It’s pretty amazing to think about how quickly health care advances these days. Just in the past couple of decades, medical specialists have made significant strides with everything from mapping the human genome to improving telemedicine and even introducing robotic surgery. According to Singularity Hub, we’re likely to see medicine advance more in the next 10 years than it did in the past 100 years.
If you have a respiratory condition such as asthma, COPD, or cystic fibrosis, you might also be surprised to find that your treatment plan would have looked very different 100 years ago than it does today. Using modern testing procedures and techniques, doctors are able to provide a more accurate diagnosis than ever before and help patients plan their life accordingly.
With all that being said, the way we treat COPD will likely look very different in another 10 years than it does today. As we speak, researchers are working on a number of different medicines, tests, and surgeries that may prove to be breakthroughs in the way that we treat and diagnose one of the world’s most prevalent illnesses.
In this post, we’re going to take a look at several different emerging medical breakthroughs that COPD patients should keep an eye on in the coming years. While these procedures show promise, it’s important to remember that they’re still in a developmental stage. Currently, your best bet for reducing COPD symptoms and slowing the progression of your disease is to follow your doctor’s instructions.
Stem Cell Therapy
Stem cell therapy is possibly one of the most talked-about medical breakthroughs, not just for COPD, but also for a variety of other conditions such as macular degeneration, spinal cord injury, stroke, burns, heart disease, and more. Also known as “regenerative medicine,” the goal of stem cell therapy is to generate healthy cells in the body to replace diseased ones.
In essence, a stem cell is a sort of canvas on which all other types of cells are made. When they’re exposed to the right conditions — either in the body or in a lab — stem cells divide into “daughter cells” which are more specialized and suited to accomplish a certain task or goal. For example, white blood cells can be produced to help fight and dispose of foreign invaders in the body.
The reason there is so much talk around COPD and stem cell therapy is that COPD is a “progressive disease.” What this means is that once inflammation starts to develop in the airways of the lungs, the damage cannot be reversed. In order to slow the disease progression, you’ll need to follow a strict treatment plan created by your pulmonologist.
According to DVCStem, stem cells can repair damaged lung tissue to combat either emphysema or chronic bronchitis, the two diseases that makeup COPD. A study conducted by the Lung Institute showed a number of positive results, stating that patients “averaged an increase of 35.5% to their Quality of Life (QLS) score within three months of treatment.” It also found that 84% of patients saw an increase in their quality of life after 3 months.
However, since stem cell therapy is such a new procedure, more tests are needed to verify its efficacy using larger sample sizes and other factors such as exercise tests, hospital visits, the use of oxygen therapy, and more. Periodic patient follow-up will also help researchers better understand the long-term benefits of stem cell therapy on COPD. So far, these studies have shown no negative side-effects to using stem cell therapy.
Endoscopy is the process of inserting a tube with a camera into the body in order to view certain organs in more detail. In certain situations, health professionals may need to look inside a patient’s airways either to examine signs of damaged tissue or to take samples. This is known as a bronchoscopy.
One of the more recent advancements in endoscopy is something called an endobronchial valve (EBV). This is a small implantable medical device that can help people with lung disease (primarily emphysema) breathe easier. While endobronchial valves were approved by the U.S. Food and Drug Administration in 2018, they’re still considered a developing technology, and studies are being done to improve their efficacy.
According to the Cleveland Clinic, about 3 million people have emphysema in the United States. It’s one of the diseases under the umbrella term “COPD” and it’s characterized by swollen and damaged alveoli, the tiny air sacs in the lung that are responsible for the transfer of oxygen and carbon dioxide to and from the blood.
One of the primary symptoms of emphysema is breathlessness. As the air sacs in the lungs become inflamed, they lose a lot of their elasticity and they begin to trap air inside the lungs. This stagnant air, also known as “dead-space ventilation,” prevents new, oxygen-rich air from entering the lungs making it very difficult to get the oxygen your body needs.
While it may sound counterintuitive, endobronchial valves actually block off a portion of the lungs that are most damaged by emphysema. By doing so, medical professionals can actually improve the mechanical efficiency of the lungs meaning it will take less energy and effort to breathe. Endobronchial valves are one-way, meaning inspired air is redirected to healthy parts of the lungs but carbon dioxide-rich air is still able to escape from the damaged part.
One of the greatest benefits of endobronchial valves is that they are an effective alternative to other more invasive procedures such as lung volume reduction surgery and lung transplant surgery. Lung volume reduction is a procedure that surgically removes the damaged tissue in the lungs while lung transplants are a full replacement of both lungs. Either way, these procedures are extremely invasive and they can be very costly as well.
With that being said, endobronchial valves are not without their problems as well. While they have been proven to increase Forced Expiratory Volume (FEV1) for many patients, there isn’t enough information to verify its efficacy for all patients. The number one complication associated with these valves is pneumothorax, a condition where the lungs partially or fully collapse. The good news is that endobronchial valves can be quickly and easily removed if this risk is identified.
There are several other implantable medical devices that can be used for lung volume reduction in emphysema patients. Endobronchial coils, for example, are implanted through a similar process as endobronchial valves, and they’re intended to prevent hyperinflation of the lungs. Intrabronchial valves are another device with a similar function to endobronchial valves but they’re typically used to manage post-operative air leaks and allow mucus to clear correctly.
