Al Rizzo, MD: Finding and Treating COPD Risk


How do at-risk exacerbation patients present, and what developing therapies could benefit them?

While the global rates of asthma and chronic obstructive pulmonary disease (COPD) rise, just 1 of those respiratory conditions has a promising slate of disease-altering therapies in the pipeline.

As Al Rizzo, MD, chief medical officer of the American Lung Association, told MD Magazine®, the outlook for asthma care is more optimistic than that of COPD. What the latter needs is a better rate of initial diagnoses.

In an interview with MD Mag, Rizzo explained the common trends of patients initially presenting with COPD to their physicians, and where biologic therapy potential currently stands in the chronic condition.

MD Mag: What does the population of patients at risk of COPD exacerbations look like?

Rizzo: Well, a couple things. We know that COPD patients, by the time they presents to their physicians, it’s often about 50% of their lung function that is gone.

This goes back a little bit to a question about stigma we may have had earlier, where COPD patients don't want to go into the office and automatically say, “I'm coughing and bringing up mucus, and I'm short of breath.”

They don't want to talk about the fact that they might still be smoking. They don't want to be told to they're overweight. They don't want to be told that they're out of shape. They may be all those things, but they also may have COPD. And unless they bring that symptom to the physician's attention, they may not have a test done called a spirometry, that really defines the airway narrowing and the obstructive nature of the airway’s disease.

If it's diagnosed, it can be treated with the medications we mentioned that help control symptoms. So the best thing is, right now half the patients with COPD in this country aren't diagnosed because they haven't brought the symptoms to their physicians attention. Once they're diagnosed, we need to treat them with smoking cessation.

Vaccinations becomes very important—because as I mentioned, these individuals have comorbidities as well, but they have a higher risk of developing complications of pneumonia, influenza infections, recurrent bronchitis, and often need oral corticosteroids in a recurrent basis which could be detrimental to their long-term health as well.

MD Mag: How has the introduction of pathway-targeting biologics influenced the care of COPD?

Rizzo: Well, it’s really changed the treatment for asthma much more at this point in time. A number of the biologics that are being used in asthma have had studies or studies ongoing looking at a subset of individuals with COPD who may respond. And in particular, that may include individuals who have a high eosinophil in their blood.

It's not been approved at this point in time, as far as any biologic being indicated in that population. But as I said, there's ongoing studies of the current biologics. And there are other mediators of inflammation being looked at in the lung that may have biologics that are still in the pipeline of some of the different companies, but not available on the market today.

So I think the best thing that a COPD patient who may have an overlap with asthma—that may be an individual who would benefit from a biologic if they're continuing to be uncontrolled despite being on their inhaled bronchodilators and inhaled steroids.

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