ERS 2022: COPD Treatment: New Mechanisms and Novel Insights
In this session, the panel of experts discussed the new mechanisms and insights in treating COPD using clinical trial data.
Inhaled corticosteroids (ICS) are highly effective in asthma and provide significant but modest clinical benefits to the collective COPD population. 39% of COPD patients present with a high mass of airway smooth muscle cells (ASMC), a well-described feature in asthma. The HISTORIC study showed that high ASMC mass appears to be associated with ICS response in COPD patients receiving triple therapy.
Palliative care is rarely or only late provided in COPD. However, palliative care increases the quality of life and decreases healthcare use in oncological patients. The COMPASSION study aimed to evaluate the effect of integrated palliative care on quality of life and acute healthcare use in COPD patients. The study found no evidence that palliative care improves QoL in COPD patients, but the results suggest that it can potentially reduce acute healthcare use.
Pulmonary rehabilitation (PR) is an intervention measure composed of exercise and medication. It shows 3 to 5 times greater improvement than pharmacological therapy alone. The presence of chronic persistent lung inflammation changes the lung environment, facilitating lower airway colonization, which promotes airway microbiota dysbiosis. The association between microbiota dysbiosis and COPD severity has been extensively established. PR modulates oral microbiota and inflammatory profile in COPD patients; this modulation is associated with PR effectiveness. PR-induced changes in microbiota and inflammatory profile revealed consistent patterns among responders and non-responders. Distinct patterns of network correlations between bacteria/bacteria and bacteria/inflammatory markers could help explain PR success.
Single-inhaler triple therapies (SITTs) have been developed to facilitate greater treatment persistence and adherence by reducing the burden of the mode of administration. A study aimed to investigate the impact of prompt versus delayed initiation of SITT with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) following a first acute exacerbation of COPD (AECOPD). Compared with delayed initiation, prompt initiation of SITT with FF/UMEC/VI following a first AECOPD was associated with fewer subsequent exacerbations, hospital readmissions and lower COPD-related medical costs.
The incidence of pneumonia is 18 times higher in COPD patients. The real-world risk prediction model, developed using routinely available primary care data, can be used to identify COPD patients at risk of pneumonia. Reduced pneumonia risk in COPD patients commencing extra fine beclomethasone (ef-B) is an important observation, especially for individuals at high risk due to demographic and clinical factors. The existing model's separability measure in identifying COPD patients at risk for developing pneumonia can be improved by adding FEV1 and ICS types.
Non-typeable Haemophilus influenzae (NTHi), the most common colonizer of COPD patient lungs, is often resistant to antibiotics. Gallium has a high chemical similarity to iron. Therefore, it can be imported by iron import proteins in bacteria. A study assessed Gallium protoporphyrin (GaPP) as an antimicrobial for antibiotic-resistant NTHi from COPD patients. GaPP inhibited the growth of COPD NTHi isolates. The study concluded that GaPP might be a useful future antibiotic, particularly in diseases with high iron levels, such as COPD.
Alveolar macrophages regulate lung immune responses to cigarette smoke. A study was conducted to analyze key immune markers in peripheral lungs and bronchoalveolar lavage (BAL) in two cohorts of COPD patients with and without non-small cell lung cancer (NSCLC) and controls. The study demonstrated that GOLD 1-2 COPD patients have more significant expression of programmed death ligand 1 (PD-L1) than other groups. A strong correlation was observed in COPD patients between PD-L1 expression and FEV1% predicted and functionally active macrophages. Similar PD-L1 expression was observed in patients with GOLD 1-2 COPD and NSCLC. The study concluded that active macrophage-derived PD-L1, abundant in the earlier stages of COPD, may play a crucial role in NSCLC and represent a potential therapeutic target to prevent NSCLC onset and progression.
European Respiratory Society (ERS) International Congress 2022, 3rd-6th Sept. 2022, Barcelona
