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ISSN: 2161-105X
Journal of Pulmonary & Respiratory Medicine
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Treatments Based on Phenotypic Variants in Chronic Obstructive Pulmonary Disease

Kamyar Afshar*

Division of Pulmonary and Critical Care, University of Southern California, Keck School of Medicine, USA

*Corresponding Author:
Kamyar Afshar
Assistant Professor of Clinical Medicine
Division of Pulmonary and Critical Care
University of Southern California, Keck School of Medicine
2020 Zonal Ave, IRD 723, Los Angeles, CA 90033, USA
Tel: 323-226-7923
Fax: 323-226-2873
E-mail: [email protected]

Received date: June 03, 2013; Accepted date: June 05, 2013; Published date: June 07, 2013

Citation: Afshar K (2013) Treatments Based on Phenotypic Variants in Chronic Obstructive Pulmonary Disease. J Pulm Respir Med 3:e128. doi: 10.4172/2161-105X. 1000e128

Copyright: © 2013 Afshar K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Referring physicians may ask, “My patient with COPD is on her inhalers, so why does she continue to complain of worsened shortness of breath?”

Chronic Obstructive Pulmonary Disease (COPD) is characterized by progressive airflow limitation that is not fully reversible. Patients are stratified into low and high risk based on severity of airflow limitation (GOLD stages) and/or number of annual exacerbations [1]. Although COPD is the fourth leading cause of death, it is still underdiagnosed and frequently misunderstood [2,3]. Even when individuals have been diagnosed appropriately with COPD, the phenotypic variants (eg. emphysema, chronic bronchitis, etc.) may not be fully appreciated. Even within the same phenotypes, there is heterogeneity with symptomatology, physiological parameters and radiographic appearance. Ultimately, this may lead to sub-optimal management resulting in increased rate of exacerbations, disease progression and ultimately death.

Evaluation of the overall health of a COPD patient is shifting focus towards utilizing both subjective (St. George’s respiratory questionnaire, COPD Assessment Test, modified Medical Research Council (MMRC) dyspnea scale) and objective physiological parameters (spirometry, lung volumes, diffusion capacity, 6-minute walk distance) [4]. This provides anintegrated evaluation of symptom burden and risk of exacerbation and mortality.

There is ample evidence for the association of COPD exacerbations and decline in lung function [5]. Importantly, it has been shown that successive severe exacerbations are more frequent, intervals between exacerbations are less (“clustering of exacerbations”) and severity of the exacerbation increases following the first severe exacerbation [6]. The major contributing risk factor for frequent exacerbations in all GOLD stages is a history of exacerbation [7]. Therefore, key strategy to successful management of COPD is a concerted effort to reduce exacerbation rates.

A number of trials have evaluated therapies to either reduce decline in lung function or reduce exacerbation rates [8-12]. However, trends in lung function decline were not significantly better in the treatment groups compared to the placebo group. With respect to the UPLIFT and TORCH studies, the treatment groups did have a 14-16% reduction in exacerbation rates. A potential criticism of these studies is that all phenotypes were lumped together for analysis. Future studies will most likely delve into therapeutic benefits in specific sub-populations.

Nonetheless, general recommendations remain to counsel patients on tobacco cessation, remainupdated on immunizations, enroll in pulmonary rehabilitation and be on combination therapy with a long acting β2 - agonist (LABA), Long Acting Muscarinic Antagonists (LAMA) and inhaled corticosteroids [1]. However, not all COPD is the same and perhaps should not be treated the same.This may be illustrated by the studies withroflumilast.Roflumilast, a phosphodiesterase-4 inhibitor, reduces airway inflammation. In two randomized clinical trials in a bronchitic COPD phenotype, comparing roflumilast 500 μg once daily to placebo over a 52-week period, FEV1, FVC and mid-flow volumes improved along with a 16% reduction in exacerbations [13,14]. These effects were independent of concomitant inhalation medications or smoking status.

With respect to α1-antitrypsin (AAT) deficiency, augmentation therapy is an additional therapeutic regimen that has been evaluated, but not administered consistently. Augmentation therapy is recommended in patients with α1-antitrypsin (AAT) deficiency with s serum AAT level11.0 μM and FEV1 between 25-30% predicted at the lower limits and 65-80% predicted at the upper limits [15,16]. Although treatment with augmentation therapy has not reduced lung function deterioration, or frequency of exacerbation, it has reduced the severity of exacerbations [17]. An additional randomized controlled trial addressing the question of mortality benefits with augmentation therapy has recently ended enrollment and we look forward to results [18].

