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Updates in COPD Guidelines and Treatment
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Dharani K. Narendra, MD, FCCP

Click to view more from Pulmonology Data Trends 2024. 

References

  1. Al Wachami N, Guennouni M, Iderdar Y, et al. Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMC Public Health. 2024;24(1):297. doi:10.1186/s12889-024-17686-9 

  1. COPD trends brief. American Lung Association. Accessed July 11, 2024. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief  

  1. Chronic obstructive pulmonary disease (COPD). World Health Organization. March 16, 2023. Accessed July 11, 2024. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)  

  1. Shalabi MS, Aqdi SW, Alfort OA, et al. Effectiveness and safety of bronchodilators and inhaled corticosteroids in the management of chronic obstructive pulmonary disease. Int J Commun Med Public Health. 2023;10(8):2955-2959. doi:10.18203/2394-6040.ijcmph20232392 

  1. McCormick B. FDA approves ensifentrine for maintenance treatment of adult patients with COPD. AJMC. June 26, 2024. Accessed July 11, 2024. https://www.ajmc.com/view/fda-approves-ensifentrine-for-maintenance-treatment-of-adult-patients-with-copd  

  1. Kersul AL, Cosio BG. Biologics in COPD. Open Resp Arch. 2024;6(2):100306. doi:10.1016/j.opresp.2024.100306  

  1. 2023 GOLD Report. Global Initiative for Chronic Obstructive Lung Disease. Accessed July 11, 2024. https://goldcopd.org/2023-gold-report-2 

  1. 2024 GOLD Report. Global Initiative for Chronic Obstructive Lung Disease. Accessed July 11, 2024. https://goldcopd.org/2024-gold-report/  

  1. Regeneron Pharmaceuticals Inc. Dupixent® (dupilumab) late-breaking data from NOTUS confirmatory phase 3 COPD trial presented at ATS and published in the New England Journal of Medicine [press release]. May 20, 2024. Accessed July 11, 2024. https://investor.regeneron.com/news-releases/news-release-details/dupixentr-dupilumab-late-breaking-data-notus-confirmatory-phase  

  1. Pavord ID, Chapman KR, Bafadhel M, et al. Mepolizumab for eosinophil-associated COPD: analysis of METREX and METREO. Int J Chron Obstruct Pulmon Dis. 2021;16:1755-1770. doi:10.2147/COPD.S294333  

  1. Mepolizumab as add-on treatment in participants with COPD characterized by frequent exacerbations and eosinophil level (MATINEE). Clinicaltrials.gov. Updated August 28, 2023. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT04133909  

  1. Singh D, Criner GJ, Agustí A, et al. Benralizumab prevents recurrent exacerbations in patients with chronic obstructive pulmonary disease: a post hoc analysis. Int J Chron Obstruct Pulmon Dis. 2023;18:1595-1599. doi:10.2147/COPD.S418944  

  1. Efficacy and safety of benralizumab in moderate to very severe chronic obstructive pulmonary disease (COPD) with a history of frequent exacerbations (RESOLUTE). Clinicaltrials.gov. Updated May 8, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT04053634  

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (TITANIA). Clinicaltrials.gov. Updated June 27, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05158387 

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (OBERON). Clinicaltrials.gov. Updated June 21, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05166889 

  1. Long-term efficacy and safety of tozorakimab in participants with chronic obstructive pulmonary disease with a history of exacerbations (PROSPERO). Clinicaltrials.gov. Updated June 20, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05742802 

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (MIRANDA). Clinicaltrials.gov. Updated June 4, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT06040086 

  1. Study to assess the efficacy, safety, and tolerability of SAR440340/REGN3500/itepekimab in chronic obstructive pulmonary disease (COPD) (AERIFY-1). ClinicalTrials.gov. Updated June 21, 2024. Accessed July 11, 2024. https://classic.clinicaltrials.gov/ct2/show/NCT04701983 

  1. Study to assess the efficacy, safety, and tolerability of SAR440340/REGN3500/itepekimab in chronic obstructive pulmonary disease (COPD) (AERIFY-2). ClinicalTrials.gov. Updated May 9, 2024. Accessed July 11, 2024. https://classic.clinicaltrials.gov/ct2/show/NCT04751487 

  1. ALIENTO and ARNASA: study designs of two randomised, double-blind, placebo-controlled trials of astegolimab in patients with COPD. Medically. 2023. Accessed July 11, 2024. https://medically.gene.com/global/en/unrestricted/respiratory/ERS-2023/ers-2023-poster-brightling-aliento-and-arnasa-study-des.html 

