A Look at What is New in COPD Research and Innovation

This post was authored by: Amanda Atkinson, MSN, RN, and David Mannino, MD.

The science of medicine is always evolving. In the past, innovation has pushed us forward, resulting in treatments and even cures for diseases that once held a not-so-positive outcome. Today we will be exploring a few treatment innovations on the horizon for those living with COPD. Dr. David Mannino discusses the positives, as well as the potential cautions associated with these innovations.

Q: Can you discuss some of the promising innovations that are on the horizon for COPD treatment and research?

A: Most current treatment innovations for COPD focus on advanced disease. There is currently a procedure under investigation called bronchial rheoplasty. This procedure uses electrical energy, delivered via bronchoscope, to kill mucus-producing cells, in hopes that when the lung cells regenerate there will be fewer of these cells, and less mucous. A similar innovation that is also under investigation is called targeted lung denervation. This procedure interrupts the nerve reflexes that constrict the air tubes, with the intent of inducing a type of permanent bronchodilation.

One intervention that is now approved for use in advanced COPD is lung volume reduction using valves or coils (the use of valves has been widely approved, coil approval varies by country). Valve and coil procedures are done bronchoscopically, or with a tube inserted down the airways, rather than surgically like traditional lung volume reduction. These procedures attempt to reduce emphysematous parts of the lung so that more normal parts of the lungs can expand.

Work is also being done to look at the use of non-invasive ventilation in patients with high levels of carbon dioxide. These and related techniques aim to help improve ventilation of the lungs.

Regarding new innovations in research, a lot of work is being done surrounding early disease. This includes defining disease using different tools with the hope of finding COPD at an earlier stage when interventions may be more likely to change the development and progression of the disease. There is also work being done surrounding the development of disease markers that could assist in guiding the development of therapies.

Q: Are you seeing any effective treatments that may still be underutilized by health care providers as a whole?

A: In earlier stages of the disease, COPD is often not diagnosed. Because of this, people who might benefit from standard COPD therapies such as bronchodilators and steroids do not get them. Screening, testing, and early diagnosis are important steps towards making sure that individuals receive the proper treatment in a timely manner.

In more advanced COPD, pulmonary rehabilitation is an often-underutilized treatment. There are several reasons for this, including inadequate availability of rehabilitation centers, and poor reimbursement by insurance. Patient-related issues such as distance to the center, transportation, and other physical issues can also be a hindrance.

In severe COPD, interventions like lung volume reduction surgery have traditionally not been utilized as much as they should have been. Hopefully, with the new innovations in this area, more individuals will have access to this treatment option when appropriate.

Q: In 2021, studies were published that looked at Hyaluronan as a potential experimental treatment for COPD. Can you discuss the merits or potential benefits/harm to individuals with COPD?

A: Hyaluronan is a naturally occurring sugar that is present in the body and has anti-inflammatory properties. It has been investigated by several studies with hospitalized patients who are on ventilators. In these studies, hyaluronan was delivered via inhalation and was shown to decrease the time that people needed to be on a ventilator. Hyaluronan seems to thin secretions and has the potential to be used as an inhaled option in diseases that might benefit from better hydration of the airways, such as bronchiectasis or cystic fibrosis.

Q: There have been some suggestions that individuals with COPD may benefit from stem cell therapy. Can you speak to that as a potential treatment?

A: While the FDA has approved clinical trials for stem cell use in COPD, there is no information to date about their safety or efficacy (whether they work or not). Unfortunately, there are some clinics that are offering "stem cell therapies" that are neither approved nor covered by insurance. Due to the FDA approval for clinical trials of this therapy, it is important to note that if individuals are enrolling in a true “clinical trial” they should never be required to pay any of the costs of participating in the trial.

Q: What are your thoughts on the use of steroid bursts or prophylactic steroid use as part of a COPD treatment regimen?

A: Systemic steroids should only be used in the short-term treatment of exacerbations. If longer-term steroids are needed, every attempt should be made to transition the individual to inhaled steroids. If this is not possible, they should be maintained on as low a dose as possible, and if possible, only used every other day.

As you can see, there are many promising innovations on the horizon for individuals living with all stages of COPD. As medicine continues to advance, we look forward to many more to come. Treatment of chronic disease does not carry a one size fits all solution. You are a unique individual in all areas of your life, and your COPD symptoms and progression are no different. If you have any questions about new treatments or innovations, reach out to your health care team. There may just be an upcoming innovation that will be a great fit for you. Special thanks to Dr. Mannino for taking the time to share with us a few of the exciting innovations on the horizon.