The unmet needs in COPD

Understanding the clinical need for patients with COPD and what we can do to modify both their disease and its impact are now a major focus of attention in healthcare systems across the world.

COPD is increasing across both the developed and the developing world.^1,2 So, why is this occurring? What are the unmet needs in COPD that are responsible for this increase?

What are the unmet needs?

Current anti-inflammatory medication used to treat COPD, such as inhaled corticosteroids, do not reduce the neutrophil mediated inflammation³ seen in COPD and this is the primary unmet need in COPD.

The pathogenesis of COPD is complex, and studies have demonstrated that airway inflammation plays an important role.^4,5 The inflammation seen in COPD is clearly different from that seen in asthma with a predominantly neutrophilic rather than eosinophilic bronchitis.^6,7 The lung is a primary target for neutrophil recruitment and activation⁸  and the neutrophil is a primary mediator of inflammation in COPD.

The other major unmet clinical needs are summarised below.

Unmet needs in COPD⁹
Adapted from Calverly PMA. Br J Pharmacol 2008;155:487-493. Available at http://www3.interscience.wiley.com/journal/121548564/home.

1. More effective diagnosis and disease prevention
2. Better symptom control
3. Prevention of exacerbations
4. Slowing and possible prevention of disease progression
5. Reduction of disease-related mortality
6. Identification and reduction of systemic disease secondary to COPD and co-morbidities

Expert opinion

References

1. Chapman KR, Mannino DM, Soriano JB, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J  2006;27:188–207.
2. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007;370:741–750.
3. Cox G. Glucocorticoid treatment inhibits apoptosis in human neutrophils. J Immunol 1995;154:4719–4725
4. Anthonisen NR, Connett JE & Muruay RP. Smoking and Lung Function of Lung Health Study Participants. Am J Respir Crit Care Med 2002;66:675-79.
5. Barnes NC, Qiu YS, Pavord ID, et al. Anti-inflammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease. Am J Respir Crit Care Med 2006;173:736–743.
6. Barnes PJ. Mechanisms in COPD: differences from asthma. Chest 2000;117(suppl 2);10S-14S.
7. Sutherland ER & Martin RJ. Airway inflammation in chronic obstructive pulmonary disease: comparisons with asthma. J Allergy Clin Immunol 2003;112:819–827
8. Saetta M. Airway inflammation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160:S17-20
9. Calverly PMA. COPD: What is the unmet need? Br J Pharmacol 2008;155:487-493.