The Future of COPD Research: Overcoming Current Barriers

This article was written by Michael W. Hess, MPH, RRT, RPFT.

After November, many people feel COPD Awareness Month is behind them. However, for the millions of people affected by COPD, awareness of this condition never goes away. Living with a chronic breathing problem can affect literally every moment of every day. That is why it is so important to not only make sure people with COPD have access to the best available therapies, but that medical research includes helping people breathe better at the top of the list.

I recently asked Dr. David Mannino, Chief Medical Officer and co-founder of the COPD Foundation, for his thoughts on COPD treatments available today and the future of clinical research. Dr. Mannino has experience in epidemiology (the study of how health conditions begin and spread) and continues to see patients at the University of Kentucky. His experience allows him to see COPD disease not only as a scientist, but also as a health care professional and researcher.

In his view, one of the biggest concerns about COPD management right now is the treatments themselves. "Current therapies for COPD have been approved almost exclusively on their ability to increase lung function," he told me. That is largely because the US Food and Drug Administration (FDA), the agency in charge of approving new medications, has historically focused on things like spirometry measurements to see how "effective" a new drug might be. Getting more air in and out of the lungs is clearly important, but Dr. Mannino adds, "it does not really address the symptoms that are important to patients, such as shortness of air, cough, and sputum (mucus) production."

That was something that really struck a chord with me. Before joining the Foundation, I was a respiratory therapist in a primary care clinic. I worked with people living with COPD to create the best therapy plan for their health and their goals. Very few of those goals said things like, "Please increase my forced expiratory volume in one second by 10%." Most people saw improving their quality of life as being able to do more things that were important to them. Some wanted to play with their kids or grandkids and not run out of breath as fast. Others wanted to have fewer embarrassing coughing fits in public. Many just wanted to get around more easily, or maybe even travel farther. Everyone really just wanted to feel closer to how they did before they had COPD.

Current research is starting to look more closely at those more practical outcomes. In 2018, the FDA agreed to allow researchers to use the St. George's Respiratory Questionnaire for COPD (SGRQ-C) as a "patient-reported outcome measure assessment tool." The SGRQ-C is a survey that asks about frequency of symptoms like how often someone coughs or wheezes. That means new studies can use changes in the SGRQ-C score to see if a new therapy is effective in those ways that often matter most to a person, not just their lung function numbers.

Dr. Mannino mentioned another current problem. Even looking at current COPD therapies through patient-relevant outcomes, they still have serious limits. “No current therapy is considered 'disease-modifying,' or able to change the actual course of disease progression,” he told me. That means that medications and procedures may ease symptoms or improve quality of life, but they cannot fix any of the damage done to the lungs. COPD has long been known as a disease that, in most cases, steadily gets worse throughout life. That makes the "holy grail" of COPD research (other than a full cure) a treatment that could stop that progress in its tracks, or even reverse it. Some experimental treatments, like stem cell therapies, show some promise. Unfortunately, they are all are in very early stages of research.

It is good to remember that these barriers and challenges also represent opportunities. Dr. Mannino is optimistic about the future of clinical innovations in COPD. He told me, "it is our hope that future therapies, will, in fact, change how COPD progresses in some people." We are already seeing research with new medications that may lower a person's risk of symptom flares (also called exacerbations). These flares are a leading cause of COPD progression. They also have a big impact on the quality of life, so having them less often is a very positive step. Organizations, researchers, and advocates throughout health care can all work together to find ways to fight COPD and its burdens until the day comes that brings a cure!

This blog post was supported by Sanofi and Regeneron.