Lung volume reduction surgery has been a therapeutic option in selected patients with heterogenous lung involvement in emphysema. It improves dyspnea, lung function, exercise tolerance and prolongs life in selected patients [19]. It is not benign however. Perioperative death and post-operative complications have lead to less invasive procedures to allow for similar benefits while minimizing risks [20,21]. Endobronchial one-way valves (EBV) are being utilized to achieve similar goals without the need to undergo surgery. EBVs are reserved for advanced heterogenous emphysema. Successful placement of EBVshas been shown to improve lung function, dyspnea and exercise tolerance, but exacerbation episodes were more frequent post procedure compared to the control group who received standard medical therapy [22]. It has been proposed that the EBV itself may not be the contributing factor to developing an exacerbation as much as self-discontinuation of inhalation therapies.

In summary, it is proven that pulmonary rehabilitation, smoking cessation and preventive immunizations are beneficial in all sub-types of COPD. We know that exacerbations greatly contribute to disease progression, increase subsequent exacerbation severity and frequency, profoundly limit functional capacity and increase mortality.Future trials require re-evaluation of the currently recommended combination therapies with LAMA, LABA and ICS in specific subpopulations. A number of considerations should be taken into account when evaluating the status of the COPD patient. Most important, health care providers should be proactive in identifying the COPD phenotype and make attempts to limit exacerbation events based on targeted therapies. Hopefully molecular profiling can also assist us in identifying COPD subtypes to better provide targeted therapies.

