Advances in the Understanding and Management of Chronic Obstructive Pulmonary Disease

Robert Burkes, MD, MSCR

Christina MacRosty, DO

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. While the main causes of COPD and clinical outcomes of concern have been well-described,[1] a deeper understanding of mechanisms of disease, innovational therapeutic paradigms, and the addressing the interface of COPD with other comorbidities are areas of innovation in modern COPD care and research. The guest editors of this dedicated issue on COPD aim to provide you with updated information on diagnosis and treatment of COPD and illustrate other important considerations in COPD care. We appreciate your readership and hope you learn as much from this issue as we did.

Novel approaches to COPD treatment have been emerging rapidly. Among these are the identification of COPD endotypes, which may provide insight into the future of therapeutics and targeted medicine in this chronic disease.[2] Further, understanding how COPD is influenced by other comorbidities remains a necessary endeavor to ensure quality, all-encompassing care for patients.[3] In the office setting, the approach to COPD is changing rapidly and we are pleased to cover topics related to these changes in this issue.

Beyond inhaled therapies, pulmonary rehabilitation, long-term oxygen therapy, and other medical therapies for COPD are minimally invasive procedures to treat the physiological effects of COPD such as hyperinflation and ventilation–perfusion mismatch due to emphysema in those patients who have persistent symptoms despite optimal pharmacological and physiological therapies. Bronchoscopic lung volume reduction (BLVR) with endobronchial valves is one such therapy and is recommended in the Global Initiative for Chronic Obstructive Lung Disease Report 2024 as it can improve exercise tolerance, health status, and lung function.[1] BLVR is not indicated for every patient with COPD and has somewhat narrow inclusion criteria based on pulmonary function testing, cardiac function, functional status, and others. There is early evidence that BLVR may lengthen survival; however, more research is needed to definitively assess the mortality benefit from this approach.[4]

For those with advanced COPD, lung transplant may be an option. While improving the quality of life for patients who can undergo the surgery, lung transplant is a complicated process limited by donor organ availability, patient- and hospital-associated resources, and limitations based on patients' level of fitness to undergo the surgery.

Other nonpharmacological interventions for COPD are on the horizon to help fill the gaps for patients who are not candidates for BLVR, lung transplant, or a combination of the two well-studied interventions. These include therapies targeting chronic bronchitis such as bronchial rheoplasty and cryospray to reduce COPD exacerbations such as targeted lung denervation. Other interventions are aimed to treat symptoms of dyspnea and include sealants, thermal ablation, and coils. These therapies are under investigation.

Publication History

Article published online:
12 November 2024

• References

• 1 Venkatesan P. GOLD COPD report: 2024 update. Lancet Respir Med 2024; 12 (01) 15-16
• 2 Burkes RM, Panos RJ, Borchers MT. How might endotyping guide chronic obstructive pulmonary disease treatment? Current understanding, knowledge gaps and future research needs. Curr Opin Pulm Med 2021; 27 (02) 120-124
• 3 Putcha N, Drummond MB, Wise RA, Hansel NN. Comorbidities and chronic obstructive pulmonary disease: prevalence, influence on outcomes, and management. Semin Respir Crit Care Med 2015; 36 (04) 575-591
• 4 Hartman JE, Welling JBA, Klooster K, Carpaij OA, Augustijn SWS, Slebos DJ. Survival in COPD patients treated with bronchoscopic lung volume reduction. Respir Med 2022; 196: 106825