In a previous post, Professor Peter Barnes and I discussed the role of cell senescence and cell ageing and how this affects the lungs in patients with Chronic Obstructive Pulmonary Disease (COPD). In this post, we will dive more deeply into the key topics of disease progression and the importance of early intervention as they relate to COPD treatment today as well as research into new treatment options for patients.
Deterioration of lung function is progressive in COPD, and early diagnosis and intervention therefore play a central role for physicians and their patients. This is true with today’s treatment standards but could be even more imperative with potential disease modifying treatments in the future.
Despite being a common diagnosis – in fact, 1 in 10 people over 30 globally will be diagnosed with COPD – the early signs and symptoms of COPD remain poorly recognised by patients and healthcare professionals alike.
COPD often progresses undiagnosed until symptoms are more severe and the disease is harder to treat, with patients experiencing significantly impaired lung function and an increased rate of exacerbations. COPD exacerbations can have a life-changing impact. Broadly speaking, COPD exacerbations are under-recognised, under-reported and under-treated, with one study showing that more than 40% of COPD patients take no immediate action when having an exacerbation.
Given the high prevalence of COPD, and that it can impact quality of life and inflict social and financial burden on patients, caregivers and healthcare systems, why is timely diagnosis and intervention such a challenge? Peter, what is your view?
Peter: “COPD is very heterogeneous, both in terms of symptoms and more importantly its causes. We don’t fully understand what drives the disease. It is therefore fundamental that research is driven forward, so that we may improve our understanding of the disease processes to enable discovery of effective new treatments. It is important that treatment should be tailored to the individual patient and that we acknowledge that COPD is not a singular entity.
More specific biomarkers are also needed to allow us to recognise different phenotypes of COPD, such as pathological changes caused by bacterial versus viral inflammation, which can help to predict which patients may better respond to a certain type of treatment.”
Maria: “I agree. And with no current therapy options tackling the underlying disease processes, we should be aiming to develop drugs which act on specific pathways and are also ultimately able to modify and reverse the decline in lung function in COPD patients. But early diagnosis and intervention are just as important today, right?”
Peter: “Yes. Today, several different types of treatments are available for COPD. The mainstay is long-acting bronchodilators and, for more severe cases, also anti-inflammatory treatments which act similarly in their biological effects with the goal of controlling the exacerbations. Currently for uncontrolled patients, particularly those who continue to experience exacerbations, escalation to triple therapy with an inhaled steroid in addition to dual bronchodilators may be recommended.
Essentially, treatment will be more effective if administered early on and it is important to intervene before irreversible structural changes take place.
Diagnosis of COPD is currently based on abnormal spirometry measurements, which do not detect early disease, where small airways are already affected. Ultimately, the diagnosis of COPD needs to be redefined and not based on abnormal spirometry to ensure patients are identified earlier and treated in a timely manner. More research is needed into exploratory endpoints to accurately determine factors which are detectible in early disease and progress over time. AstraZeneca is currently investing significantly in this area and working with collaborators that run patient cohort studies to explore biomarkers further.”
It is also important to understand the place of comorbidities in COPD. As many as 95 percent of COPD patients present with at least two comorbidities and by understanding shared biological pathways, it can help us to elucidate the common disease mechanisms. Each patient must be treated beyond their compartmentalised disease states with the potential to avoid development of a number of comorbidities by early interventions and also to reduce the number of medicines a patient will need to take overall.”
Maria: “This is hugely important, and part of why I’m so proud of the work we’re doing at AstraZeneca around pre-clinical and clinical research into the development of novel drugs aiming to treat COPD pathological mechanisms and improve patient outcomes. We closely collaborate with an extensive global network of scientific and clinical experts to drive this forward. As well as investigating disease modifying treatments, we ultimately would like to be able to offer treatment that can halt disease progression and reverse damage already done.”
AstraZeneca is currently recruiting. To help make a real-life difference for COPD patients around the world, visit our Careers site for open roles.
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019. [Online]. Available at: http://goldcopd.org. [Last accessed: August 2019].
Adeloye D, Chua S, Lee C, et al. Global Health Epidemiology Reference Group (GHERG). Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health. 2015; 5 (2): 020415.
Roche N, Wedzicha JA, Patalano F, et al. COPD exacerbations significantly impact quality of life as measured by SGRQ-C total score: results from the FLAME study. Eur Resp J. 2017; 50 (Suppl 61): OA1487
Ho TW, Tsai YJ, Ruan SY, et al. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12): e114866.
Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012; 67 (11): 957-63.