New and controversial therapies for chronic obstructive pulmonary disease

There is a medical need in chronic obstructive pulmonary disease (COPD) for novel therapies with improved anti-inflammatory activity and the potential to affect disease progression. The concept of "super bronchodilators" is currently in development. Nonsteroidal antiinflammatory approaches are now being developed and are going under investigation. Restoration of steroid sensitivity is also a potential target in COPD. This could be done by increasing HDAC-2 expression and/or activation, by decreasing p38-kinase or delta-isoform of PI3K. Disease modification that may impact on long-term health status and survival of the patient is the primary and most challenging target for novel therapy in COPD. There is need, however, for new methods and biomarkers to follow disease progression. There has been significant innovation in the nonpharmacological management of COPD including team-based approaches with collaborative self-management. Information and guidelines about self-management, coupled with interventions that provide patients with needed skills to increase their confidence, have potential impact on patient health. Recently, it has been shown that self-management programs reduce the probability of COPD hospital admissions. We should certainly be enthusiastic about these results, but there is need to increase our understanding of the relative effectiveness of specific components and how to best support COPD patients in self-management. Conceptualization of a research plan for COPD self-management is needed for future research to be successful.