COPD may be a familiar problem, but approaches to treating COPD are anything but common or predictable. In fact, the Global Initiative for Chronic Obstructive Lung Disease released a new treatment strategy earlier this year.

“This is a rapidly evolving time in COPD research,” says Meilan K. Han, MD, MS, associate professor of medicine and medical director of the Women’s Respiratory Health Program at the University of Michigan School of Medicine. “Due to some surprising data that have come out of clinical trials in the last year or two, we are rethinking our treatment algorithms for COPD.”

Meilan K. Han, MD, MS

Dr. Han will co-chair a series of debates focused on some of the more controversial issues that have come out of recent clinical trials. Debaters will argue the details of five key questions in COPD treatment in light of recent data.

An important debate is the role of eosinophils in guiding corticosteroid treatment in COPD, Dr. Han says. The utility of eosinophils leads directly to another debate over the role of inhaled corticosteroids in minimizing exacerbations. The data regarding whether inhaled corticosteroids are useful and, if so, in which patients they are most likely to be beneficial, remain challenging.

Another key debate focuses on the use of long-term oxygen therapy.

“For many years, physicians, particularly in the United States, have followed a fairly standard rubric on who to treat with oxygen,” Dr. Han explains. “The approach was based on data generated from patients with severe hypoxemia and extended to patients with more moderate hypoxia. Results from a large trial in patients with more moderate hypoxemia showed no reduction in a combined endpoint of mortality and time to first hospitalization. This data suggests a potentially major shift in current clinical practice.”

Hospital readmissions is another hot topic in the field. The Centers for Medicare and Medicaid Services has made COPD readmission a quality indicator, but roughly two-thirds of COPD patients who go back to the hospital are readmitted for something other than COPD.

“It is a huge challenge to figure out how to reduce readmissions for any reason,” Dr. Han says. “In this debate, we will review the data on what, if anything, can be done.”

The final debate examines the role of pharmacotherapy in slowing disease progression. None of the major clinical trials designed to show a reduction in lung function loss or mortality as a primary endpoint have been convincingly positive, Dr. Han says. But several trials have demonstrated a reduction in lung function decline as a secondary endpoint. 

“A lot of the nihilism that surrounds treatment for COPD in the general health care area centers on the belief that there is no reason to intervene early,” she says. “We will discuss the existing data suggesting that we may be able to modify the course of COPD, particularly in individuals with early disease.”

Hot Topics in COPD: A Pro/Con Debate (B82) is supported by an educational grant from AstraZeneca LP, Mylan, Inc., Sunovion Pharmaceuticals, Inc., and, GlaxoSmith Kline.

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