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  1. Judith
    Posted on Feb 13 2017 at 9:39 pm
    (MUST READ: COPD TREATMENT) I am Judith Hall from Portland, Oregon, USA. I was diagnosed of COPD/Emphysema in Providence St. Vincent Medical Center in 2014. In August 2016 my condition worsened and my doctor adviced me for Lung volume reduction surgery to remove part of my lungs, making room for the rest of the lung to work better, considering the risk involved i was scared and i resorted online for help, I was in a health website when i read a testimony of a woman from Canada who was totally cured of COPD through the herbal remedy she purchased from a herbal clinic in South Africa, i immediately contacted this herbal clinic via their website and purchased the COPD herbal remedy, i received the herbal remedy within 7 days via courier service and commenced usage. After four weeks and two days of usage, i did another lungs function test and CT scan to be sure, my doctor confirmed my airway are repaired, Thank you Health herbal clinic. Contact this herbal clinic via their website www.healthherbalclinic.weebly.com, email: [email protected]
  2. joan
    Posted on Jan 17 2017 at 12:33 pm
    (MUST READ: COPD TREATMENT) I am Joan Barragan from Portland, Oregon, USA. I was diagnosed of COPD/Emphysema in Providence St. Vincent Medical Center in 2014. In August 2016 my condition worsened and my doctor adviced me for Lung volume reduction surgery to remove part of my lungs, making room for the rest of the lung to work better, considering the risk involved i was scared and i resorted online for help, I was in a health website when i read a testimony of a woman from Canada who was totally cured of COPD through the herbal remedy she purchased from a herbal clinic in South Africa, i immediately contacted this herbal clinic via their website and purchased the COPD herbal remedy, i received the herbal remedy within 7 days via courier service and commenced usage. After four weeks and two days of usage, I did another breathing test and my doctor confirmed my lungs were repaired. Thank you Health herbal clinic. Contact this herbal clinic via their website www.healthherbalclinic.weebly.com, email: [email protected]
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    WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David Clara I’m a citizen of United Kingdom, My younger sister was sicking of breast cancer and her name is David Sandra I and my family have taking her to all kind of hospital in UK still yet no good result. I decided to go to the internet and search for cancer cure so that was how I find a lady called peter Lizzy she was testifies to the world about the goodness of a herbal man who has the root and half to cure all kind of disease and the herbal man email was there. So I decided to contact the herbal man for my younger sister help to cure her breast cancer. I contacted him and told him my problem he told me that I should not worry that my sister cancer will be cure, he told me that there is a medicine that he is going to give me that I will cook it and give it to my sister to drink for one week, so I ask how can I receive the cure that I am in UK, he told me That I will pay for the delivery service. The courier service can transport it to me so he told me the amount I will pay, so my dad paid for the delivery fee. two days later I receive the cure from the courier service so I used it as the herbal man instructed me to, before the week complete my sister cancer was healed and it was like a dream to me not knowing that it was physical I and my family were very happy about the miracle of Doctor so my dad wanted to pay him 5 million us dollars the herbal man did not accept the offer from my dad, but I don't know why he didn't accept the offer, he only say that I should tell the world about him and his miracle he perform so am now here to tell the world about him if you or your relative is having any kind of disease that you can't get from the hospital please contact [email protected] for the cure, he will help you out with the problem. And if you need more information about the doctor you can mail me [email protected]
  5. Dr. Ayes
    Posted on Jan 07 2017 at 4:05 am
    I was diagnosed of COPD in July 2016. I was on Albuterol Nebs and levalbuterol to ease the situation as i constantly go out of breath when talking or when walking, I was adviced for Lung Volume reduction surgery (LVRS) because my both upper lobes of the lungs were affected, i was making preparation for this surgery when a friend of mine told me about a traditional herbal doctor called doctor Ayes who prepares herbal medicine to cure all kind of diseases including COPD disease, When i contacted Dr Ayes his email and bought the herbal medicine I received the herbal medicine through courier service in 3days, when i received this herbal medicine i used it as prescribed and was totally cured of COPD within 18-20 days of usage, he is able to cure any kinds of disease such as 1. Diarrheal Diseases,2. HERPES 1/2,3. CANCER,4. ALS (Lou Gehrig’s disease),5. Herpatitis B,6.chronic pancreatitis,7.Emphysema,8.COPD (Chronic Obstructive Pulmonary Disease),9.asthma,10.Acute angle-closure Glaucoma,11.CHRONIC PANCREATITIS,12. Preterm Birth contact Dr Ayes via his email: [email protected]
  6. alexes
    Posted on Jan 05 2017 at 4:49 am
    (MUST READ) I am Alexes Hayden, i purchased chronic obstructive pulmonary disease (COPD/Emphysema) herbal remedy from a herbal health clinic in South Africa (NewLife Herbal clinic), it really helped me. I was diagnosed of COPD in Elisabeth-bruyère Hospital Ottawa Canada in August 2014. In June 2016, I had COPD exacerbation, my condition worsened and the doctors could not help me, the Flovent HFA and antibiotics prescribed stopped working, it was a terrible experience i had, so my wife reached out for an alternative treatment. My wife's co-worker who had initially bought pulmonary fibrosis herbal remedy from New Life herbal clinic referred us to them for help. We contacted them via their website (www.newlifeherbalclinic.weebly.com) and purchased the COPD herbal remedy, i immediately commenced usage as soon as i received it, it worked miraculously, my airways are repaired. Visit www.newlifeherbalclinic.weebly.com or email [email protected] I did promised i will post my experience as many forums as possible if i am cured
  7. alexes
    Posted on Jan 02 2017 at 10:52 pm
    (MUST READ) I am Alexes Hayden, i purchased chronic obstructive pulmonary disease (COPD) herbal remedy from a herbal health clinic in South Africa (NewLife Herbal clinic), it really helped me. I was diagnosed of COPD in Elisabeth-bruyère Hospital Ottawa Canada in August 2014. In June 2016, I had COPD exacerbation, my condition worsened and the doctors could not help me, the Flovent HFA and antibiotics prescribed stopped working, it was a terrible experience i had, so my wife reached out for an alternative treatment. My wife's co-worker who had initially bought pulmonary fibrosis herbal remedy from New Life herbal clinic referred us to them for help. We contacted them via their website (www.newlifeherbalclinic.weebly.com) and purchased the COPD herbal remedy, i immediately commenced usage as soon as i received it, it worked miraculously, my airways are repaired. Visit www.newlifeherbalclinic.weebly.com or email [email protected] I did promised i will post my experience as many forums as possible if i am cured
