World Chronic Obstructive Lung Disease (COPD) Day is an annual event organised by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) to raise awareness of COPD, and to improve treatment and prevention of this lung disease for patients around the world.

The first World COPD Day was held in 2002 and now each year more than 50 countries worldwide participate making the day one of the world's most important COPD awareness and education events. Raising awareness of COPD is an important part of COPD day. Although COPD is one of the most common respiratory diseases with more than 3 million people living with the disease in the UK,2 many people are not familiar with symptoms, prevention or treatment and are unware of the impact that COPD can have on a patient’s quality of life.

This year, World COPD Day 2015 will take place on Wednesday 18th November 2015 around the theme "It's Not Too Late." The theme encourages everyone who is affected by COPD (undiagnosed people with symptoms of COPD, patients with diagnosed COPD, and doctors that care for patients with the disease) that it is not too late to address the impact that COPD has on their daily lives, and to look for ways in which their quality of life can be improved. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines GOLD was launched in 1997 in collaboration with the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization.1

GOLD is working to raise awareness of COPD and improve the lives of people with this disease through the development of evidence-based strategy documents and guidelines for the diagnosis, prevention and management of COPD. The GOLD guidelines for COPD care were initially developed and continue to be updated by committees made up of leading experts from around the world. What is COPD? According to the latest GOLD strategy document for the diagnosis, management and prevention of COPD, it is a ‘common preventable and treatable disease, characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.’3 There is no cure for COPD, but treatment can help slow the progression of the disease and reduce symptoms maintaining a good quality of life.

The main cause of COPD is smoking and the likelihood of developing COPD is known to increase according to the number of years and the quantity of tobacco the patient has smoked.2 Over many years, the inflammation caused by smoking leads to permanent changes in the lung causing the walls of the airways to thicken and the amount of mucus produced to increase. Damage to the delicate walls of the air sacs in the lungs causes emphysema and the lungs lose their normal elasticity. The smaller airways also become scarred and narrowed. These changes cause the symptoms of breathlessness, cough and phlegm that are associated with COPD.

Whilst preventing and quitting smoking is the obvious route to reducing the incidence of COPD, many patients find this very difficult. In addition, it is likely that the inflammatory process initiated by cigarette smoking may continue even when smoking has ceased.4 Current therapies for COPD Bronchodilators are a mainstay of treatment for COPD and are most commonly given by inhalation. Inhaled corticosteroids (ICS) are another COPD treatment used to reduce inflammation in the lungs. If the patient’s symptoms are not completely controlled with bronchodilators alone, ICS may be recommended in combination with a long-acting bronchodilator (LABA). Common combinations include fluticasone proprionate/salmeterol and budesonide/formoterol, which are taken twice-daily, and fluticasone furoate/vilanterol, which is taken once-daily.5 Overuse of inhaled corticosteroids?

The treatment guidelines set out by GOLD1 have suggested that an ICS should only be prescribed after single and combination bronchodilator treatment has failed. Despite these recommendations it is thought that the use of ICS in COPD patients is generally greater than 70%, and concerns have been raised over the potential adverse effects of long-term ICS use. Interestingly, no advantage in adding ICS to bronchodilator therapy in patients at low risk of exacerbations has been observed. If the patient has had exacerbations but is clinically stable then ICS can be stopped, provided the patient is using appropriate LABA treatment.6 In patients exclusively using LABAs to treat their COPD, studies so far have suggested that there is no loss of effectiveness in the occurrence of exacerbations, although lung function may be reduced, particularly amongst patients with severe COPD. 7

The management of COPD could therefore be improved by limiting the use of ICS to the minority who might actually benefit; in particular COPD patients with asthma–COPD overlap syndrome and those with the more severe form of the disease.6 Novel treatment approaches for COPD Phenotyping and personalised medicine The latest GOLD guidelines do not fully reflect the heterogeneous nature of the disease, but instead represent a progress in the personalised treatment of COPD. Personalised treatment is increasingly being recognised as the most appropriate way to treat COPD, as patients can experience a number of symptoms ranging from mild to severe. The complexity of the disorder also creates an individual response to the currently available COPD treatments and there is growing evidence to suggest that different COPD patients with very similar pulmonary function measurements experience COPD differently.8 The two most commonly recognised clinical phenotypes of COPD are emphysema and chronic bronchitis, with the majority of COPD patients exhibiting both of these features.9 Recent advances in thoracic X-ray computed tomography and magnetic resonance imaging mean that lung structure and function abnormalities can now be identified and measured. These imaging endpoints may be used as biomarkers of COPD that can be used to phenotype and treat patients’ accordingly.8 Genetic background, clinical presentation, comorbidities, variation in the response to treatment and propensity to exacerbations may also identify other phenotypes such as frequent exacerbators, asthma and COPD overlap syndrome and the persistent systemic inflammation phenotype.

A more precise definition of COPD phenotypes should lead to a better targeted therapeutic approach.9 Due to the complexity of COPD there is much scope for the development of new therapies, and here we have outlined some of the latest research and treatments. The prevalence of COPD is increasing worldwide together with the burden of health-care costs. Better understanding and awareness of COPD is crucial to help to reduce the numbers of newly diagnosed COPD cases each year.

Furthermore, novel treatment approaches will contribute to a better quality of life for COPD patients and will reduce morbidity.

References: 1. http://www.goldcopd.org/ (accessed November 2015). 2. http://www.nhs.uk/conditions/Chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx (accessed November 2015). 3. http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html (accessed November 2015) 4. Rutgers S.R., Postma D.S., ten Hacken N.H. et al. Ongoing airway inflammation in patients with COPD who do not currently smoke. Thorax 2000;55:12–8. 5. http://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-copd-treatments-beyondthe-basics (accessed November 2015). 6. Calverley P. Knowing when to stop: inhaled corticosteroids and COPD. Eur Respir J. 2015 Nov;46(5):1236- 8. 7. Suissa S. and Rossi A. Weaning from inhaled corticosteroids in COPD: the evidence. Eur Respir J. 2015 Nov;46(5): 1232-5. 8. Sheikh K, Coxson H.O. and Parraga G. This is what COPD looks like. Respirology. 2015 Aug 26. (Epub ahead of print). 9. Corhay J.L. Personalized medicine: chronic obstructive pulmonary disease treatment. Rev Med Liege. 2015 May-Jun;70(5-6):310-5