  1. Anzueto A, Barjaktarevic IZ, Siler TM, et al. Ensifentrine, a novel phosphodiesterase 3 and 4 inhibitor for the treatment of chronic obstructive pulmonary disease: randomized, double-blind, placebo-controlled, multicenter phase III trials (the ENHANCE trials). Am J Respir Crit Care Med. 2023;208(4):406-416. doi:10.1164/rccm.202306-0944OC 

  1. US Preventive Services Taskforce. Lung cancer: screening. March 9, 2021. Accessed July 11, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening  

Author and Disclosure Information

Dharani K. Narendra, MD, FCCP

Assistant Professor, Department of Pulmonary Critical Care Medicine
Baylor College of Medicine
Houston, TX

Dr. Narendra has disclosed no relevant financial relationships.

Publications
MDedge Internal Medicine
CHEST Physician
Topics
COPD
Author(s)
Dharani K. Narendra, MD, FCCP
Author(s)
Dharani K. Narendra, MD, FCCP
Author and Disclosure Information

Dharani K. Narendra, MD, FCCP

Assistant Professor, Department of Pulmonary Critical Care Medicine
Baylor College of Medicine
Houston, TX

Dr. Narendra has disclosed no relevant financial relationships.

Author and Disclosure Information

Dharani K. Narendra, MD, FCCP

Assistant Professor, Department of Pulmonary Critical Care Medicine
Baylor College of Medicine
Houston, TX

Dr. Narendra has disclosed no relevant financial relationships.

Click to view more from Pulmonology Data Trends 2024. 

Click to view more from Pulmonology Data Trends 2024. 

References

  1. Al Wachami N, Guennouni M, Iderdar Y, et al. Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMC Public Health. 2024;24(1):297. doi:10.1186/s12889-024-17686-9 

  1. COPD trends brief. American Lung Association. Accessed July 11, 2024. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief  

  1. Chronic obstructive pulmonary disease (COPD). World Health Organization. March 16, 2023. Accessed July 11, 2024. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)  

  1. Shalabi MS, Aqdi SW, Alfort OA, et al. Effectiveness and safety of bronchodilators and inhaled corticosteroids in the management of chronic obstructive pulmonary disease. Int J Commun Med Public Health. 2023;10(8):2955-2959. doi:10.18203/2394-6040.ijcmph20232392 

  1. McCormick B. FDA approves ensifentrine for maintenance treatment of adult patients with COPD. AJMC. June 26, 2024. Accessed July 11, 2024. https://www.ajmc.com/view/fda-approves-ensifentrine-for-maintenance-treatment-of-adult-patients-with-copd  

  1. Kersul AL, Cosio BG. Biologics in COPD. Open Resp Arch. 2024;6(2):100306. doi:10.1016/j.opresp.2024.100306  

  1. 2023 GOLD Report. Global Initiative for Chronic Obstructive Lung Disease. Accessed July 11, 2024. https://goldcopd.org/2023-gold-report-2 

  1. 2024 GOLD Report. Global Initiative for Chronic Obstructive Lung Disease. Accessed July 11, 2024. https://goldcopd.org/2024-gold-report/  

  1. Regeneron Pharmaceuticals Inc. Dupixent® (dupilumab) late-breaking data from NOTUS confirmatory phase 3 COPD trial presented at ATS and published in the New England Journal of Medicine [press release]. May 20, 2024. Accessed July 11, 2024. https://investor.regeneron.com/news-releases/news-release-details/dupixentr-dupilumab-late-breaking-data-notus-confirmatory-phase  

  1. Pavord ID, Chapman KR, Bafadhel M, et al. Mepolizumab for eosinophil-associated COPD: analysis of METREX and METREO. Int J Chron Obstruct Pulmon Dis. 2021;16:1755-1770. doi:10.2147/COPD.S294333  

  1. Mepolizumab as add-on treatment in participants with COPD characterized by frequent exacerbations and eosinophil level (MATINEE). Clinicaltrials.gov. Updated August 28, 2023. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT04133909  

  1. Singh D, Criner GJ, Agustí A, et al. Benralizumab prevents recurrent exacerbations in patients with chronic obstructive pulmonary disease: a post hoc analysis. Int J Chron Obstruct Pulmon Dis. 2023;18:1595-1599. doi:10.2147/COPD.S418944  

