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It is expected that a better understanding of the basic biological mechanisms of COPD will lead to many new directions for research. Some of these directions will include improved methods for early detection, new ways to identify the “susceptible” smoker, and better treatment options such as targeted drug therapy. A very promising approach is to identify markers of inflammation, possibly derived from sputum or exhaled breath, which may predict the usefulness of new management and prevention strategies for COPD. One of the characteristics of COPD is inflammation in the lung. We need to better understand what is involved with the development of inflammation. How do inflammatory responses differ among nonsmokers, ex-smokers, and smokers with and without COPD? What mechanisms are responsible for the persistence of the inflammatory response in COPD? How is inflammation different in the lungs of stable COPD patients vs. inflammation during flare-ups of the disease? There is also a pressing need to develop drugs that control symptoms and prevent the progression of COPD. Scientists at Lovelace Respiratory Research Institute (LRRI) have discovered that COPD sufferers who use inhaled corticosteroids may have an overall survival rate that is higher than those who do not. This encouraging news is the result of a retrospective clinical review (conducted jointly with Kaiser Permanente Georgia) of over 1100 COPD patients who were enrolled in health plans at Lovelace Health Systems and at Kaiser Permanente Georgia in the mid- to late 1990's. Study results were reported at the annual meeting of the American College of Chest Physicians in November of 2002 (Mapel, D.W., Roblin, D., Hurley, J.S., Davis, K.J., Schreiner, R., Roberts, M., and Frost, F.J., Chest, 122(4), 2002, p. 74S). Corticosteroids are potent anti-inflammatory agents that reduce airway hyper-responsiveness. According to Dr. Floyd Frost of LRRI's Center for Pharmacoeconomic and Outcomes Research, this latest study shows that the use of inhaled corticosteroids was "associated with longer survival in COPD patients, independent of patient demographics and other disease characteristics". This improved survival may be due to the role of inhaled corticosteroids in reducing the frequency and severity of inflammation in the lung. Thus the control of airway inflammation may be important in COPD even in the absence of asthma. Dr. Frost's team is also studying patients with a history of acute respiratory infections to determine if COPD can be identified and treated in its earliest stages before symptoms become severe. Because only 30% of smokers develop COPD it is crucial to understand which changes in the genetic make-up make people susceptible to developing COPD in response to smoking. What treatments are effective in suppressing inflammation in COPD? Better information gathering and statistical methods are needed to estimate the future costs of COPD around the world, so that countries can better anticipate the costs of providing health care to people with COPD. Primary prevention of COPD is another major objective. Strategies to prevent people from starting to smoke and better methods for smoking cessation require constant evaluation and improvement. Studies are needed to determine the best methods for educating both COPD patients and their doctors. The cost effectiveness of pulmonary rehabilitation programs has not been evaluated. The feasibility and health outcomes of rehabilitation programs that can be delivered outside the major teaching hospital setting must be assessed. These are some of the research areas that hold promise. They cover the basic disease process involved in COPD, new ways to detect COPD sooner, better handling of clinical information about COPD patients, and better treatment options for the future. |
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