Tackling COPD: a multicomponent disease driven by inflammation

Abstract

In recent years, research has revealed more about the factors underlying the pathogenesis of chronic obstructive pulmonary disease (COPD). In particular, inflammation in the lungs leads to the structural changes observed in COPD, while extrapulmonary symptoms and comorbidities may be systemic manifestations of these inflammatory processes. A new multicomponent disease model is proposed that takes into account all elements that should be considered in treatment decisions. Current monotherapies act on different aspects of COPD and may not address all components. A combination of a long-acting beta2 agonist and an inhaled corticosteroid has complementary effects, addressing a wider range of components of COPD. This combination appears to have greater clinical benefits than either agent alone in reducing the frequency of exacerbations, reducing the number of hospitalizations, and potentially promoting survival. Minimizing the burden of COPD within--and potentially outside--the lung means treating patients early and addressing as many disease components as possible.

Figure 1

Prevalence of physician-diagnosed chronic obstructive pulmonary disease in the United Kingdom. Reproduced from Soriano JB, et al. Thorax. 2000;55:789–794, with permission from the BMJ Publishing Group.

Figure 2

Therapy at each stage of COPD. Reproduced with permission from http://www.goldcopd.com.

Figure 3

The multicomponent nature of COPD. Reproduced from Agusti AG, et al. Respir Med. 2005;99:670–682. Copyright 2005, with permission from Elsevier.