  1. Efficacy and safety of benralizumab in moderate to very severe chronic obstructive pulmonary disease (COPD) with a history of frequent exacerbations (RESOLUTE). Clinicaltrials.gov. Updated May 8, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT04053634  

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (TITANIA). Clinicaltrials.gov. Updated June 27, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05158387 

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (OBERON). Clinicaltrials.gov. Updated June 21, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05166889 

  1. Long-term efficacy and safety of tozorakimab in participants with chronic obstructive pulmonary disease with a history of exacerbations (PROSPERO). Clinicaltrials.gov. Updated June 20, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05742802 

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (MIRANDA). Clinicaltrials.gov. Updated June 4, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT06040086 

  1. Study to assess the efficacy, safety, and tolerability of SAR440340/REGN3500/itepekimab in chronic obstructive pulmonary disease (COPD) (AERIFY-1). ClinicalTrials.gov. Updated June 21, 2024. Accessed July 11, 2024. https://classic.clinicaltrials.gov/ct2/show/NCT04701983 

  1. Study to assess the efficacy, safety, and tolerability of SAR440340/REGN3500/itepekimab in chronic obstructive pulmonary disease (COPD) (AERIFY-2). ClinicalTrials.gov. Updated May 9, 2024. Accessed July 11, 2024. https://classic.clinicaltrials.gov/ct2/show/NCT04751487 

  1. ALIENTO and ARNASA: study designs of two randomised, double-blind, placebo-controlled trials of astegolimab in patients with COPD. Medically. 2023. Accessed July 11, 2024. https://medically.gene.com/global/en/unrestricted/respiratory/ERS-2023/ers-2023-poster-brightling-aliento-and-arnasa-study-des.html 

  1. Anzueto A, Barjaktarevic IZ, Siler TM, et al. Ensifentrine, a novel phosphodiesterase 3 and 4 inhibitor for the treatment of chronic obstructive pulmonary disease: randomized, double-blind, placebo-controlled, multicenter phase III trials (the ENHANCE trials). Am J Respir Crit Care Med. 2023;208(4):406-416. doi:10.1164/rccm.202306-0944OC 

  1. US Preventive Services Taskforce. Lung cancer: screening. March 9, 2021. Accessed July 11, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening  

References

  1. Al Wachami N, Guennouni M, Iderdar Y, et al. Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. BMC Public Health. 2024;24(1):297. doi:10.1186/s12889-024-17686-9 

  1. COPD trends brief. American Lung Association. Accessed July 11, 2024. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief  

  1. Chronic obstructive pulmonary disease (COPD). World Health Organization. March 16, 2023. Accessed July 11, 2024. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)  

  1. Shalabi MS, Aqdi SW, Alfort OA, et al. Effectiveness and safety of bronchodilators and inhaled corticosteroids in the management of chronic obstructive pulmonary disease. Int J Commun Med Public Health. 2023;10(8):2955-2959. doi:10.18203/2394-6040.ijcmph20232392 

  1. McCormick B. FDA approves ensifentrine for maintenance treatment of adult patients with COPD. AJMC. June 26, 2024. Accessed July 11, 2024. https://www.ajmc.com/view/fda-approves-ensifentrine-for-maintenance-treatment-of-adult-patients-with-copd  

  1. Kersul AL, Cosio BG. Biologics in COPD. Open Resp Arch. 2024;6(2):100306. doi:10.1016/j.opresp.2024.100306  

  1. 2023 GOLD Report. Global Initiative for Chronic Obstructive Lung Disease. Accessed July 11, 2024. https://goldcopd.org/2023-gold-report-2 

  1. 2024 GOLD Report. Global Initiative for Chronic Obstructive Lung Disease. Accessed July 11, 2024. https://goldcopd.org/2024-gold-report/  

  1. Regeneron Pharmaceuticals Inc. Dupixent® (dupilumab) late-breaking data from NOTUS confirmatory phase 3 COPD trial presented at ATS and published in the New England Journal of Medicine [press release]. May 20, 2024. Accessed July 11, 2024. https://investor.regeneron.com/news-releases/news-release-details/dupixentr-dupilumab-late-breaking-data-notus-confirmatory-phase  

  1. Pavord ID, Chapman KR, Bafadhel M, et al. Mepolizumab for eosinophil-associated COPD: analysis of METREX and METREO. Int J Chron Obstruct Pulmon Dis. 2021;16:1755-1770. doi:10.2147/COPD.S294333  

