Is ‘GOLD’ standard for the management of COPD in clinical practice?

Abstract

Background: COPD is a treatable disease and therapy can improve quality of life (QoL), the level of symptoms, functionality and life expectancy. Primary therapy remains removal of the toxic agent (in most cases, tobacco smoke). Additional therapy includes bronchodilators (β-adrenergic and antimuscarinic classes). Inhaled corticosteroids (ICS) are used to prevent exacerbations and, in carefully selected patients, may have additional benefits due to exacerbation prevention. Long-acting bronchodilators also reduce the risk of exacerbations. Pulmonary rehabilitation, immunizations and, in very severe COPD, long-term oxygen therapy are the conventional COPD therapies. However, COPD is a systemic disease and often requires therapy of its protean-associated morbidities from depression to osteoporosis and muscle-wasting. Despite pessimism from several quarters, COPD is treatable.

Research needs: As with all common chronic diseases, the opportunities to improve the understanding and management of COPD are numerous. We have limited understanding of COPD with regard to inflammatory cells, inflammatory triggers; the role of each step in the inflammatory cascade; the physiology of parenchyma destruction, hyperinflation and formation of blebs and bullae; and the role of genes, epigenetics and phenotypes.

In addition we need workers in biophysics and bioengineering sectors to design better drug-delivery devices, delivering new and old drugs more effectively to the lungs (and perhaps even to the sub-sections of the lungs). Additional devices and delivery systems are needed to introduce one-way valves to deflate large areas of hyperinflation. Imaging techniques are advancing, but many methods introduce larger doses of radiation than is optimal for already damaged lungs.

Conclusions: The research opportunities are unlimited but the funds are not. As COPD moves into third place amongst the most common causes of death in the world, the need for new basic-science information, therapies and delivery systems will increase. For now we have to work with the information and therapies we have, knowing that the understanding and management of COPD has improved significantly in the past 10 years, but we still have a long way to go.