Dr Nicola Hanania Examines COPD Clinical Uncertainties

Major issues still surround the clinical treatment of chronic obstructive pulmonary disease (COPD), chief of which is the benefit of combination long-acting muscarinic antagonist (LAMA)/long-acting beta-agonist (LABA) bronchodilator treatment, highlighted Nicola Hanania, MD, MS, pulmonary critical care physician and director, Airway Clinical Research Center, Baylor College of Medicine, Houston, Texas.

Transcript

What are the top clinical uncertainties that surround COPD?

I think there are several uncertainties in the COPD world that we need to still answer. One of the hot areas is the effects of these drugs [LAMAs and LABAs] on the natural history of the disease, meaning declining lung function over time but also mortality, because as you know, COPD now is the fourth most common cause of death in the United States. And there are only few avenues that reduce mortality.

And so there are emerging data suggesting that inhaled corticosteroid added to LABAs/LAMAs, which [are] triple inhalers, may have an effect on mortality. But none of these drugs have a label for that. So that’s one.

The second is if the LABA/LAMA work on improving symptoms, like I’m going to be debating [Hanania debated the pro stance for combination bronchodilator therapy at this year’s CHEST meeting], will the LABA/LAMA effect decline lung function over time, which occurs in COPD, and that’s a major issue. We don’t know the answer to this.

And of course, we are still looking at more intervention. COPD, for example, can we target certain subtypes of COPD, like COPD with eosinophilia? This is a small group but a very important one. These patients have a higher risk of exacerbation; they tend to respond better to inhaled steroids. Would they respond to biologics that we have for asthma?

So far that the studies have not been very promising. There are ongoing studies right now. And I think that’s an unmet need that we need to explore more