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.