New Treatments for COPD

6 Signs of Hope for COPD
Happy old man having a casual talk with a doctor

Living with COPD is tough, because the condition, which causes shortness of breath and decreases the capacity of the lungs to absorb oxygen, is so debilitating. People with COPD struggle simply to breathe, which often severely curtails their ability to exercise or even to get around.

Meanwhile the number of people in the U.S. suffering with COPD continues to rise at a rapid rate. More than 12 million Americans have currently been diagnosed with COPD, and experts from the National Heart Lung and Blood Institute estimate that an additional 12 million people have the disease but don't know it yet, doubling the national total. Clearly, new treatments -- and a potential cure -- are much needed. Here, the latest treatment options for COPD and those soon to become available.

The treatment: Inhalers

What's new: Triple therapy

Asthma-style inhalers are standard treatment for COPD, but researchers are studying new combinations that make them much more effective. So many different studies have come out in the past couple of years that there's no agreed-upon strategy.

However, many experts now believe that patients do best on "triple therapy," taking three different medications: a long-acting beta-agonist, an inhaled corticosteroid, and the anticholinergic Spiriva (generic name tiotropium bromide). A study conducted at Hannover Medical School in Germany found that when patients took all three medications, their severe episodes of breathing difficulty, known as "exacerbations," dropped by 62 percent. They also had fewer emergency room visits and hospitalizations.

Why it's encouraging: Every patient is different, and treatment depends on how many exacerbations a person with COPD is experiencing, says Byron Thomashow, chairman of the board of the COPD Foundation. But since all three medications treat different aspects of the disease, many people do best taking all of them. Anticholinergics like Spiriva work by relaxing the smooth muscles, preventing airway spasms. Long-acting beta-agonists also relax the muscles and increase airway flow. Inhaled corticosteroids (brand names Qvar, Asmanex, Flovent, and Pulmicort) reduce inflammation in the airways.

What to watch for: Inhalants containing corticosteroids have to be used with care because they can cause a yeast infection called thrush in the back of the throat. Inhaled corticosteroids have been shown to increase the risk of pneumonia, so patients taking them need to be on the alert if they get the flu.

The treatment: Medications to dilate blood vessels

What's new: Lowering pulmonary blood pressure

Pulmonary hypertension, or high blood pressure in the arteries leading to the lungs, is a common complication of COPD. It's the primary cause of the edema, or swelling in the feet and ankles, that so many COPD sufferers experience. When this occurs, doctors may prescribe a drug that works by dilating the pulmonary arteries, reducing the pressure of the blood pumping through.

Calcium channel blockers are one type of drug doctors may prescribe to lower pulmonary blood pressure. Others include Flolan (generic name epoprostenol), which is given by injection or infusion pump, and Tracleer (bosentan), which must be carefully monitored due to potential liver problems.

Why it's encouraging: When blood flow to the lungs is restricted, the result is lack of oxygen, known as hypoxemia. Medications that relax blood vessels allow the much-needed oxygen to get through, and they can also prevent dangerous blood clots.

What's coming: Viagra, the popular drug for erectile dysfunction, is now being used to treat pulmonary hypertension. New research shows that sildenafil (the generic name for Viagra), a vasodilator, works to relax and open the blood vessels leading to the lungs just as it does to the penis. By making it easier for the heart to pump blood to the lungs, sildenafil lowers blood pressure in the lungs, relieving pulmonary hypertension. The FDA has approved a new formulation of sildenafil called Revatio that's specifically for pulmonary hypertension. Studies are ongoing to determine the extent to which sildenafil reduces shortness of breath and gives patients an improved capacity for exercise. If studies are encouraging, sildenafil may come into wider use among COPD patients.

The treatment: Oxygen therapy

What's new: Replacing oxygen with a mix of helium and oxygen

Standard oxygen therapy benefits patients with advanced COPD by boosting the ability of the lungs to supply oxygen to the blood. Now new research suggests that a better version of this treatment will soon be available. Canadian researchers at the University of Calgary determined that when 60 percent helium was combined with 40 percent oxygen -- making a mixture known as Heliox -- COPD patients were able to increase their exercise capacity by an average of 245 percent. Because helium is less dense than oxygen, it allows COPD sufferers to empty their damaged lungs more completely.

