Improved understandings of the basic mechanisms that result in COPD are creating a foundation for new therapeutic approaches, particularly in early or moderate stages of disease. Certainly smoking, which is the root cause in most patients must be addressed. All smoking must be absolutely stopped, if any degree of airflow limitation, as measured by spirometry, is found. The rate of decline of FEV1 can be stopped with smoking cessation, but otherwise continues in an inexorable fashion. New nicotine replacement products now include gum, patch, spray, and inhaler, which looks very much like a cigarette. Other drugs, such as bupropion can help curb smoking. New strategies are being developed which may make smoking cessation much more successful than ever before.
Beyond smoking cessation, a search for new antiinflammatory drugs, which are not related to prednisone or derivatives, is progressing. Medications which cause the lungs to grow new alveoli are another exciting avenue of research that may soon lead to therapeutic intervention. Both antiinflammatory drugs and the iso-retinins, which stimulate alveolar growth, are currently under study in humans.
Finally, a naturally occurring protease inhibitor of the airways has been found to have powerful antibacterial activity. This stuff is known as secretory leukoprotease inhibitor (SLPI) or “SLIPPI”. “SLIPPI” can also prevent the development of emphysema in experimental animals. “SLIPPI” is now being manufactured through recombinant DNA technology, and has begun to be studied in Europe. Thus, it appears that a whole new therapeutic armamentarium is on the horizon for COPD.
Use of these new therapies requires identification of the problem. Here’s where the National Lung Health Education Program (NLHEP) comes in. NLHEP intends to find all smokers with early stages of disease so that they can not only stop smoking, but be candidates for trials of new therapeutic strategies.
I will be in touch next month.
Thomas Petty, MD