{"id":200,"date":"2019-10-07T22:28:05","date_gmt":"2019-10-07T16:58:05","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=200"},"modified":"2019-10-07T22:28:05","modified_gmt":"2019-10-07T16:58:05","slug":"recent-advances-in-treatment-of-copd","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/recent-advances-in-treatment-of-copd\/","title":{"rendered":"Recent Advances in Treatment of COPD"},"content":{"rendered":"\n<ul><li>COPD is a\ncommon, preventable and treatable disease that is characterized by <strong>persistent\nrespiratory symptoms <\/strong>and <strong>airflow limitation <\/strong>that is due to airway\nand\/or alveolar abnormalities usually caused by <strong>significant exposure to\nnoxious particles or gases.<\/strong><\/li><li>Terms emphysema\nand chronic bronchitis are <strong>no more included<\/strong> in the definition.<\/li><\/ul>\n\n\n\n<ul><li>Global\nPrevalence: <strong>11.7%<\/strong><\/li><li>Deaths \u2013 3\nmillion annually. Expected to rise to 4.5 million by 2030.<\/li><li>Second\nlargest non-communicable cause of death in India<\/li><li>The fourth\nleading cause of years of life lost in Empowered Action Group (EAG) <\/li><li><strong>DALYs due to COPD increased 36.3% from 1990 to\n2016<\/strong> and it became the <strong>second leading cause of DALYs in India<\/strong><strong><\/strong><\/li><\/ul>\n\n\n\n<p><strong>Pathophysiology<\/strong><\/p>\n\n\n\n<ul><li>inflammation\nof the respiratory tract with a pattern that differs from that of asthma.<\/li><li>&nbsp;In COPD, there is a <strong><em>predominance of neutrophils, macrophages, cytotoxic T lymphocytes\n(Tc1 cells), and T helper-17 (Th17) cells<\/em><\/strong>. <\/li><li>The\ninflammation <strong><em>predominantly affects\nsmall airways<\/em><\/strong>, resulting in <strong>progressive\nsmall-airway narrowing and fibrosis<\/strong> (chronic obstructive bronchiolitis) and\n<\/li><li>destruction\nof the lung parenchyma with the <strong>destruction\nof the alveolar walls (emphysema)<\/strong><\/li><li>These\npathological changes result in <strong>airway\nclosure on expiration, leading to air trapping<\/strong> and hyperinflation,\nparticularly on exercise <strong>(dynamic\nhyperinflation). <\/strong><\/li><li>This\naccounts for <strong>shortness of breath on\nexertion and exercises<\/strong> limitations that are characteristic symptoms of\nCOPD.<\/li><\/ul>\n\n\n\n<ul><li>Bronchodilators\nreduce air trapping by dilating peripheral airways and are the mainstay of\ntreatment in COPD. <\/li><li><strong>In contrast to asthma, the airflow obstruction\nof COPD tends to be progressive.<\/strong>\n<\/li><li><strong>In contrast to asthma, the inflammation in\npatients with COPD is largely corticosteroid resistant, and there are currently\nno effective anti-inflammatory treatments.<\/strong> <\/li><\/ul>\n\n\n\n<p><strong>Diagnosis<\/strong><\/p>\n\n\n\n<ul><li><strong>Spirometry \u00e0<\/strong> post-bronchodilator <strong>FEV1\/FVC &lt; 0.70 confirms<\/strong> the presence of persistent airflow limitation.<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"533\" height=\"280\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-47.png?w=533\" alt=\"\" class=\"wp-image-202\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-47.png 533w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-47-300x158.png 300w\" sizes=\"(max-width: 533px) 100vw, 533px\" \/><\/figure>\n\n\n\n<p><strong>Treatment<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"489\" height=\"253\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-48.png?w=489\" alt=\"\" class=\"wp-image-203\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-48.png 489w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-48-300x155.png 300w\" sizes=\"(max-width: 489px) 100vw, 489px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"660\" height=\"377\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-49.png?w=660\" alt=\"\" class=\"wp-image-204\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-49.png 660w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-49-300x171.png 300w\" sizes=\"(max-width: 660px) 100vw, 660px\" \/><\/figure>\n\n\n\n<p><strong>Non-pharmacologic Treatment<\/strong><\/p>\n\n\n\n<ul><li>Symptom\ncontrol and palliative care<\/li><li>Oxygen\ntherapy and ventilatory support<\/li><li>Surgical\ninterventions<\/li><li>Vaccination\n\u00e0 <\/li><li><strong>Influenza vaccination<\/strong> can reduce serious illness (such as\nlower respiratory tract infections requiring hospitalization)24 and death in\nCOPD patients.<\/li><li><strong>Pneumococcal vaccinations,<\/strong> PCV13, and PPSV23 are recommended\nfor all patients \u2265 65 years of age <\/li><\/ul>\n\n\n\n<p><strong>Smoking cessation <\/strong><strong>\u00e0<\/strong> <strong>long-term quit success rates of up to 25% can be achieved.