Chronic Obstructive Pulmonary Disease (COPD) is characterized by a persistent airflow limitation that is progressive and interferes with normal breathing. It is one of the leading, yet under-recognized causes of morbidity and mortality worldwide. Worldwide, more than 300 million people are estimated to have COPD with more than 19 million adults in the US. The US annual healthcare burden with COPD is estimated at $50 billion per year.
COPD is an umbrella term used to describe a group of diseases, such as small airway disease (chronic bronchitis) and emphysema, characterized by chronic and incompletely reversible airway obstruction that interferes with normal breathing.
Airway obstruction (narrowing of the airways) can result from any combination of four basic mechanisms:
- Smooth muscle contraction leading to bronchoconstriction causes a narrowing of the airway
- Excess mucous production leading to blockage of the airway opening
- Thickening of the airway wall, which may be the result of a combination of inflammation or hypertrophy of the smooth muscle or mucous glands.
- Alteration of structures around the airway, such as emphysematous destruction of the lung tissue itself, can lead to a loss of radial traction on the airway wall with subsequent airway narrowing.
These four basic mechanisms combine to produce widespread and variable airflow obstruction that makes it difficult for patients to breathe and produces symptoms of shortness of breath (dyspnea), wheezing, chest tightness, and a productive cough.
Doctors use a combination of assessments that evaluate a patient’s airflow obstruction and symptoms (breathlessness, persistent cough, mucus production etc.) to guide treatment selection. A group of the world’s leading COPD experts form an advocacy group called The Global Initiative for Chronic Obstructive Lung Disease (GOLD). They have published guidelines for assessment of disease severity and appropriate treatment sometimes called the GOLD COPD stages. One GOLD assessment test categorizes patients based on the extent of airflow limitation using spirometry (breath) testing (GOLD grade 1-4). Another categorizes patients based on their symptoms and risk of exacerbation (GOLD group A-D). Recommendations for treatment are based on the GOLD group A-D score.
Pharmacological treatment is the approach for most patients. For example, treatment guidelines for GOLD group A patients, also called GOLD A patients, is the administration of an inhaled bronchodilator (short or long acting) once or twice daily to relax and temporarily open airways. Other forms of treatment include: pulmonary rehabilitation, oxygen administration and surgical intervention.
The AIRFLOW-2 Clinical Trial is investigating a minimally invasive device to treat COPD. This one-time bronchoscopic treatment, called Targeted Lung Denervation or TLD, has the potential to provide lasting whole lung improvement for COPD patients by opening obstructed airways to make breathing easier. TLD is only available under clinical investigation.
For more information about COPD, the following websites may be useful:
Global Initiative for Chronic Obstructive Lung Disease (GOLD)
European Respiratory Society (ERS)
European Lung Foundation
American Lung Association
National Heart Lung and Blood Institute
For current COPD treatment options, please consult a healthcare professional.