Why it's encouraging: The treatment is already in use by Canada's health services in the province of Alberta as a pilot project, and experts think it will become more widespread. Heliox is also already used in many emergency rooms as a treatment for acute asthma, so hospitals have the treatment available.

What to watch for: Helium is much more expensive than plain oxygen, so it might not be covered by insurance. And while many hospitals have it available onsite, it hasn't been marketed as a home treatment due to cost and the fact that specialized equipment is required for delivery.

The treatment: Lung surgery

What's new: Lung Volume Reduction Surgery

Currently, in advanced cases of COPD, some doctors recommend a type of surgery known as LVRS, which stands for Lung Volume Reduction Surgery. What LVRS does is remove 20 to 30 percent of the most severely damaged lung tissue in hopes that the remaining sections will function better. The treatment is relatively new, so doctors don't know how long the effects will last.

Why it's encouraging: Studies show that in cases where the surgery works, patients' breathing is much improved.

What to watch for: Current open-chest surgery is both highly invasive and dangerous, with a mortality risk of around 5 percent. There are other complications as well, such as pneumonia or the creation of an air leak from the lung.

What's coming: Some surgeons -- instead of opening the chest -- are experimenting with video-assisted thoracic surgery, using a series of tiny cuts to remove small sections of lung tissue. If this method proves successful, expect it to become a mainstream treatment.

The treatment: Airway bypass

What's new: Bronchoscopic surgery

When COPD damages and weakens the walls of the air sacs in the lungs, the result is that the small airways in between collapse when patients exhale. Air then becomes trapped in the lungs, which don't fully empty and, over time, become overexpanded.

To fix this, researchers are experimenting with using a bronchoscope-guided needle to create tiny holes through the airway walls. Miniature tubes called stents are then inserted to connect the smaller, collapsed airways with the healthier, bigger airways.

Why it's encouraging: In a small study, those who underwent the procedure found that their breathing eased considerably. A large-scale double-blind placebo-controlled study called EASE (short for Exhale Airway Stents for Emphysema) is underway at numerous medical centers to make sure that the treatment works and that side effects such as scarring aren't a serious problem.

What to watch for: In the preliminary study, two participants had minor bleeding from the procedure, but there were no major side effects reported.

The treatment: A new anti-inflammatory drug

What's new: Roflumilast

In June of 2010, a new medication, roflumilast (brand name Daxas) was approved in Europe for COPD. Doctors and patients are excited because it's the first time in ten years that a medication with a new type of action has been approved to treat COPD. Daxas works by counteracting the effect of an enzyme that contributes to inflammation -- so it targets the underlying inflammatory mechanism of COPD rather than the symptoms of inflammation.

Clinical trials showed roflumilast to be effective but to have side effects, such as nausea, diarrhea, and headache. Because of these side effects, the FDA refused to approve Daxas in the U.S., and patient advocates say the approval process is stalled.

Why it's encouraging: In Canada, Daxas is well on its way to approval. The four major clinical trials of Daxas included Canadian populations, and the research centers studying the drug at McMaster and other Canadian universities are enthusiastic. Nycomed, which makes the drug, is working with Merck to ramp up major production and promotion of Daxas in both Europe and Canada; insiders expect Canadian approval this winter. That might spur the FDA to speed up the approval process here in the U.S.

What to watch for: While it may be tempting to import Daxas from Canada, and Canadian drug sites are already listing it, this is a risky thing to do as there have been numerous reports of counterfeit drugs passed off as the real thing.


12 days ago, said...

I have COPD. I was first diagnosed in 1997 and quit smoking. At first, I couldn't I tell had any breathing problem, but as the years past, it worsened and now I am so short of breathe that I can only walk short distances. I was very active , worked out, and played golf. I still play golf but with the help of ellipta anoro and canned enriched oxygen. I am interested in the stem cell treatment and would like to hear about that.