<\/strong><strong><\/strong><\/p>\n\n\n\n<p><strong>Bronchodilator Therapy<\/strong><\/p>\n\n\n\n<ul><li>Inhaled\nbronchodilators are <strong>central to symptom\nmanagement<\/strong> <strong>and given or a regular\nbasis<\/strong> to prevent or reduce symptoms <\/li><li><strong>Regular and as-needed use of SABA or SAMA<\/strong> improves FEV1 and symptoms. <\/li><li>Combinations\nof SABA and SAMA are superior to either medication alone in improving FEV1 and\nsymptoms <strong><\/strong><\/li><li>LABAs and\nLAMAs significantly improve lung function, dyspnea, health status and reduce\nexacerbation rates<\/li><li><strong>LABA + LAMA increases FEV1 and reduces symptoms\ncompared to monotherapy<\/strong>. <\/li><li><strong>Theophylline exerts a very small bronchodilator\neffect in stable COPD<\/strong> and that\nis associated with modest symptomatic benefits.<\/li><\/ul>\n\n\n\n<p><strong>Anti Inflammatory drugs<\/strong><\/p>\n\n\n\n<ul><li><strong>Inhaled\ncorticosteroids <br>\n<\/strong>An ICS + LABA more\neffective than monotherapy.<br>\nRegular treatment with ICS increases the chances of pneumonia<strong>. <\/strong><strong><\/strong><\/li><li><strong>Triple inhaled therapy of ICS\/LAMA\/LABA <\/strong>improves lung function, symptoms, and health\nstatus.<strong><\/strong><\/li><\/ul>\n\n\n\n<ul><li><strong>Oral\ncorticosteroids<br>\n<\/strong>Long term use of oral\nglucocorticoids has numerous side effects with no evidence of benefits.<strong><\/strong><\/li><li><strong>Long term ICS monotherapy is not recommended. <\/strong><\/li><li><strong>Longterm ICS + LABA may be considered in\npatients with a history of exacerbations <\/strong><\/li><li>Long term\noral corticosteroids not recommended. <\/li><li><strong>Consider PDE4 inhibitors <\/strong>in patients with exacerbations despite LABA\/ICS\nor LAMA\/LABA\/ICS<strong><\/strong><\/li><li><strong>In former smokers with exacerbations,\nmacrolides can be considered.<\/strong><\/li><li>Statin\ntherapy is not recommended for the prevention of exacerbations. <\/li><li><strong>Antioxidant mucolytics are recommended only in\nselected patients. <\/strong>&nbsp;<\/li><\/ul>\n\n\n\n<p><strong>Miscellaneous<\/strong><\/p>\n\n\n\n<ul><li><strong>Alpha\n1 antitrypsin augmentation therapy<br>\n<\/strong>Iv augmentation therapy<strong> may slow down <\/strong>the progression of emphysema.\n<\/li><li><strong>Antitussives<br>\n<\/strong>No conclusive benefit<strong><\/strong><\/li><li><strong>Antibiotics:<\/strong><strong><br>\n<\/strong>Long term <strong>azithromycin<\/strong> therapy <strong>reduces\nexacerbations<\/strong> over one year. <br>\nIt can lead to bacterial resistance and impaired hearing tests. <\/li><\/ul>\n\n\n\n<p><strong>Recently Approved Drugs\/ FDCs for COPD<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"458\" height=\"300\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-50.png?w=458\" alt=\"\" class=\"wp-image-205\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-50.png 458w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-50-300x197.png 300w\" sizes=\"(max-width: 458px) 100vw, 458px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Drugs in pipeline<\/strong><\/p>\n\n\n\n<ul><li>Benralizumab<\/li><li>Mepolizumab<\/li><li>Lebrikizumab<\/li><\/ul>\n\n\n\n<p><strong>Asthma-COPD overlap syndrome (ACOS)<\/strong> <\/p>\n\n\n\n<p>asthma-COPD\noverlap captures the subset of patients with airways disease who have features\nof both asthma and chronic obstructive pulmonary disease (COPD).<\/p>\n\n\n\n<p><strong>Eosinophilic COPD<\/strong><\/p>\n\n\n\n<ul><li>Inhaled corticosteroids + LABA (mixed evidence)<\/li><li>Anti Ig-E therapies<\/li><li>Anti IL-5\/ IL-5Ra therapies<\/li><li>Anti IL-13\/ IL-4Ra therapies<\/li><\/ul>\n\n\n\n<p><strong>Neutrophilic Asthma:<\/strong> Macrolides<\/p>\n\n\n\n<p><strong>Pauci-granulocytic ACOS:<\/strong> LAMA<\/p>\n","protected":false},"excerpt":{"rendered":"<p>COPD is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and\/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. Terms emphysema and chronic bronchitis are no more included in the definition. Global Prevalence: 11.7% Deaths \u2013 3 million[&#8230;]\n","protected":false},"author":3,"featured_media":202,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/200"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=200"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/200\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media\/202"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=200"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}