4 things pulmonologists are excited about for the future of COPD care
MDlinx Oct 10, 2024
COPD treatment is evolving at a rapid clip, with promising advances in research, technology, and personalized medicine. MDLinx spoke to physicians working on the frontlines of COPD management to get their take on the future of care.
Alok Mohta, MD, MBBS, a board-certified physician with over 30 years of experience treating COPD; Raj Dasgupta, MD, a quadruple board-certified physician specializing in internal medicine, pulmonology, critical care, and sleep medicine; and Michael O. McKinney, MD, a board-certified physician and respiratory disease specialist, shared their insights on the most promising trends.
The results of recent trials will hopefully open a new era in the treatment of patients with COPD.
Breakthroughs in precision medicine
COPD treatment is moving beyond the "one-size-fits-all" approach, with precision medicine—a form of tailored treatment based on individual molecular and genetic profiles—considered the new kid on the block.
"Identifying different COPD phenotypes (like eosinophilic vs neutrophilic inflammation) means treatment can be more specific to the patient’s needs," Dr. Mohta explains. “This includes emerging therapies that focus on inflammation at a cellular level, such as biologics targeting specific cytokines."
“For example, dupilumab has shown impressive results in phase 3 trials for COPD patients with type 2 inflammation, specifically targeting eosinophilic inflammation. This type of tailored therapy could drastically reduce exacerbations in the right patients,” he adds.
Dupilumab has recently become the first biologic to receive FDA approval for COPD. It is now indicated as a maintenance therapy for adults with uncontrolled eosinophilic COPD, marking a major advancement in the field.
Dupixent approved in the US as the first-ever biologic medicine for patients with COPD [press release]. Sanofi. September 27, 2024.
Dr. Dasgupta is similarly excited about biologics and personalized medicine, noting, "Personalized medicine customizes therapies for each patient, and biologics are part of that."
New biologic therapies will offer patients with COPD new and more effective remedies for their disease.
A report from the International Journal of Molecular Sciences outlines new precision medicine drugs for COPD.
Bolger GB. Therapeutic targets and precision medicine in COPD: inflammation, ion channels, both, or neither? Int J Mol Sci. 2023;24(24):17363.
These drugs target inflammation and immune pathways beyond traditional treatments acting on β2-adrenergic, muscarinic, glucocorticosteroid, and phosphodiesterase 4 (PDE4) receptors.
Dupilumab, which blocks IL-4 and IL-13 receptors, has shown promise in patients with eosinophilia, which was pivitol in it becoming the first FDA-approved biologic for COPD. The drug is indicated as maintenance therapy for adults with uncontrolled COPD.
Other drugs in development include mepolizumab and benralizumab (IL-5 inhibitor), itepekimab (IL-33 inhibitor), astegolimab (Il1rl1/ST2 inhibitor), tozorakimab (blocks IL-33), ensifentrine (PDE3/PDE4 inhibitor), and CFTR potentiators such as ivacaftor and icenticaftor.
Biomarkers for early diagnosis and monitoring
Traditionally, COPD diagnosis has relied on symptoms and spirometry results. But molecular biomarkers are offering new ways to diagnose the disease earlier and monitor its progression more accurately. According to a 2024 review on COPD molecular mechanisms and biomarkers, biomarkers found in blood and sputum, and even imaging scans, are now being used to identify inflammation levels, lung tissue remodeling, and oxidative stress, providing a clearer picture of disease activity.
Li CL, Liu SF. Exploring molecular mechanisms and biomarkers in COPD: an overview of current advancements and perspectives. Int J Mol Sci. 2024;25(13):7347.
"Blood biomarkers, like eosinophil counts, can predict which patients will respond to therapies like corticosteroids. This allows us to avoid unnecessary treatments and focus on what will work for each patient,” Dr. Mohta explains.
Remote monitoring gets easier
The use of telemedicine, wearable devices, and digital health tools has skyrocketed, and their use in COPD management is no exception. Remote monitoring of COPD patients with wearable devices can track vital signs, symptoms, and treatment adherence, giving pulmonologists a way to intervene early if the disease worsens.
Dr. Dasgupta notes that AI should help doctors make better treatment decisions by whipfast analysis of patient data. “Certain wearable devices have the ability to monitor blood oxygen saturation and heart rate, which are important data points to measure in COPD patients, especially since heart disease is closely related to COPD,” he explains. “Hopefully, by monitoring these factors, it’s going to help the individual better manage their health, and also help healthcare providers monitor their patients closely and allow for timely responses to COPD symptoms."
Dr. McKinney also notes how AI is helping enhance COPD care.
Innovations like wearable devices and retina monitor-based AI are changing the paradigm for managing the illness.
“This technology enables monitoring of lung function and symptoms whenever possible so that a serious exacerbation is avoided by early management of the patient,” Dr. McKinney says. “Another innovation is that AI is being utilized to forecast flare-ups based on meteorological conditions and patient conditions, allowing for appropriate actions to be taken by patients and healthcare providers."
Exciting omics tech
Omics technologies, such as genomics, proteomics, and metabolomics, are providing a deeper understanding of the molecular pathways involved in COPD. These advanced tools can profile a patient's disease at the molecular level, identifying unique biomarkers that can lead to highly personalized treatments.
Li CL, Liu SF. Exploring molecular mechanisms and biomarkers in COPD: an overview of current advancements and perspectives. Int J Mol Sci. 2024;25(13):7347.
"Genomics is really transforming how we understand COPD,” says Dr. Mohta. “For example, genetic studies have shown that variants in certain genes are linked to increased disease susceptibility. This information could help us predict who’s most at risk and develop targeted interventions before COPD even develops.”
Dr. McKinney shares similar optimism: "In the next 5 to 10 years, the treatment of this disease will be increasingly individualized. Genetic profiling as well as therapies directed at biomarkers will make it possible to allocate the most optimal treatment regimens for each condition, thus increasing effectiveness and limiting side effects."
New and novel procedures
Another area with significant potential is regenerative medicine, specifically the use of stem cells to repair lung damage. While still in its early stages, regenerative treatments may offer new hope to patients by potentially reversing some of the lung damage caused by COPD.
"One of the treatments that I am very sure has what it takes to change the game in COPD treatment is the area of regenerative medicine. Stem cell therapy has the possibility of replacing any destroyed lung tissue, thereby increasing the chances of reversing the chronic effects of the disease," says Dr. McKinney. He also notes innovations in surgical techniques, such as lung volume reduction surgery, which may improve breathing for patients with severe COPD by reducing lung hyperinflation.
What this means for you
The future of COPD care is heading toward more personalized and targeted treatments, made possible by advances in biomarkers, genomics, and precision medicine. With new biologic therapies, improved monitoring technologies, and a better understanding of the disease at the molecular level, pulmonologists are more hopeful than ever about transforming the way COPD is managed.
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