Year in Review: COPD

While outwardly 2021 was a quiet year in the field of chronic obstructive pulmonary disease (COPD), with no major research breakthroughs or new drug approvals, that doesn’t mean it can be written off as dull.

For starters, there’s the growing problem of “long COVID” — continued respiratory and other symptoms persisting for months after the infection is cleared — and the as-yet-unanswered question of how many of these patients will develop overt COPD.

But even apart from the headline-dominating pandemic, the year was not without interesting developments in COPD.

Try This One Weird Trick

An astonishingly simple and inexpensive treatment was an effective palliative for COPD patients, according to a report at September’s European Respiratory Society (ERS) meeting.

A single dose of intravenous iron improved exercise capacity by at least 33% in more than half of COPD patients in a small trial, Spanish researchers said. This level of improvement was seen in just 18% of a placebo group.

Quality-of-life scores also showed signs of improvement with the iron infusion relative to placebo, though the difference fell short of statistical significance — perhaps because only 66 patients were enrolled.

COPD patients often show iron deficiency, and in fact, serum ferritin levels had to be less than 100 ng/mL (or less than 300 ng/mL with coexisting transferrin saturation less than 20%) for patients to participate in the trial.

Exercise capacity was measured with two assessments, the 6-minute walk test and a constant work-rate exercise test.

The study’s lead researcher said the IV formulation was chosen for “logistical” reasons, but might be the preferred type of product anyway: oral supplements aren’t always well tolerated and their absorption is more variable.

How Does Triple Therapy Lower Mortality in COPD?

A new analysis of data on one of the leading “triple therapies” in COPD may help answer a long-standing question about these products, which combine an inhaled corticosteroid (ICS), long-acting beta agonist (LABA), and a long-acting muscarinic antagonist (LAMA).

The product’s pivotal trial had demonstrated 46% lower mortality risk with triple therapy versus dual LABA/LAMA and ICS/LABA inhalers. But it was unclear where specifically this reduced risk was most strongly felt.

The answer, according to a study presented at ERS: cardiovascular death. These rates were more than twice as high with LABA/LAMA as with the three-drug combination, and also higher (though to a smaller extent) with ICS/LABA. The difference was greatest in patients with relatively high eosinophil counts.

Oddly, though, there was no difference in rates of nonfatal stroke, for which the investigators had no real explanation.

Don’t Let Weight Gain After Smoking Cessation Scare You

It’s true that most smokers put on pounds after they quit, but the overall health benefit — which comes in part from lessened COPD progression — remains positive, researchers reported in April.

In a large longitudinal study, post-cessation weight gain averaged more than 3 kg relative to smokers who continued the habit.

Nevertheless, even though this gain might increase their vulnerability to metabolic disease, there was no increase in risk for cardiovascular disease or type 2 diabetes, with mean follow-up of 6 years.

And overall, risk of all-cause mortality among quitters was half that of continual smokers. The study focused on a relatively young age group, with mean age 43 at baseline.

9/11 Responders, 20 Years After

As a roundup by MedPage Today’s Sophie Putka on the tragedy’s 20th anniversary indicated, studies tracking the health of police, firefighters, and medical personnel who rushed to the World Trade Center site as the towers collapsed have confirmed that the incident led to essentially permanent lung damage for those responders.

Much of that was funded through a special “World Trade Center Health Program” set up following the attack, as the thousands of responders almost immediately began complaining of respiratory and other health problems.

For many it was “the cough,” attributed to the dust ejected skyward and for blocks around the collapsed towers, and which continued to be emitted as workers excavated the wreckage in search of survivors and bodies.

Eventually, enough people with 9/11 dust exposure developed COPD that it was added to the list of conditions qualifying for coverage under the program.

Other research this year included:

Vaping Alone May Boost Lung Troubles

Targeting Bacteria in COPD Shows Promise

‘Hot Enough for You?’ It’s No Joke for COPD Patients

Ho-Hum Oral Presentations on COPD Turn Into Fascinating Roundtable

Last Updated November 08, 2021