13 days ago, said...

Does anyone know anything about this Omorukunwa Health Center? Would this Steve give us further info and what about the tech staff here, do they know anything about it? Thanks!


4 months ago, said...

Gene therapy should be considered too.


8 months ago, said...

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11 months ago, said...

I have been in end stage c.o.p.d. since 2006 and am very excited about these trial and treatments. Does anyone know where I can inquire further?


about 1 year ago, said...

What about Daliresp


about 1 year ago, said...

I have asthma, COPD, and lost 40% use of my lungs. Lung and brochol infections have been a big problem along with allergies to many medications.


over 1 year ago, said...

Availability by state of these treatments.


over 1 year ago, said...

Why don't the pulmonary drs. ever mention any of the newer medicines or surgeries?


over 1 year ago, said...

I see ZERO mention of alpha-1-antitrypsin deficiency. This is what I have and I am sure my dad - who was diagnosed COPD and died from it - had, as it is hereditary. Replacement therapy does exist. I wonder how many suffer from COPD that is a result of this condition...


over 1 year ago, said...

only copd and not needed assisted liviing


over 1 year ago, said...

I do have C.O.P.D and yes all the syntoms are present, however, my ADVAIR, 2 puff a day and COMBIVENT 4 puff a day, + i pill a day of SINGULAIR, HELP to keep me going, as well having severe sleep apnea, that air pressure at night is helpful to open the airway ! BUT over time had noticed if helped the fact of aging and have ths medial condition as others, sure increase the shortness of breath, lately chest pain and very tired, seems like my battery run out now days often, tired at all times.


over 1 year ago, said...

was prescribed Spiriva but $300 co-pay so I just struggle to breathe.


over 1 year ago, said...

I have been treating my COPD with theophylline for 30 years and it is by far the best treatment I have ever done. A lot of talk about side effects, but I have had none and it is the cheapest treatment ever.


over 1 year ago, said...

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over 1 year ago, said...

I would like to have a printout of this article, but don't see any way for that to happen


over 1 year ago, said...

i would like to know about airway by pass .. i have had copd forever it seems like ...i do pretty good unless i have a flair up ..i am an x smoker ..it makes me so sick when i smell that second hand smoke . exercise your shoulders and arms you will be amaZed ..it really helps the lungs .. don't give up ..


over 1 year ago, said...

i am having a pretty bad flair up .. went to my pulmonary dr ..hate going to e.r they fill me so much prednisone .. i hate it ..last year i did have 2 sprays but not the spriva .. told they would block other sprays ??? i am taking my regular treatments and pulmocortreatmrnts x 2 aday .. plus my treatments i take normally .and mucinex 1200 mg twice a day .. she said it takes 5 days for mucinex to work on c.o.p.d


over 1 year ago, said...

I have copd for at least 5 yrs . O2 24/7 trying to keep a good attitude preformist is so expensive but I've found it's the treatment that works best for me .to many side effects with advair and spiriva .


over 1 year ago, said...

I have had COPD since I was 45. I am now 62. It is really a challenge to get up everyday and do what little bit I can do. I have been on Spiriva just about ever since it came out. I am on Breo now too. Oxygen 24/7 and breathing treatments. These meds are what keeps me going without them I couldn't even get out of bed. I hope they keep coming up with better meds before I get any worse. God bless you all !


over 1 year ago, said...

All this is so interesting and encouraging.


over 1 year ago, said...

Glad I found this site!


over 1 year ago, said...

C.O.P.D; is a trip ,constantly packing and unpacking our life saving meds daily and than are our daily pills for other health issues. Now begin a pleasurable day, you know I pray, TV, reading, sewing etc, Hugs to all


over 1 year ago, said...

I am 76 years old female with C.O.P.D. mine began at age 66 it has gotten extremely worse over time. I was in the ER just a few days ago, with the worst episode ever. I am being treated with an antibiotic, a nebulizer, and steroid tablets { prescription} at home.


over 1 year ago, said...

Info regarding the hospitals where doctors performing this type of procedure?