Eliminating the 'Chronic' from COPD

People who have chronic obstructive pulmonary disease (COPD) have it forever; that’s why it’s called “chronic.” Though it can be managed, it can’t be reversed. The only known cure is a lung transplant. And though the primary cause of COPD is cigarette smoking, growing evidence is showing that environmental factors such as air pollution are also triggering the disease.

Department of Medicine researchers are taking on this disease with new vigor, and they are uncovering potential pathways for recovery, or at least for improved outcomes, for COPD.

Lauren Eggert, MD, shows a patient how to use a mobile spirometer

Undiagnosed COPD a Key Focus

In the United States, an estimated 16 million people have been diagnosed with COPD. But it is estimated that an additional 8 million may have undiagnosed COPD, putting them at risk for onset of symptoms such as shortness of breath and severe coughing or wheezing.

Researchers are trying to find easy, cost-effective, accessible ways to diagnose more people with COPD so that physicians can intervene earlier and prevent both morbidity and unnecessary costs to the health system. According to Lauren Eggert, MD, clinical assistant professor of pulmonary, allergy, and critical care medicine, “There is growing evidence confirming that COPD is underdiagnosed by at least 50% (and as high as 78% in some studies).”

Much of this undercounting has to do with the lack of routine screening. “A simple procedure called spirometry could easily be incorporated into an annual physical exam,” notes Eggert. “It takes just a couple of minutes to perform and can reveal vital, lifesaving information about the patient and whether or not they have COPD.” That information could be used to develop a plan of care. Though this approach wouldn’t eliminate the disease, it could enable the patient to begin treatment sooner than if advanced COPD were detected because of a life-threatening event.

While the U.S. Preventive Services Task Force (USPSTF), which develops screening guidelines, does not currently recommend screening for COPD, the American Thoracic Society has suggested that this may need to be reevaluated.

“This is an important step forward in tracking down this disease,” says Eggert. She is currently creating a plan to study how inexpensive mobile spirometry units in the primary care setting could identify undiagnosed individuals with COPD.

“There is growing evidence confirming that COPD is underdiagnosed by at least 50% (and as high as 78% in some studies)”

Reversing or Preventing Lung Damage

“It would be great if alternative therapies and treatments were available for COPD,” muses lung transplant specialist Shravani Pasupneti, MD, instructor of pulmonary, allergy, and critical care medicine at Stanford. “Right now, lung transplantation is the only cure for patients with end stage COPD. While it is helpful for some, it has limits and is not a viable option for everyone."

Pasupneti took one small step closer to achieving that goal with research reported in 2020—the first time anyone at Stanford had published basic science research about COPD. She showed that genetically knocking out a transcription factor called HIF-2 alpha in mice led to COPD, and that increased HIF-2 prevented the disease. Given that cigarette smoke decreases HIF-2 alpha, this finding has important real-world applications and could be used to develop new therapies. She hypothesizes that HIF-2 alpha is a central regulator of lung health, and therapies that manipulate its expression could be used to treat COPD. Pasupneti is now embarking on studies to find the appropriate pathways for this process.

“The overall direction of our work,” comments Pasupneti, “is to find the mechanism of action of HIF-2 alpha in the development of COPD, with a goal of developing better therapies to treat (and ideally prevent) the disease.”

This important work demonstrates the close link between laboratory research and patient care that is the hallmark of Stanford Medicine.

Unique Offerings Help Patients Cope With COPD

“At a big medical center like Stanford, we have the resources to provide aggressive management of COPD,” says Eggert. This includes pulmonary rehabilitation programs, nutrition counseling, and comprehensive medication management.

Often, the upper section of a COPD patient’s lungs stops functioning, which makes breathing more challenging. Air can get in, but the patient can’t expel it. Physicians at Stanford can insert mechanical valves to block off airflow entirely to the top part of the lungs.

“At a big medical center like Stanford, we have the resources to provide aggressive management of COPD"

Working with medical residents, Eggert is developing a digital educational tool to teach patients how to use an inhaler. “There are many types of inhalers, and they’re all different,” she notes. “They’re not intuitive. We want to work with patients before they leave the hospital to make sure they understand how to use theirs.” With an iPad or computer, patients will be able to check on their continued correct use of the inhaler once they get home.

It’s Not Easy

Of course, the most effective step that a patient with COPD can take is to stop smoking. Though this won’t reverse the damage that’s already been done, it will certainly stop its progression.

“But I understand that it’s really hard to do,” says Eggert. “It’s like dieting: It’s easy to tell someone to do it, or to know yourself that you should, but it’s very difficult to break the habit.”