This blog post was written by Dr. Byron Thomashow, COPD Foundation Chief Medical Officer.
The times are changing. All COPD is not the same and everyone with COPD should not be treated the same way. For over 50 years, we have known that some people with advanced COPD have increased survival when they use Oxygen. For over 20 years, we have known that there is an inherited form of COPD called alpha-1 antitrypsin deficiency that can be treated with intravenous therapy. Everyone with COPD should be tested for alpha-1.
For over 10 years, we have known that a subset of people with upper lobe predominate emphysema can benefit from a surgical procedure called Lung Volume Reduction Surgery where the worst areas of emphysema are removed. In carefully selected patients, this procedure can improve quality of life, exercise capacity, and even survival, the first therapy since Oxygen shown to improve survival in advanced COPD. We are now developing less invasive approaches using a flexible tube called a bronchoscope which allows placement of valves or coils to perform lung volume reduction. Several of these devices have already been approved in Europe and will be evaluated here by the FDA in coming years.
Over the last decade we he have learned that there are people with COPD who are “frequent exacerbators”, who have two or more “flares of disease” a year and that they behave differently than those with COPD who are not “frequent exacerbators.” We now have a number of excellent medications that can treat these “frequent exacerbators” and reduce the “flares of disease.” We are learning that even this group can be better defined. We now know that those with a chronic bronchitic form of COPD with chronic cough and sputum who have frequent exacerbations could benefit from a daily oral pill. And more recently we are learning that “frequent exacerbators” with an elevated number of eosinophils (allergy blood cells) might well benefit from specific therapy, and new therapies for this subtype are already being studied.
You should talk to your health care provider about what type of COPD you have, whether you have more emphysema or more chronic bronchitis, whether you are a “frequent exacerbator” or not, and if you are a “frequent exacerbator” what your eosinophil count is. All COPD is not the same. All COPD should not be treated the same. That is what “personalized medicine” is all about, and that is the future.