Inflammation in chronic obstructive pulmonary disease: implications for new treatment strategies

Chronic obstructive pulmonary disease (COPD) is a treatable and preventable disease but current predictions are that it will continue to rise as an important cause of mortality and morbidity worldwide. COPD is a complex inflammatory disease with both airway and parenchymal lung injury. Currently there is growing recognition that the inflammatory response extends beyond the lung, with evidence of systemic inflammation, which may account for the multi-organ effects associated with COPD. Early diagnosis and timely therapeutic intervention are likely to make a significant contribution to tackling this disease. Smoking cessation remains the single most effective means of preventing lung function decline and reducing mortality. At present, no currently available drugs have been shown to slow the progression of the disease. Pharmacological treatment has focused largely on symptomatic relief and short-acting bronchodilators have been the mainstay therapy. Long-acting beta-2 agonists and anti-cholinergics have provided additional benefit and anti-inflammatory agents such as inhaled corticosteroids and theophylline seem to offer benefit in selected patients. Combinations of the different classes of treatment, particularly in the same inhaler device, seem to confer particular advantage with improvements in symptoms, exercise capacity, health status and reductions in exacerbations. More research is needed to unravel the important cellular and molecular processes involved in the pathophysiology of COPD and ultimately to develop new and more effective forms of therapy.