Lung disease: optimal treatment for people with COPD
Chronic obstructive pulmonary disease (COPD), also known colloquially as smoker’s cough or smoker’s lung, is a progressive and so far incurable disease of the lungs. Thanks to new knowledge, those affected can be treated better in the future.
People with COPD are given drugs to improve breathing combined with corticosteroids, which reduce the risk of acute lung deterioration. The balance between this reduction and the increase in harmful side effects depends on the dosage and characteristics of the sick, as researchers from the University of Zurich are now showing. Thanks to the new findings, COPD sufferers can be treated more specifically.
Permanent narrowing of the airways
As explained in a current communication from the University of Zurich (UZH), patients with chronic obstructive pulmonary disease (COPD) suffer from permanent narrowing of the airways, which makes breathing difficult.
This narrowing is caused by inflammation of the small airways, which leads to the production of mucus and destroys lung tissue. Inhalation corticosteroids are usually used in combination with long-acting bronchodilators to prevent acute worsening of the lungs in people with COPD.
While corticosteroids reduce inflammation or deterioration, bronchodilators improve breathing by widening the bronchi.
Harmful side effects
The use of corticosteroids in the very heterogeneous group of COPD patients has been debated for years. A personalized treatment approach is suggested in guidelines, but these remain rather vague because it is unclear for whom the benefits outweigh the harmful side effects.
A study published in the journal “The Lancet Digital Health” under the direction of Henock Yebyo, postdoc at the Institute for Epidemiology, Biostatistics and Prevention at UZH, now sheds light on this question.
“Our results show that three main factors influence the balance between therapeutic benefits and side effects of different doses of corticosteroids: the risk of acute deterioration, the amount of certain blood cells and the age of the patient,” explains lead author Yebyo.
The scientists took into account numerous characteristics of therapies and patients that have an impact on the risk-benefit ratio.
The researchers carried out extensive statistical analyzes in order to calculate how high the risk of acute deterioration must be for the patient so that the benefit of reducing this risk outweighs the side effects: severe pneumonia, fungal infection of the oral mucosa and hoarseness.
They found that sufferers from low-to-medium-dose corticosteroids did not benefit if their risk of acute deterioration in the next two years was less than 32 percent. What are typically those affected whose lung condition has been stable in the past.
The dosage of the corticosteroids has not yet been considered in the guidelines. The new study now clearly shows that high doses are associated with significant side effects that do not justify the benefits.
Patients over 80 years of age hardly benefit from the therapy either, since their risk of developing pneumonia is higher than the reduction in acute deterioration. Sick people with larger amounts of certain blood cells typical of asthma – so-called eosinophils – are more likely to benefit.
“Clear and useful recommendations”
When the researchers checked their results on the basis of data from two groups of patients from Switzerland and the Netherlands, it was found that some patients are over-treated with corticosteroids while others are under-treated.
“Our results do not necessarily lead to fewer corticosteroids being used. But they help to minimize over- and undersupply by tailoring the therapy in terms of dosage and patient characteristics, ”explains Henock Yebyo.
Precision medicine is often reduced to a single factor such as a genetic marker, but the reality is usually more complicated.
With their systematic approach, the scientists considered three categories of factors that influence the treatment outcome and combined them comprehensively: factors that change treatment effects, factors that are associated with the risks of benefits and side effects without treatment, and patient preferences.
“Our study serves as an example of how the complexity of the benefit-harm balance can be approached systematically so that medical guidelines can provide clear and useful recommendations for personalized treatments,” says UZH Professor Milo Puhan. (ad)
Author and source information
This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.
- University of Zurich: Optimal treatment of patients with chronic lung disease, (accessed: 08/25/2021), University of Zurich
- Yebyo HG, Braun J, Menges D, Riet Gt, Sadatsafavi M, Puhan MA: Personalising add-on treatment with inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a benefit-harm modelling study; in: The Lancet Digital Health, (veröffentlicht: 25.08.2021), The Lancet Digital Health
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.