  1. Mepolizumab as add-on treatment in participants with COPD characterized by frequent exacerbations and eosinophil level (MATINEE). Clinicaltrials.gov. Updated August 28, 2023. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT04133909  

  1. Singh D, Criner GJ, Agustí A, et al. Benralizumab prevents recurrent exacerbations in patients with chronic obstructive pulmonary disease: a post hoc analysis. Int J Chron Obstruct Pulmon Dis. 2023;18:1595-1599. doi:10.2147/COPD.S418944  

  1. Efficacy and safety of benralizumab in moderate to very severe chronic obstructive pulmonary disease (COPD) with a history of frequent exacerbations (RESOLUTE). Clinicaltrials.gov. Updated May 8, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT04053634  

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (TITANIA). Clinicaltrials.gov. Updated June 27, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05158387 

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (OBERON). Clinicaltrials.gov. Updated June 21, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05166889 

  1. Long-term efficacy and safety of tozorakimab in participants with chronic obstructive pulmonary disease with a history of exacerbations (PROSPERO). Clinicaltrials.gov. Updated June 20, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT05742802 

  1. Efficacy and safety of tozorakimab in symptomatic chronic obstructive pulmonary disease with a history of exacerbations (MIRANDA). Clinicaltrials.gov. Updated June 4, 2024. Accessed July 11, 2024. https://clinicaltrials.gov/study/NCT06040086 

  1. Study to assess the efficacy, safety, and tolerability of SAR440340/REGN3500/itepekimab in chronic obstructive pulmonary disease (COPD) (AERIFY-1). ClinicalTrials.gov. Updated June 21, 2024. Accessed July 11, 2024. https://classic.clinicaltrials.gov/ct2/show/NCT04701983 

  1. Study to assess the efficacy, safety, and tolerability of SAR440340/REGN3500/itepekimab in chronic obstructive pulmonary disease (COPD) (AERIFY-2). ClinicalTrials.gov. Updated May 9, 2024. Accessed July 11, 2024. https://classic.clinicaltrials.gov/ct2/show/NCT04751487 

  1. ALIENTO and ARNASA: study designs of two randomised, double-blind, placebo-controlled trials of astegolimab in patients with COPD. Medically. 2023. Accessed July 11, 2024. https://medically.gene.com/global/en/unrestricted/respiratory/ERS-2023/ers-2023-poster-brightling-aliento-and-arnasa-study-des.html 

  1. Anzueto A, Barjaktarevic IZ, Siler TM, et al. Ensifentrine, a novel phosphodiesterase 3 and 4 inhibitor for the treatment of chronic obstructive pulmonary disease: randomized, double-blind, placebo-controlled, multicenter phase III trials (the ENHANCE trials). Am J Respir Crit Care Med. 2023;208(4):406-416. doi:10.1164/rccm.202306-0944OC 

  1. US Preventive Services Taskforce. Lung cancer: screening. March 9, 2021. Accessed July 11, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening  

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COPD is a common and preventable condition characterized by persistent respiratory symptoms and airflow obstruction. Its prevalence ranges from 7.4% to 12.6% among adults aged 40 years and older, with higher rates observed in non-Hispanic White individuals, women, and those aged 65 years and older.1,2 Despite declining mortality trends, COPD remains the third leading cause of death worldwide and sixth in the United States.2,3

Current pharmacological treatments include bronchodilators, inhaled corticosteroids, combination inhalers,azithromycin, and phosphodiesterase-4 (PDE4) inhibitors, the latter two for exacerbation prevention. Each treatment has limitations, such as side effects, disease progression, and pneumonia risks.4 Ensifentrine,a breakthrough COPD treatment, was recently approved by the FDA and targets both PDE3 and PDE4 enzymes, offering significant benefits in  managing moderate to severe COPD.5 Biologics are also emerging as promising therapies due to their targeted approach against specific inflammatory pathways.6

More nonpharmacological approaches are discussed in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, which is updated annually to align with our current understanding of COPD and the available literature. In 2023, GOLD significantly revised its COPD assessment tool, from ABCD to ABE, to simplify classification and focus on effectively treating patients with frequent exacerbations. This new tool helps clinicians identify patients who experience exacerbations and tailor treatments specifically for their needs.7 The 2024 GOLD report includes updated screening, vaccination, and spirometry guidelines, among many other changes that will be discussed below.8 These evolving  recommendations, combined with the potential introduction of more targeted therapies, offer hope for improved COPD prevention and management in the future.

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