VIENNA – The chronic inflammatory process that contributes to structural changes in the airways in COPD isn’t just responsible for airflow obstruction and a decline in lung function - it affects the entire body. “As respiratory physicians, for too long, we concentrated on the lungs when dealing with COPD,” said Professor Leonardo Fabbri of the University of Modena in Italy, speaking at the 19th Annual Congress of the European Respiratory Society. Recently, the focus of research has shifted to include the systemic manifestations of the disease, which are probably the result of inflammatory mediators “spilling” into the general circulation.
The immunological mechanisms, involved in COPD, at least when the disease is associated with smoking, are those of an “auto-immune disease”. This is backed up by the fact that even when patients stop smoking, the inflammatory cascade perpetuating the disease carries on. Smoking itself not only causes damage by “going through the lungs” but is associated with important comorbidities in other organ systems, such as the cardiovascular, cerebrovascular and endocrine systems.
According to a recent study, as many as half of COPD patients also suffer from metabolic syndrome.
While respiratory symptoms may impact on patients every day, the systemic inflammation associated with the disease serves as a silent extrapulmonary marker of morbidity and mortality. In order to assess a patient’s disease severity correctly, the physician therefore needs to address the complexity of the disease: that means classifying a patient according to symptom severity or impairment in lung function (GOLD classification of COPD) may not be enough. A new terminology is needed, taking into account the comorbidities that determine prognosis in individual patients.
Current COPD therapies, including inhaled corticosteroids, long-acting beta-agonists and theophylline, already have the potential to decrease systemic COPD manifestations.
Building on this line of thought, Prof. Fabbri mentioned treatments additionally targeting the systemic effects of the disease or risk factors. These include pulmonary rehabilitation and novel anti-inflammatory compounds such as phosphodiesterase-4-inhibitors.
Patients with COPD may even benefit from treatments primarily aimed at comorbidities such as heart failure or hypertension, such as medications that exhibit anti-inflammatory properties such as statins, ACE-inhibitors or sartans.
Looking further ahead, and beyond the anti-inflammatory concept, studies are currently examining the hypothesis that statins may have a further role, aiding the prevention or even reversing airway wall remodelling in COPD.