COPD Research: Is the Glass Half Empty or Half Full?

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     It is all too easy to be pessimistic about the progress we are making in finding new drugs for COPD.  Our mainstays of treatment continue to be bronchodilators of two classes: beta agonists(*) and anticholinergic(**).  True, the newer preparations have longer durations of action than previous versions, but drugs of these classes have been with us for a long, long time.  Patients suffering with COPD certainly have the right to be most impatient with this apparent lack of progress.  But people like me, who have spent their professional lives working toward new COPD therapies, come in a close second in terms of impatience.

 

     So it is easy to view the glass as half empty.  Is there any reason to be more optimistic?  One that I see is that the pace of COPD research has been steadily rising for years.  When I first started working in this field some 25 years ago, even the American Lung Association had little interest in COPD.  There were no medications specifically designed for COPD and the pharmaceutical industry was paying scant attention to the needs of COPD patients.  Today the profile of COPD is much higher.  One only has to watch television for a while to hear advertisements for COPD drugs (for example, who can avoid that annoying Spriva violin?).

 

    What is in the pipeline?  My laboratory at the Los Angeles Biomedical Research Institute is by no means the busiest in the country, but we have a large number of studies underway –  mostly multicenter clinical research studies funded either by the National Institutes of Health (i.e., your tax dollars) or the pharmaceutical industry.  Here are some examples of ongoing research:

•  Can taking an antibiotic pill daily make it less likely that a COPD illness (“exacerbation”) will occur?  A study involving 1130 COPD patients that will answer this question is just finishing up.

• Statin drugs make it less likely that people with high cholesterol levels will have heart problems.  But it seems possible that all COPD patients (whether their cholesterol profile is normal or abnormal) may benefit – both in terms of lessening the probability of COPD exacerbation and in terms of lessened risk of heart problems.  A study to test this possibility, three years long and involving over 1100 COPD patients, is now underway.

• Oxygen therapy is a lifesaver for those COPD patients with very low oxygen levels.  A large-scale study is underway that is trying to determine whether those with moderately  low oxygen levels or those whose oxygen levels are only low with exercise will similarly gain long-term benefits.

• Why some smokers develop COPD and others don’t is a mystery.  It likely has something to do with the genetic makeup of the individual.  A study involving over 10,000 smokers, half who have COPD and half who do not have COPD, is underway.  It is hoped that identifying genes that predispose to COPD will lead to novel therapies.

• A mad dash is underway, with several large pharmaceutical firms trying to be the first to develop a once-daily combination bronchodilator.  It seems likely that we will see one or more of these reach the market in two or three years.

• Inflammation is a major component of COPD in most patients.  Calming down inflammation is likely to yield symptomatic benefits.  Inhaled steroids help to decrease inflammation, but are not ideal drugs for COPD.  The process underlying inflammation is very complex, with a large number of mediators involved.  Several pharmaceutical companies are funding multi-center studies that test anti-inflammatory molecules.  Potential difficulties with these studies are that 1) blocking a single pathway for inflammation may prove ineffective and 2) inflammation is an essential part of warding off infections; blocking inflammatory pathways may have adverse effects.

• In theory, at least, it may be possible to re-grow damaged parts of the lung.  The first class of drugs that may be able to accomplish this has been in clinical trials for about 10 years.  The largest trial, a two year long study, is near completion.

• Stem cells are being touted as having almost unlimited potential.  Stem cell therapies are being offered outside of the US, but the value of the therapy offered is suspect.  The first small clinical trial of stem cell therapy for COPD performed in the US is winding up in the next few months.

Yes, impatience is entirely understandable, but there is reason for at least a modest amount of optimism.  Here’s to the day that we see the glass full to the brim!