Evidence-Based Strategies for COPD Diagnosis, Management, and Prevention

Panelists discuss COPD as a chronic inflammatory lung disease characterized by persistent airflow limitation, typically diagnosed through spirometry, and highlight common respiratory symptoms including chronic cough, sputum production, and dyspnea.

Panelists discuss major risk factors for COPD development, including smoking, long-term exposure to environmental pollutants, and genetics, while noting that a history of asthma, early bronchitis, respiratory infections, and sex (with higher prevalence in men) may also influence disease onset and progression.

Panelists discuss current statistics indicating that COPD is one of the top three leading causes of death worldwide, with high morbidity and mortality rates, particularly in individuals over 40 years of age, and a growing global burden due to risk factors like smoking and air pollution.

Panelists discuss how, despite being preventable and treatable, chronic obstructive pulmonary disease (COPD) has emerged as a major global health challenge due to widespread exposure to risk factors, particularly tobacco smoke, which remains the primary cause despite declining smoking rates in some regions. Early environmental exposures play a crucial role—workplace pollutants, air pollution, and secondhand smoke can damage developing lungs, whereas genetic factors like α1-antitrypsin deficiency increase susceptibility.

Panelists discuss how chronic obstructive pulmonary disease (COPD) management follows a stepwise approach, beginning with bronchodilators (typically short-acting β2-agonists/long-acting β2-agonists) and progressing to combination therapy with long-acting muscarinic antagonists/inhaled corticosteroids based on symptom severity. Current unmet needs include more targeted anti-inflammatory treatments, better biomarkers for phenotyping, and therapies to halt disease progression, particularly for those who don’t respond well to conventional treatments.

Panelists discuss the initial thought that postbronchodilator spirometry would help differentiate chronic obstructive pulmonary disease (COPD) from asthma. However, postbronchodilator spirometry adds time and effort, as well as exposing a patient to short-term medication that may have adverse effects. Guidelines favor a fixed ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC; < 0.7) because of the ratio’s simplicity and is independent of other reference values.

Panelists discuss how dysbiosis of the lung microbiome can exacerbate chronic obstructive pulmonary disease (COPD) through increased inflammation and altered immune responses. In contrast, chest CT imaging is indicated for patients with severe COPD, suspected comorbidities, surgical planning, or unexplained symptoms despite standard treatment. These factors highlight the complexity of COPD management.

Panelists discuss how the coexistence of heart disease and chronic obstructive pulmonary disease (COPD) requires careful management as these conditions significantly impact each other. In stable COPD, cardiovascular complications are a leading cause of mortality, whereas acute exacerbations can worsen heart function. Key treatable traits in COPD-associated pulmonary hypertension include hypoxemia, inflammation, and right ventricular dysfunction. Management focuses on optimizing respiratory and cardiac function through appropriate medication selection, oxygen therapy when indicated, and careful monitoring of both conditions to prevent deterioration.

Panelists discuss how monitoring blood eosinophil counts is crucial for assessing inflammation in asthma and chronic obstructive pulmonary disease (COPD). It guides treatment decisions by identifying patients who may benefit from corticosteroids or biologics.

Panelists discuss how ensifentrine is a nebulized inhaled therapy, a small molecule inhibitor of PDE3 and PDE4, and is compelling because there are very few adverse effects. There are also compelling results from studies that show bronchial dilatation and exacerbation reduction.

Panelists discuss how the BOREAS and NOTUS phase 3 trials demonstrated that dupilumab significantly reduced exacerbations, improved lung function, and enhanced quality of life in patients with uncontrolled chronic obstructive pulmonary disease (COPD), particularly those with elevated eosinophil counts, highlighting its potential in targeted therapy.

Panelists discuss how the ENHANCE trials assessed ensifentrine in patients with chronic obstructive pulmonary disease (COPD) with moderate-to-severe airflow obstruction and a history of exacerbations. Outcomes showed improved lung function and reduced exacerbations. Clinically, ensifentrine may be used as monotherapy or an add-on, addressing diverse patient needs.

Panelists discuss how individualized chronic obstructive pulmonary disease (COPD) maintenance therapy considers symptom severity, exacerbation risk, and eosinophil levels. Dupilumab and ensifentrine require adherence to prescribed dosing for efficacy and safety.

Panelists discuss how key nonpharmacological interventions include vaccinations to prevent infections, pulmonary rehabilitation to improve function, and lung cancer screening for high-risk patients to enable early detection.

Panelists discuss how chronic obstructive pulmonary disease (COPD) management is evolving with personalized therapies, nonpharmacological care, and advanced treatments. Early diagnosis, adherence, and innovation offer hope for improved outcomes and quality of life.