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
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