New developments in our understanding of the basic underlying inflammatory processes involved in the development of COPD, will soon lead to new therapeutic approaches. Recent science has shown that the inflammatory mechanisms involved in COPD are quite different from asthma. This is why the corticosteroid derivative, given orally as prednisone, and by the inhaled route with numerous preparations, are not nearly as effective in COPD as they are in asthma. A new family of drugs, called the phosphodiesterase-4 inhibitors are specifically designed to deal with COPD mechanisms. Already one drug, which will be marketed as "Ariflo", probably in about two to three years, appears extremely promising.
A new inhaled bronchodilator, related to ipratropium, (Atrovent) is also in the wing. It is a 24-hour potent inhaled agent that promises to replace existing bronchodilators. This drug will be marketed as "Spiriva", by Boehringer Ingelheim. What a great name. Spiriva literally means, 'the breath of life'.
Couple these new developments with the emerging National Lung Health Education Program, (NLHEP), which is now calling for all primary care physicians to do simple spirometry in their offices for early identification of COPD and related disorders, and we have a potential revolution going on. You can't treat a disease until you diagnose it, of course. By involving all primary care physicians in the use of simple, easy to use spirometers for office testing, we will probably find the 15 to 16 million unidentified patients with early stage COPD. Now, if we can curtail smoking in these patients, and deal with the underlying inflammatory and bronchospastic processes with these new drugs, we can probably prevent the progress of disease. Improving symptoms and the quality of life is a top priority, but also preventing and forestalling premature symptoms and death is the major challenge. Thus, the future of COPD looks very bright, but it would be brightest of all if no one ever started smoking.
I will be in touch next month
Thomas Petty, MD