The Future of COPD Research: Overcoming Current Barriers

Posted on January 08, 2024   |   

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.


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  • Thanks so much for this inspiring and informative post. Dave and you (Dr. Mannino), are doing such great work!
  • Thanks Mike and Dr Dave and everyone who works to help us have a better quality of life
    -----Dave S
  • Wouldn't increased numbers ease your exacerbations or severity of symptoms? I believe the location of any lung damage has a great deal to do with performance as in my case, and also believe stem cell treatment would be the only path to a possible "cure". As with any disease I believe it will progress as quick or slow as it progresses as we are all individual.
    • Increased lung function or "better numbers", do not necessarily equate to fewer exacerbations or symptoms, or to improved quality of life. Shortness of breath, for instance, has many causes, that may not relate at all to your lung function. We have to look beyond numbers and the holy grail of a cure, and think more about the COPD patient holistically.
      Medications are only part of the picture. Activity, mental health, diet and avoiding infections play a huge role as well.

  • Well said, Phyllis! I just wanted to add that ecause the progression of the disease is usually pretty slow, almost glacial in speed, many of us don't even realize we have a problem until it's relatively severe. Drops in numbers can be worrisome. However, it;s really important to remember that the numbers don't define you: what you can do and the comfort and grace with which you can do it are very important!
  • Well Stated Mike. The more we talk about it, the more attention it will get.
  • Thank you for this article, it says a lot.
    The COPD disease is as it progresses is very depressing. No one seems to catch this except the patients.
    Even just a little light in the tunnel is helpful. The fact that the FDA maybe approving a new drug that's a game changer next month is exciting and gives us HOPE. I have been counting the days for this.
    "Ensifentrine, if approved, is expected to be the first novel mechanism available for the maintenance treatment of COPD in more than 10 years,” David Zaccardelli, the CEO of Verona Pharma, said in an email to COPD News Today. “We believe it has potential to change the treatment paradigm for COPD patients as demonstrated by the analyses of our Phase 3 ENHANCE data recently presented at CHEST 2023.”
    Another game changer is a treatment of removing 100 good lung cells from a patient and growing millions more from those and placing them back into the patient's lungs. a group of research in China has done this successfully. I am no Dr., but I don't think this is stem cell research. I was also told by a prominent Dr that research is not done for cures because there more money in drugs to treat diseases. So, there's no serious research money available. Perhaps that's why stem cell research is so slow? Seems a that we need a lobbyist

    • Thank you for reading!

      I've come across a couple of articles and research papers that seem to be discussing the Chinese study that you mentioned. It does indeed seem to be using stem cells and, as discussed in the article, is at an extremely early phase of study. A group of 20 patients did see some improvement over the course of 24 weeks, which is promising. What remains to be seen is if there are certain people the treatment works differently in and how long the effects last.

      I would respectfully disagree with the doctor you mentioned about research funding, though. That perception is something the healthcare system has had to struggle against for a very long time. From what I have seen, the issue is more that policymakers have, for some reason, not been convinced that your lungs are as important as your heart or your brain. However, thanks to some great advocates (including a lobbying team), that seems to be changing! Stay tuned...