no cure for COPD, but various pharmacotherapeutic treatment options include inhaled and oral, bronchodilators and steroids. Often missed treatment option in management of COPD is Pulmonary Rehabilitation which is a holistic multi-disciplinary approach to COPD patients to improve their physical function and exercise capacity and thus reduce symptoms, minimize hospitalisations and improve overall well-being.

In Pulmonary Rehabilitation patients are given exercise training under supervision, education, nutritional, and psychological counselling. Other treatment options for some patients with severe COPD are Lung Volume Reduction Surgery (LVRS) and Bullectomy which involves removing damaged, hyperinflated and non-functioning portions of the lung and improve lung function by allowing the remaining healthy lung part to work better.

Patients with advanced COPD who keeps worsening despite of all above mentioned treatment options should be evaluated for possibility of Lung Transplant which involves replacing the COPD lungs with healthy lungs from an appropriate brain-dead donor. Lung transplantation requires meticulous patient selection and is a specialised procedure performed by team of experts at select centres. It is a costly treatment option and need long term immunosuppression treatment and closed follow up.

Latest Advancements in treatment of COPD include triple drug combinations which includes combination of Long acting beta agonists (LABA) and Long acting muscarinic antagonist (LAMA) and inhaled steroids  Ultra-long-acting bronchodilators, such as indacaterol and vilanterol and glycopyrinium and umediclinium , offer prolonged bronchodilation, allowing for once-daily dosing and  thus better convenience and improved compliance, These latest treatment options provide reduce worsening of COPD, and decrease hospitalisation and improve  overall quality of life.

Other newer pharmacotherapy options are long term Macrolides antibiotics and Phosphodiesterase-4 (PDE-4) inhibitors, such as roflumilast. Non-Invasive Ventilation (NIV) at home has also improved the management of acute worsening and chronic respiratory failure in COPD patients. Domiciliary NIV means providing ventilatory support through an interface like oronasal mask at home. This, reduce work of breathing, thus improves respiratory failure and reduce mortality.

Long Term Oxygen Therapy (LTOT) is the most important treatment of COPD patients who have developed respiratory failure and it aims to improve low blood oxygen level and improve exercise tolerance and quality of life and survival. LTOT can be given through stationary and portable oxygen concentrators, oxygen cylinders. Other emerging Treatments and Research in COPD is Stem Cell Therapy, a potential treatment for COPD which is under Phase 1/2 clinical trial. It involves repair and regeneration of lung tissue of COPD patients by stem cells, taken from either patient’s body or from a donor However, we have to wait for results of ongoing trials and further research before we know the effectiveness and long-term safety of stem cell therapy in COPD management.

Gene Therapy is in preclinical phase and being tested in field of COPD treatment research. It aims to modify and correct genetic defects in patients of COPD, by incorporating therapeutic genes into COPD patients and potentially reverse the COPD. ‍In conclusion, COPD treatment is rapidly emerging and various pharmacological treatment in form of newer drugs and their combinations and non-pharmacological treatments like pulmonary rehabilitation, LTOT, NIV, LVRS, lung transplantation when offered appropriately to selected COPD patients can improve their quality of life and survival.