  8. Robert Williams
    Posted on Dec 23 2016 at 3:37 am
    HOW I GOT CURED OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE BY DOCTOR ODI I was diagnosed of Chronic Obstructive Pulmonary Disease (COPD) 2 years ago, my family doctor told me there is no cure but it can only be controlled. Ever since then i have been looking for a solution to my problem because i was going to lose my Job if i dont get better, Until i ran into this online testimony of Mrs Sarah who have been cured of COPD by this herbal clinic in Africa (Dr. Odi Herbal Home), i immediately contacted them via their email. To God be thy glory, i bought this COPD herbal remedy and was cured within 3 weeks of usage, To those who need a cure to COPD, this is a breakthrough for all COPD patients contact this herbal doctor via his email [email protected] or call +2348115531558
  9. jennifer snoddy
    Posted on Dec 11 2016 at 4:24 pm
    How can I explain this to the world that there is a man who can cure COPD, I was diagnosed for the past 9years I have being into COPD drug since then,so I decide to look for help in the internet then I found this woman post write about this great man Dr.Abumere, telling people about him that this man have cured to COPD I don’t believe that because all I have in mind is COPD had no cure,thank god for my life today am COPD negative through the power of Dr.Abumere, I contacted this man for help because who write about him drop an email of the man I pick the email and emailed him for the cure this man told me what to do about the cure well am from Philadelphia so i bought the medicine from him,he deliver it to me without wasting any time because he told me my health is so much important to him,so i receive the herbal remedies on the address given to him,so i go with the instruction given to me,truly i went for check up which the doctor told me that am fully cured he was also surprise because i told him about this great doctor tho he never believed him,I'm a great testimony of it so i assure you that once you use his herbal medicine you shall be one,you can simply email him and follow the instruction given to you. Email address :[email protected] thank you Dr i will never stop sharing you testimony
  10. Mary
    Posted on Dec 06 2016 at 3:47 pm
    I smoked for thirty years, then over a dozen years ago, I thought I had come down with a very bad case of pneumonia. After my wife nagged me for a week, I finally saw the doctor. I was diagnosed with severe COPD. They were amazed that I had waited so long, years in fact, before going to a doctor over it. They gave me three years tops before it killed me. That was thirteen years ago and I am still living. I don't do much, because I no longer have the ability. I can no longer walk, am always hooked up to an oxygen air line, and my body is starting to shut down. There are times that I can't remember my wife's name, even though we have been married for nearly forty years. Truth be told, there are times that I truly wish I had died years ago when I could still walk, talk, play with my grandkids, but GOD decided that it might be better for me to live a bit longer. My wife asks me, when I am having a bad day, if I want to go to the hospital. I always decline, reminding her that I do not want to die in the hospital, but to die at home with the people that I love most. Hospitals can no longer do anything good for me. Even Duke Hospital admits that they do not know why I am still living. GOD purpose will eventually be known until i found testimonies of Great Dr. Lusanda in an online research and on Facebook, Like anybody would be, I was very skeptical about contacting him, but i later did email him and he started the remedies for my health. Thank God, i am cured from COPD by the herbal medication I received from him. I never thought that COPD can be cured, from the bottom of my heart I’m truly grateful,i pray you have long life so you can help many more people on earth with your herbal medical support. Contact Lusanda today, Email: drlusandaherbal(AT)gmail(dot)com or website on www(DOT)drlusandaherbal(DOT)com
  11. Mr Alexander Francisco
    Posted on Oct 13 2016 at 1:07 am
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  12. Derek Taylor
    Posted on Sep 20 2016 at 8:53 am
    I was diagnosed of COPD in July 2014. I was on Albuterol Nebs and levalbuterol to ease the situation as i constantly go out of breath when talking or when walking, I was adviced for Lung Volume reduction surgery (LVRS) because my both upper lobes of the lungs were affected, i was making preparation for this surgery when a friend of mine told me about a traditional herbal doctor called doctor Abumere who prepares herbal medicine to cure all kind of diseases including COPD disease, When i contacted Dr Abumere his email and bought the herbal medicine I received the herbal medicine through courier service in 3days, when i received this herbal medicine i used it as prescribed and was totally cured of COPD within 18-20 days of usage, he is able to cure any kinds of disease such as 1. Diarrheal Diseases,2. HERPES 1/2,3. CANCER,4. ALS (Lou Gehrig’s disease),5. Herpatitis B,6.chronic pancreatitis,7.Emphysema,8.COPD (Chronic Obstructive Pulmonary Disease),9.asthma,10.Acute angle-closure Glaucoma,11.CHRONIC PANCREATITIS,12. Preterm Birth contact Dr Abumere via his email: [email protected]
  13. christo elandri
    Posted on Sep 10 2016 at 4:10 am
    I appreciate the wonderful work done by doctor prince in taking the shame away from my life, for more than 12 years i have been terribly infected with HIV/AIDS this devious disease was so bad that it almost took my dignity and inability to do what i was ought to be doing as a man, i visited several places all told me that i can’t be cured, but i believed that one day i will regain my life back to it normal state, one certain afternoon i was checking a report on the web then i came across some post of so many people talking about doctor prince on how he has cured all manners of diseases, such as HIV/AIDS, i contacted him on his email and then i spoke with him on the phone and he assured me that he will make sure that i am totally cured that i shouldn’t worry that all is going to be fine, he told me what was needed to buy and that was it,two days later dr. prince sent me some herbal medicine and when i received it and used it in 2 weeks i was totally cured, all thanks to Dr prince you can contact him true his email at [email protected] or his mobile number +2348163241499
 

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