ERS 2022: Towards Elimination of COPD
From a revised definition of the disease and its exacerbations to a new etiological classification, the Lancet Commission on COPD proposed unprecedented ideas for addressing one of the world's major health problems. In this session, experts tried to identify the reasons why COPD became a worldwide major health problem and discussed the shortcomings in COPD, new diagnostic methods and classification, pharmacological and non-pharmacological unmet needs in COPD and ways to eliminate it.
In 2019, COPD was the third leading cause of death worldwide with 3.23 million deaths. The death rate of COPD has continued to rise over the years. COPD is often diagnosed late in the course of the disease. Lung function starts to deteriorate slowly, but symptoms do not present until late. COPD is an unequal pandemic, disproportionately impacting the poor, disadvantaged, and vulnerable. Early life events can impact the development of COPD. Environmental risk factors like air pollution, biomass fuel, and environmental tobacco smoke impact COPD development.
A study by Shin S et al. showed that air pollution was associated with a high COPD incidence but was not associated with a higher adult-onset asthma incidence. Disparities exist in access to pharmacological and non-pharmacological therapy between middle, upper-middle- and high-income countries. The NIH funding for COPD-specific research is low compared to other chronic diseases. Improving general health, prohibiting all kinds of smoking, and eliminating exposure throughout life to anything but clean air is expected to reduce the burden of the disease markedly. Elimination of COPD requires consistent and coordinated action and a significantly more significant investment of financial and intellectual resources from all stakeholders.
COPD is a complex and heterogeneous disease, and its pathophysiology implicates varying degrees of airway remodelling, inflammation, and tissue destruction. Diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry. The diagnosis of COPD should go beyond the spirometric-defined obstruction. Diagnosis should be based on expanded criteria, including respiratory symptoms, personal history of risk factors, and persistent airflow limitation or ventilatory heterogeneity as assessed by spirometry, another pulmonary function testing, or CT. COPD should be classified into five subtypes based on the predominant risk factor driving the disease: genetics, early-life events, respiratory infections, tobacco exposure, or other environmental exposures. The diagnosis of exacerbation should be based on standardized assessments, and its severity should be measured objectively.
The elimination of COPD requires mitigation of risk factors, identification of early COPD, and the development of novel targets and drugs for disease modulation and treatment. Mitigation of risk factors is from pre-conception to old age. Early diagnosis should be transformed to early COPD before the individual loses 50% of the small airways. Treatment should be based on a person-centred approach.
The strategies to eliminate COPD falls along the following considerations:
- Acknowledge the public health crisis and sound the alarm
- Recognize non-smoking risk factors and classify COPD by types
- Eliminate well-known and emerging risk factors
- Improve diagnostic tools for early disease and move beyond spirometry
- Increase treatment efficacy effectiveness, and push for a cure
Risk factors can be eliminated by preventing prematurity, widespread vaccinations, occupational protections, clean cooking systems, and no safe thresholds for air quality perspective. Drug development should focus on early disease, and new treatment should target the pathobiology of the five COPD types.
European Respiratory Society (ERS) International Congress 2022, 3rd-6th Sept. 2022, Barcelona
Abstract: Not available
