Chronic obstructive pulmonary disease, commonly called COPD, is one of the leading causes of illness and death worldwide. The disease slowly damages the lungs, making it increasingly difficult to breathe.
Many people with COPD experience daily coughing, excess mucus, tiredness, and shortness of breath. Over time, simple activities such as walking, climbing stairs, or playing with grandchildren can become challenging.
Although medicines and inhalers can help control symptoms, there is no cure, and many patients continue to suffer repeated flare-ups that often require hospital treatment.
Researchers from King’s College London have now helped bring a new treatment into routine care that could improve the lives of some people living with COPD.
Patients at Guy’s and St Thomas’ NHS Foundation Trust have become the first people in the UK to receive dupilumab injections for COPD after the treatment was recommended by NICE earlier this year. The development follows many years of research and represents an important milestone in treating a specific type of COPD.
Unlike standard inhalers, dupilumab targets the underlying inflammation that drives disease in some patients. The medicine is designed for people whose COPD is linked to high levels of eosinophils, a type of white blood cell involved in inflammation. Scientists estimate this form of COPD affects around 80 million people worldwide.
Current COPD medicines mainly open the airways or broadly reduce inflammation. However, they do not work equally well for everyone. Dupilumab blocks two proteins, called IL-4 and IL-13, that play important roles in inflammation.
By reducing this inflammatory response, the medicine helps decrease swelling and mucus inside the airways, making breathing easier and lowering the risk of severe flare-ups.
Large clinical trials showed that dupilumab reduced COPD exacerbations by around 30% to 34% each year. These flare-ups can be serious because they often lead to emergency hospital visits, extra steroid treatment, permanent lung damage, and sometimes death.
Patients receive the injection every two weeks. After the first hospital treatment, many will be taught to inject themselves at home using a pen device similar to insulin pens used by people with diabetes. Doctors will monitor patients over the following year to assess whether the medicine continues to improve their symptoms.
The research builds on more than 20 years of work by Professor Mona Bafadhel and colleagues, who helped identify the important role of eosinophils in COPD. Their discoveries made it possible to identify patients most likely to benefit from targeted treatment.
Review and analysis: This represents an important advance because it introduces precision medicine into COPD treatment. Rather than treating all patients the same way, doctors can now identify a subgroup who may respond particularly well.
However, dupilumab is not suitable for every person with COPD, and long-term effectiveness and cost-effectiveness will continue to be evaluated in routine practice. Even so, reducing flare-ups by about one-third could improve quality of life, reduce hospital admissions, and lower pressure on healthcare systems.
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Source: King’s College London.