Targeted Lung Denervation (TLD)
Targeted lung denervation is another type of bronchoscopic therapy that can be used to treat COPD. During this procedure, a specialized catheter is inserted into the main bronchial pathway. At the end of this catheter is an electrode that emits RF frequency. Ultimately, the goal is to interrupt nerve transmissions which has a permanent bronchodilatory effect. It also reduces mucus production and decreases airway inflammation through the reduction of acetylcholine. This neurotransmitter is known to affect mucus secretion, inflammation, and muscle tone.
According to studies published in Healio, a medical journal, targeted lung denervation is associated with a lower risk of COPD exacerbation and lower hospital admittance after a 1-year period. Another study found that targeted lung denervation therapy was just as effective as long-acted inhaled anticholinergic therapy (drugs that block these neurotransmitters) and there were no noted adverse side-effects either. We’ll likely need to see more thorough studies of this procedure before it becomes a major treatment option for COPD patients.
Bronchoscopy Thermal Vapor Ablation (BTVA)
Yet another lung volume reduction technique, bronchoscopy thermal vapor ablation helps to limit hyperinflation in emphysema patients. Studies have shown that this method can be particularly useful in treating patients with upper lobe-predominant emphysema by improving lung function, exercise capacity, and quality of life.
Prior to the procedure, medical specialists will use a specialized program that’s designed to target the most emphysemic areas of the lungs. Once these areas are located, a catheter is applied that delivers heated water vapor. This results in a thermal reaction and immune response which leads to permanent fibrosis and atelectasis. This has a similar effect to other lung volume reduction techniques by reducing tissue and air volume and improving lung mechanics.
Typically, BTVA is done under deep sedation or general anesthesia and patients are monitored for a minimum of 24 hours after the procedure. Periodic checkups are advised for at least three to six months after the procedure to ensure no complications occur. While future studies are needed, BTVA has been proven to have a favorable benefit-risk in patients with heterogeneous emphysema.
Not all bronchoscopy therapies are aimed at lung volume reduction. Bronchial rhinoplasty, for example, is used for patients with chronic bronchitis who are experiencing increased mucus production. Mucus can be a serious problem for COPD patients because the cilia which typically clear mucus from the airways is usually impaired or damaged due to chronic inflammation. Additionally, many patients, especially those with stage 3 or stage 4 COPD, are unable to perform mucus clearing techniques such as huff cough.
Bronchial rhinoplasty is a procedure that involves targeting cells that are producing excess mucus and applying electrical currents. This results in mucus-producing cells dying off and being replaced with healthier ones. In the fall of 2019, the RheOx Bronchial Rheoplasty system was granted Breakthrough Device Designation by the FDA, representing a significant step forward for bronchial rhinoplasty.
Robotic Lung Volume Reduction Surgery
In early 2019, the first-ever robotic lung volume reduction surgery was performed in Northwestern Memorial Hospital using the da Vinci Xi Surgical System. This system was developed by Intuitive, a company that’s been at the forefront of surgical robotics for over 20 years.
The reason this is such a significant breakthrough is that it is far less invasive than traditional lung volume reduction surgery. According to OR Today, RLVRS requires only three 8-millimeter incisions on the chest in order to remove damaged tissue in the lungs. This is much smaller than the incision required in the traditional surgery meaning it can effectively reduce scarring and pain for the patient.
Another benefit of robotic surgery is that it significantly reduces the risk of collateral damage. According to the Journal of Robotic Surgery, robotic surgery provides surgeons with a number of benefits over traditional surgery like improved depth perception and steadier incisions. Robotic surgery enables surgeons to work around tissues or organs rather than having to cut through them.
Interleukin-5 (IL-5) Antagonists
Oftentimes, standard COPD treatment options don’t work on certain patients. In this case, doctors need to perform more tests in order to better understand their condition. For example, your doctor can use blood tests to determine if you have eosinophilia or not. This results when there are a high number of white blood cells called eosinophils in your blood. According to this report, one-third of all COPD patients show signs of eosinophilia.
The problem with a high eosinophil count is that it is likely a significant contributor to airway inflammation. They have been associated with an increased risk of exacerbations as well as reduced lung function in both COPD and asthma patients. Interleukin-5 (IL-5) antagonists are a developing class of drugs that are specifically designed to target the IL-5 receptor in the body, thus reducing the release of eosinophils.
Like with most of the therapies on this list, we will need to see more evidence before IL-5 antagonists become a major part of COPD treatment plans. IL-5s have been used to treat asthma for several years, but we don’t have a significant enough body of evidence to prove its efficacy and safety when treating COPD.
As you can see, there are a number of exciting medical breakthroughs for emphysema and chronic bronchitis patients to follow. In the past, respiratory patients have typically been prescribed a standardized treatment plan. However, with more advanced testing methods, doctors are able to divide their patients into smaller groups with more specialized treatment regimens.
Whether you’ve just been diagnosed with COPD or you’re well-acquainted with your COPD treatment plan, it’s worth addressing these new therapies with your doctor. There may be additional opportunities for further testing, allowing you to better understand your disease and benefit from treatments that are not yet widely available. Clinicaltrials.gov is another great resource if you’d like to learn about getting involved with new therapies and medications.