World COPD Day: how far have we come?

Professor Pallav Shah and James Tonkin
By Professor Pallav Shah and James Tonkin     17/11/2021

For World COPD Day, Professor Pallav Shah, consultant physician in respiratory medicine, and James Tonkin, clinical fellow in respiratory medicine, explain what chronic obstructive pulmonary disease (COPD) is and highlight some of the innovative developments in the treatment of the disease, many of which have been pioneered at Royal Brompton Hospital.

What is COPD?

COPD are lung conditions that include emphysema (where air sacs in the lungs are damaged) and chronic bronchitis (inflammation of the tubes in the lungs), which often causes a restriction in the flow of air in and out of the lungs. People with COPD often have difficulty in breathing, cough and wheeze. It is often caused by smoking but also can be due to genetics, air pollution and lung infections. The diagnosis of COPD is confirmed by a lung function test called spirometry, a simple blowing test that measures how much air you can breathe out in one forced breath.

How is COPD treated/managed?

The most important thing a patient with COPD can do is stop smoking and there are a variety of services available that can support people to do this. The flu and Covid-19 vaccines are also really important for people with COPD, as they help prevent lung infections and COPD flare-ups. To help manage the symptoms of COPD, there are specific inhaler medications that can improve the flow of air in and out of the lungs, and pulmonary rehabilitation is a specialist course that includes a supervised exercise programme to improve lung function. Lastly, there are specific procedures that can be performed to help with COPD and this is an area that we specialise in here at Royal Brompton.

What advances in COPD care have you seen over the years and what do you consider to be the most significant development in COPD care/research at the moment?

One of the most significant developments in COPD has been in lung volume reduction treatments. This is a group of treatments for people with severe COPD that reduces the amount of trapped air in the lungs, leading to improvements in breathlessness and lung function.

Traditionally, lung volume reduction required surgery, whereby the most damaged part of the lung is removed. However, through research pioneered at Royal Brompton, less invasive procedures have been developed which can be performed through a bronchoscopy – where a thin tube with a camera is placed into the windpipe. Alongside bronchoscopy, there are now a variety of procedures that can be performed. For example, after successful clinical trials at Royal Brompton, ‘endobronchial valves’, a minimally invasive procedure, is now the most widely performed treatment for COPD in the UK. It works by shrinking the most damaged part of the lung through the placement of one-way valves. This allows the better parts of the lung to work more effectively and improve the overall lung function.

It is an exciting time for COPD research at the moment. There has been a great effort to develop new treatments to treat different aspects of COPD and to expand treatments to those with less severe disease. Targeted Lung Denervation is another new procedure which “zaps” a network of nerves that surround the airways. This aims to improve the flow of air in and out of the lungs during breathing and to specifically help people who suffer with COPD flare-ups. Likewise, metered dose cryospray uses a liquid nitrogen freezing spray to help people with COPD who regularly cough up phlegm. These treatments are currently going through clinical trials here at Royal Brompton Hospital.

James, what inspired you to pursue a career in respiratory care and research?

Early in my career, I remember being struck by how distressing being breathless can be for patients with lung conditions. Breathing is fundamental to everything we do, and so treatments for breathing can have a huge effect on quality of life. Working within COPD research has been a fantastic opportunity to contribute to the development of new treatments to help improve breathlessness.

And finally James, what do you enjoy most about your job?

In my job, I am very fortunate to be at the forefront of development of new treatments as they are delivered through clinical trials. Many patients come to see us feeling that there’s little than can be done for their COPD and it’s incredibly satisfying to be able to offer them a new treatment that may improve their quality of life. In the future, as more of these treatments come through clinical trials, we will have an increasing variety of treatment options and be able to offer a really personalised treatment plan to patients.