Monica Kraft, MD, formerly of Duke University and the University of Arizona, is a healthcare educator and a clinical and translational researcher of airway diseases at Icahn School of Medicine at Mount Sinai and Mount Sinai Health System. In the following article, Dr. Kraft discusses current research and treatments to alleviate symptoms of COPD.

COPD is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. COPD is the name given to a group of diseases that cause airway obstruction. These diseases include emphysema, asthma, and chronic bronchitis.

While there is no cure for COPD, those living with the disease can keep symptoms under control with lifestyle changes and medications, including inhalers and treatment of exacerbations with corticosteroids, and antibiotics. Dr. Kraft, formerly of Duke University and the University of Arizona, states that the primary treatments for combating COPD are to reduce airway obstruction which reduces work of breathing and improves symptoms of cough, wheezing, and shortness of breath.

Airway Obstruction

As the name suggests, airway obstruction is anything that prevents air from moving out of the lungs, thus preventing the adequate exchange of gases required to breathe easily. The airways are narrowed (obstructed) and air that can be easily inhaled cannot be exhaled expeditiously. This causes the lungs to be larger than normal as air is “trapped”. The larger lungs cause the diaphragm to be flattened, and the chest wall muscles to work less efficiently. This all leads to increased work of breathing and shortness of breath.

Causes of airway obstruction in COPD sufferers include:

• Inflammation and swelling of the airways, causing the airways to be narrowed.
• Excessive mucus, or sputum, which also clogs the airways, making airflow more difficult.
• Damage to the alveoli, or air sacs of the lungs, reducing the ability for oxygen to move from the lungs into the blood where it is needed by our organs.

Those who suffer from COPD do not receive enough oxygen from their lungs into the blood due to airway narrowing and destruction of the alveoli (air sacs). This results not only in shortness of breath, but also cough, chest tightness and low oxygen levels (oxygen saturation). Other issues seen in COPD include susceptibility to respiratory infections, rapid weight loss, swelling of the lower limbs, and low energy. Dr. Monica Kraft, formerly of Duke University and the University of Arizona, states that COPD sufferers find that when they better manage their airway obstruction, their symptoms can significantly improve.

GOLD Research Shows Promising Results

COPD results from destruction of the lung, usually from those who have smoked one pack or more cigarettes for more than 10 years. There are different levels of the disease, and while it predominantly affects those over the age of 50, patients can experience a rapid decline in lung function reports Dr. Monica Kraft, formerly of Duke University and the University of Arizona.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) the group that creates the treatment guidelines for COPD has revealed through extensive research that of the 5 newly classified stages of COPD progression, 4 of them involve the thickening of the walls of the airway.

Dr. Monica Kraft, formerly of Duke University and the University of Arizona, reports that the extent to which thickening of the airway wall due to inflammation impacts the progression of the disease is a vital breakthrough in future treatment considerations; treatments may now concentrate more on reducing airway wall inflammation.

Such treatments and ongoing research will concentrate on lung fibroblasts and the causes of their activation and subsequent production of mediators that cause inflammation. Dr. Monica Kraft, formerly of Duke University and the University of Arizona, says that the inflammation was found to decrease with the use of simvastatin, a drug used to lower cholesterol. These results are causing doctors to rethink how COPD should be treated.

Spirometry Remains the Number One Diagnostic Tool

Dr. Monica Kraft, formerly of Duke University and the University of Arizona, says that COPD is most likely to affect long-term smokers or workers in certain industrial professions. This raised the question as to whether screening for COPD when a patient does not have respiratory symptoms can be useful in early identification and prevention of disease progression

The conclusion was that no benefit to routine screening was discovered, according to the US Preventative Services Task Force, or USPSTF. While COPD is thought to be the third highest killer in the world (6th in the USA), symptoms only occur when lung damage reaches critical levels reports Dr. Monica Kraft, formerly of Duke University and the University of Arizona.

Instead, pulmonary function tests (also called spirometry) conducted when a patient presents with one or more of the critical symptoms of COPD (cough, wheezing or shortness of breath) remains the most reliable method of COPD diagnosis.

Treating Symptoms: A Valid Approach

In the case of most diseases, Dr. Monica Kraft, formerly of Duke University and the University of Arizona, says that the aim of treating a chronic disease is to effectively treat the underlying cause, and to see the symptoms as warning signs. As there is currently no cure for COPD except for lung transplant in severe cases, reducing symptoms such as prolonged cough and excess sputum can greatly improve patient quality of life and even prolong it, notes a recent study. Newly developed inhalants and oral medications, along with smoking cessation, are greatly alleviating COPD symptoms and are in turn improving lung function. New medications, coupled with a greater understanding of the cellular events leading to COPD, are creating a brighter future for patients who suffer from this deadly disease.