09:49pm Monday 30 March 2020

Major international study involving UNMC challenges widely accepted views on COPD, could change treatment focus

The study in the Sept. 26 online issue of the New England Journal of Medicine may provide hope to some patients and prompt health professionals and drug developers to reevaluate treatment of the disease. Since 1970 study, it’s been commonly accepted that COPD gets worse.

COPD refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema, chronic bronchitis, and in some cases asthma.

“This is the first study to show definitively that COPD does not always get worse,” said Stephen Rennard, M.D., senior author of the paper and professor of pulmonary and critical care medicine in the UNMC Department of Internal Medicine. “The medical community has suspected this and a few studies have alluded to it, but this study establishes that the disease can be stable, at least over a three-year time frame and may even improve some.

“This will change the way we think about the disease and is a cause for cautious optimism. The key message is that it’s not hopelessly progressive in everyone,” he said.

The three-year observational study looked at 2,163 patients age 40 to 75, many of whom were taking a variety of treatments. Researchers from eight different clinical sites around the world were involved in the study.

Dr. Rennard said whether specific treatments can stabilize lung function or improve it will need to be studied.

Cigarette smoking is the most common cause of COPD. Half of those who smoke are likely to get COPD. Breathing in other kinds of irritants, like pollution, dust or chemicals, may also cause or contribute to the disease.

Another key finding of the study revealed that patients with moderately severe COPD on average lose lung function more quickly than those with severe COPD. Moderate COPD is considered to be 50 to 80 percent lung function and severe COPD, 50 percent.

“Drug development to slow the disease has been aimed primarily at those with severe disease when those with moderate disease are losing lung function faster,” Dr. Rennard said. “I think we’ve frequently ignored those with moderate COPD and not treated this stage of the disease aggressively. That may be a mistake.”

Dr. Rennard said study findings could change the focus of treatment for COPD. He said the study suggests identifying those with COPD earlier. There are treatments that have very modest effects on disease progression. Whether they should be implemented earlier in the course of disease is now a key question.”

COPD kills more than 120,000 Americans each year and causes serious, long-term disability. More than 12 million people are diagnosed with COPD and an additional 12 million likely have the disease and don’t even know it. Symptoms of COPD include shortness of breath, especially with exercise, cough and production of phlegm.

Other authors of the study were from the Mayo Clinic, Denmark, the United Kingdom, Spain, Norway, Canada, and the Netherlands.

The study was supported by grants from GlaxoSmithKline. Dr. Rennard and some of the authors of the study receive grants, fees, and expenses from the GlaxoSmithKline, including in roles as consultants, speakers, and board members.

To see a one-minute story featuring Dr. Rennard and a COPD patient, log on to:
http://youtu.be/Su358ur9oTE Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.

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