As opposed to bronchial asthma, which has been well researched in the last 20 years, COPD has not been fully investigated. There is significant evidence that COPD is an inflammatory process just as is bronchial asthma, however, it seems that there are different patterns of lung inflammation in these patients. The mechanisms of baseline inflammation in COPD and inflammation during exacerbation of the disease need to be investigated and better understood. There is minimal or no information on the molecular mechanisms of inflammation in stable COPD patients. This latter issue becomes important particularly in the area of treatments. Currently, there are numerous clinical trials looking to intervene at the various inflammatory pathways.
A newer class of medications that work to reduce this inflammation is being developed. They are referred to as PDE4 inhibitors. Drugs under investigation include rolipram, piclamilast, cilomilast, and Roflumilast. These inhibitors reduce the number and the activity of the different types of inflammatory cells and inflammatory substances seen in COPD.
The concept of attempting to reduce hyperinflation is intriguing. Less invasive procedures than LVRS are being developed to reduce this air trapping. Investigational devices are being studied that are valve-like and are placed directly in the airways by bronchoscope. The effectiveness of these devices is unknown.
Another area of interest is the genetic mechanisms of why only a fraction of smokers develop emphysema. A third area of research interest is the role of nerve receptors in the lungs, which is currently the focus of final clinical trials. Finally, methods for early detection of COPD need to be refined.
