Novel therapies in the management of chronic obstructive pulmonary disease (COPD): Addressing genetic, immunologic, and physiologic principles of disease

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Chronic obstructive pulmonary disease (COPD) is a heterogeneous chronic lung disease characterized by airway inflammation, which in certain patients results in immune mediated airway remodeling, gas trapping, and/or loss in lung density with emphysema. As a result, patients have airflow obstruction associated with symptoms of cough, sputum production, dyspnea and wheeze, which are worsened during periods of exacerbation, and ultimately contributes to significant morbidity and mortality for patients, progressive lung function decline, worsening dyspnea and increased healthcare costs.1 In recent years, maintenance inhaled triple therapy has been shown to reduce mortality for those at high risk of exacerbation; however, newer research has evolved our understanding of treating aspects of the pathophysiology of the disease that, until now, have not been addressed. Newer biologic medications, such as Dupilumab, address the inflammatory and immune responses of the disease by targeting pathways that lead to airway remodeling, decreasing exacerbations, lung function decline and symptoms. Endobronchial valve placement addresses the gross physiology of lung gas trapping present in COPD as a means of improving forced expiratory volume in one second (FEV1) and hyperinflation, measured on pulmonary function tests as well as validated dyspnea scores. Alpha-1 antitrypsin augmentation therapy addresses the underlying genetics of the disease by reducing the rate of lung density loss. Each of these therapies has shown promising outcomes to further improve the management of COPD, as highlighted in the following articles.