The Latest Thinking on COPD Management

November is Chronic Obstructive Pulmonary Disease (COPD) Awareness Month—a chance to educate the public on this serious lung disease that affects 16.4 million adults in the U.S., according to the American Lung Association (ALA), and to provide resources for those diagnosed with the disease to help them live fuller, more active lives. Awareness is clearly needed: Despite being largely a preventable disease, rates of COPD are expected to grow 23% in the next 25 years, according to projections in a 2023 study in the Journal of the American Medical Association. Today, the ALA estimates that more than 300 million people worldwide could be living with COPD.

The good news? There are more effective therapies available for COPD today than even just a decade ago, offering hope for higher quality of life and breathing function for people living with this condition. To provide insight on the current COPD landscape—and share some promising developments that may be coming just around the corner—we spoke with Jordan Lee, M.D., a pulmonary critical care specialist at Queen’s Pulmonary and Critical Care Group in Honolulu, HI, and panelist for the ALA’s upcoming webinar on COPD management.

HealthCentral: How have COPD treatment options improved during the past 10 years?

Jordan Lee, M.D.: When I was first going through medical training in 2014, we would always treat COPD patients with just one or two inhalers: a long-acting muscarinic agent to relax airway muscles, as well as a long-acting beta agonist, like a bronchodilator, which also relaxes tightened muscles. Those are still very helpful but in general, we have a better understanding now when it comes to the pathophysiology of COPD and how it’s affected by chronic airway inflammation.

Because of that, there’s been a shift toward triple therapy for COPD, which includes those two options, as well as inhaled corticosteroids. That’s become the gold standard because it’s hitting three different pathways in the respiratory system, leading to better breathing. This [approach] reduces symptoms and lowers the rate of COPD exacerbations in a year.

HC: What makes you most hopeful about emerging and experimental COPD therapies?

Dr. Lee: What’s fascinating right now is the use of biologic therapy, which are injectable medicines that can dampen the inflammatory process in the lungs. For example, Dupixent [dupilumab] was just approved by the FDA last year, and it’s already an exciting option, particularly for patients who have both asthma and COPD, or who have moderate-to-severe COPD alone. Biologics, in general, are showing good response rates, especially for those who don’t respond to triple therapy, so I expect this to be an area that expands with more usage and more data.

Another option that’s likely to be promising for the future is a procedure called an endobronchial valve, which is minimally invasive and addresses issues in the upper regions of the lungs. In the past, surgery would have required a more extensive, open-chest procedure—a lung volume reduction—in which damaged parts of the lungs are removed so the healthier parts can expand, and blood flow can be redistributed to those areas. While that’s still an option for some patients, use of the valve can have the same effect without being a major operation that requires much more recovery time.

HC: Is COPD reversible if you begin treatment in its earliest stages?

Dr. Lee: For the most part, those with COPD have had years of exposure to some type of damaging substance, usually cigarette smoke, which is the majority of COPD cases. But there can also be secondhand smoke or environmental toxins. Unfortunately, these patients have long-term damage that’s not reversible, although the symptoms can be managed. Unlike the liver, which has a degree of regenerative capacity, the lungs are not as resilient. Once they’re damaged, you’re kind of stuck. However, it’s true that beginning treatment as early as possible can have some effect, especially if it involves smoking cessation, so you’re not continuing to damage lung tissue.

HC: Is treating smoking-induced COPD different from treating never-smokers with the condition?

Dr. Lee: There is a slightly different approach to diagnosis, because for those who’ve never smoked, you would look deeper into why they might have developed COPD. For example, there may be a genetic connection, or it might be their workplace that’s problematic. In terms of treatment, however, they would be treated similarly, in a way that improves lung function as much as possible.

HC: How do you advise someone with concerns about COPD who currently has no symptoms?

Dr. Lee: Particularly for those who have smoked in the past, and who are over 50, a lung cancer screening can be very helpful for detecting COPD, as well as lung cancer. This is done with low-dose CT imaging, and it can pick up both of those conditions at early stages, when they’re much more treatable. The U.S. Preventive Services Task Force recommends annual lung cancer screenings if you’re between 50 and 80 years old, have a ‘20 pack-year’ smoking history [which means smoking one pack of cigarettes per day for 20 years], if you currently smoke, or if you’ve quit within the past 15 years.

HC: How can people with COPD improve their quality of life? Can you slow its progression?

Dr. Lee: Obviously, smoking cessation is the number-one strategy, but there are many other ways to slow the progression of the disease. For example, pulmonary rehab is outstanding for people with moderate-to-severe COPD, since that focuses on retraining patients to perform more energy-efficient movements in a way that preserves lung function. That type of rehab also helps teach breathing techniques, and it has a ripple effect of reducing exacerbations, improving quality of life, and lowering risk of hospitalization from COPD-related causes.

Beyond that, focusing on supporting your health is key. Getting recommended vaccines, eating a healthy diet, getting regular exercise, avoiding secondhand smoke, reducing stress, taking your medications as directed, and even washing your hands more often all make a difference. That’s because any illness that involves the respiratory system, even just a cold, can reduce lung capacity and cause damage. That sets you back, and since we all naturally experience some reduced lung function as we age, experiencing respiratory illnesses with COPD as you’re getting older can worsen the condition.

HC: How far are we from a COPD cure?

Dr. Lee: It would be nice if it were only a couple years away, but we do have a long way to go until there’s a cure beyond getting a lung transplant—which is currently the only way to ‘cure’ the condition. I’d say maybe in the next 50 years, we might see some major development that eliminates COPD, and hopefully it won’t take that long.

I think the new wave of biologic therapy for COPD is the start of a possible revolution in treatment. And, there are other research efforts going on right now, most notably with stem cells. Hopefully, there will be an option that not only modifies the immune response and prevents further damage, but also reverses the damage that’s been done. Of course, that would be very exciting.

For more insights on COPD and its management, Dr. Lee is hosting a free American Lung Association webinar as part of the ALA’s "Learning to Live with COPD" campaign on Wednesday, November 20th at 3:00 p.m. EST. If you’d like to attend, sign up here.