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Chronic Obstructive Pulmonary Disease (COPD) (cont.)

Future Directions in COPD

As opposed to bronchial asthma, which has been well researched in the last 20 years, COPD has not been fully investigated. There is significant evidence that COPD is an inflammatory process just as is bronchial asthma, however, it seems that there are different patterns of lung inflammation in these patients. The mechanisms of baseline inflammation in COPD and inflammation during exacerbation of the disease need to be investigated and better understood. There is minimal or no information on the molecular mechanisms of inflammation in stable COPD patients. This latter issue becomes important particularly in the area of treatments. Currently, there are numerous clinical trials looking to intervene at the various inflammatory pathways.

A newer class of medications that work to reduce this inflammation is being developed. They are referred to as PDE4 inhibitors. Drugs under clinical development include rolipram, piclamilast, cilomilast, and Roflumilast. These inhibitors reduce the number and the activity of the different types of inflammatory cells and inflammatory substances seen in COPD.

The concept of attempting to reduce hyperinflation is intriguing. Less invasive procedures than LVRS are being developed to reduce this air trapping. Investigational devices such as Spiration and Emphasys are being studied that are valve-like and are placed directly in the airways by bronchoscope. The effectiveness of these devices is unknown.

Another area of interest is the genetic mechanisms of why only a fraction of smokers develop emphysema. A third area of research interest is the role of nerve receptors in the lungs, which is currently the focus of final clinical trials. Finally, methods for early detection of COPD need to be refined.

Chronic Obstructive Pulmonary Disease At A Glance

  • Chronic obstructive pulmonary disease (COPD) is characterized by chronic obstruction of airflow out of the lungs.

  • COPD is comprised primarily of two related diseases - chronic bronchitis and emphysema.

  • In chronic bronchitis there is inflammation and swelling of the lining of the airways that leads to their narrowing and obstruction.

  • In emphysema there is permanent enlargement of the alveoli due to the destruction of the walls between alveoli.

  • COPD causes poor gas exchange in the lungs leading to decreased oxygen levels in the blood, increased carbon dioxide levels, and shortness of breath.

  • The major cause of COPD is smoking. Other less common causes include air pollution, repeated lung damage from infections, and inherited disease (alpha-1 antitrypsin deficiency).

  • Treatment consists of cessation of smoking, medications to open the airways and decrease inflammation, prevention of lung infections, oxygen supplementation, and pulmonary rehabilitation.

Previous Medical Author Contributor: Zab Mohsenifar, MD


Last Editorial Review: 12/18/2009


Chronic Obstructive Pulmonary Disease - Symptoms At Onset Of Disease

The MedicineNet physician editors ask:

The symptoms of chronic obstructive pulmonary disease can vary greatly from patient to patient. What were your symptoms at the onset of your disease?

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