Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world and is associated with a symptom burden comparable to cancer.

COPD is an inflammatory obstructive lung disease characterized by airflow limitation. The mechanism of dyspnea in COPD is dynamic lung hyperinflation, leading to hypoxemia, hypercapnia, and neuromechanical dissociation. Also, there is an affective component to breathlessness, leading to “total dyspnea,” which stresses the behavioral and mood aspects of dyspnea alongside physiologic inputs.

Noninvasive COPD-specific advances

• Interruption of the dyspnea-anxiety cycle
COPD requires a palliative care model composed of the integration of nonpharmacological and pharmacological interventions. One example is “The Breathing, Thinking, Functioning,” a cognitive behavioral model that addresses three aspects of the cycle of breathlessness: inefficient breathing, anxiety, and muscle deconditioning. It reduces anxiety, depression, emergency room visits, and hospitalizations.

• Inhalation therapy
Patients with severe COPD often cannot generate of sufficient inspiratory flow to effectively use traditional metered-dose inhalers or dry powder inhalers. Newer inhaler devices use a prolonged aerosol mist delivery system. Delivering the drug through a prolonged aerosol mist facilitates ease of use and improves drug delivery (long-acting beta agonists and long-acting muscarinic antagonists) even in the situation of reduced inspiratory flow.

• Oscillating Positive Expiratory Pressure (OPEP)
The use of OPEP devices (“flutter valve”) has shown to reduce dyspnea, respiratory secretions, and exacerbations. OPEP devices, which look like a handheld inhaler device, provide rapidly oscillating positive pressure to patients’ airways when they exhale through it. These high frequency oscillations aid in secretion clearance and reduction of dyspnea and rates of exacerbations.

• Azithromycin
It reduces respiratory secretions through an anti-inflammatory mechanism as well as by reducing bacterial load. The addition of chronic azithromycin (patients are typically prescribed from many months to years) reduces exacerbations in patients who continue to experience exacerbations despite recommended therapy.

• Roflumilast
It acts as an anti-inflammatory. Its main indication is to reduce the number of exacerbations in patients experiencing two or more exacerbations a year from severe COPD. Other data indicate it can reduce cough, respiratory secretions, and breathlessness through anti-inflammatory effects on mucus production.

See reference for more information

Lou K. COPD: Emerging therapies which can also palliate symptoms. Palliative Care Network of Wisconsin. Fast facts and concepts #427. Internet. Available https://www.mypcnow.org/fast-fact/copd-emerging-therapies-which-can-also-palliate-symptoms/. Accessed on June 13, 2021