Future of COPD Management: Precision Medicine

Peter Salgo, MD: I don’t want to leave this conversation without looking a little into the future. I’ve heard rumors of a COPDGene, out there, and a SPIROMIC study? Help me out on this.

Antonio Anzueto, MD: The National Institutes of Health [NIH] has really invested in respiratory diseases. In the COPDGene initiative, 10,000 smokers were put together to help to understand this disease. “Let’s understand the natural history.” Eventually we will find a gene, but we need to understand what has changed in chronic obstructive pulmonary disease and many other respiratory conditions in the last 15 years. Our funding institutions are willing and have been putting their money into understanding this. COPDGene is an example. Ten thousand smokers: Half of them had COPD when they presented and half of them did not have COPD. Thirty percent of everything was perfectly normal, and 20% had lung fibrosis, ILD [interstitial lung disease]. So, not only smokers develop COPD. And when we brought them back, 5 years later, we found out that if they had stopped smoking, they remained normal. If they continued to smoke, they developed a condition. So, there’s a huge opportunity, with this investment that the government and other funding institutions are doing, worldwide—not only in the US—to move forward in understanding this condition.

Byron Thomashow, MD: I want to stress what Antonio said. What’s coming out of those studies will change everything. Antonio, at the very beginning, mentioned the fact that he’s got plenty of COPD patients who have normal spirometry. But if you look at their CT [computed tomography] scans, they’ve got airway disease or emphysema. We need to understand what to do with that. Spirometry is only part of this issue. It’s worth stressing that it looks like, in the pathways that are coming forward, there will be new medicines. There are some biologics, that are being used in other diseases, that may have a role in subsets of patients with this disease. And, again, it’s the concept of moving away from treating all of COPD the same. But studies like this will help to guide us.

Barbara P. Yawn, MD, MSc, FAAFP: I think some of the exciting medicines, in my opinion, are not just the biologics, for a very small subset. Some of the ones that we’re talking about may change how the disease actually affects the lungs and if it’s going to change the structure and other things. So, we’re not talking about prevention, exactly, but very early intervention. And that’s what COPDGene and SPIROMICS, I think, has to add for us. It’s very exciting.

James F. Donohue, MD: One of the big things, here, is the idea that disease has elements that are irreversible and progressive. This leads the patient to say, “Gee, what you can fix is a very small percentage, the reversible, maybe 10% of the damage or something like that. What about the big picture?” And with regenerative medicine, we really want to reverse some of this irreversible disease, whether with platforms and stem cells to regenerate alveoli, or airways, or new ways of going about business. One of the great accomplishments that are forthcoming are the improvements in science. There’s been a huge investment in science by the NIH, as we’ve heard, as well as the COPD Foundation, the Alpha-1 Foundation, and, certainly, the Foundation that I was identified with, the ATS [American Thoracic Society] Foundation.

Barbara P. Yawn, MD, MSc, FAAFP: And pharma.

James F. Donohue, MD: And pharma, too, of course, in developing it. The progress that’s going to come may be able to change the landscape. That would work by trying to do something about the progressive irreversible components of these diseases. Maybe we can nail that down.

Peter Salgo, MD: All right. This has been a tremendous discussion, a huge waterfront that we’ve covered. But the clock is not our friend, at this moment. So, we’re going to have to let a lot of this just sit until the next time we get together. That being said, I don’t want to leave without giving each of you an opportunity to sum up some point that you’d like to leave our viewers with. Dr Anzueto, why don’t you start?

Antonio Anzueto, MD: I want to emphasize that this is a disease in which the face is changing. Women, and women in their 50s, do have COPD. A second point: This is a treatable disease. There are medications that are impacting the disease in ways we never suspected. But we need to go back to the basics. The basics have to include education and prevention. We must do this as a team, using all of the healthcare resources that we have in our practices, to be able to move together, for one.

Peter Salgo, MD: Dr Donohue?

James F. Donohue, MD: I’d just like to follow up on the idea of personalizing each individual patient with COPD. Remember, smoking is the main cause. And even after you stop smoking, if you’re a COPD patient, your disease progresses for reasons that are not well understood but are partially accountable by inflammation. So, even by stopping smoking, we can’t forget that the COPD continues onward and we’ve got to treat it.

Peter Salgo, MD: Dr Thomashow?

Byron Thomashow, MD: We’re making progress. We’ve got good medicines. We need to use them correctly. We need to get people to exercise. We need to have more rehabilitation. The people with this disease and their caregivers need to help us. They need to raise their voices for us to really make a difference.

Peter Salgo, MD: Dr Yawn?

Barbara P. Yawn, MD, MSc, FAAFP: I would emphasize the concept of differential diagnosis. If you don’t include COPD in your differential diagnosis, you’re never going to be able to use all of these treatments that we’ve talked about. And then, the differential diagnosis of someone who’s not doing well on therapy, think about adherence and inhaler technique and smoking cessation.

Peter Salgo, MD: Use the drugs right.

Barbara P. Yawn, MD, MSc, FAAFP: Yes.

James F. Donohue, MD: That’s good.

Peter Salgo, MD: Well, I want to thank all of you for being here. I want to thank you for joining us. It’s been great. On behalf of the panel, I think I can speak for everybody when I say, thanks for joining us. I’m Dr Peter Salgo, and I’ll see you next time.

Transcript edited for clarity.