Biomedical Engineering Reference
In-Depth Information
19
Therapeutic Implications and Future
Developments
Peter J. Barnes
National Heart and Lung Institute, Imperial College School of Medicine,
London, U.K.
I.
INTRODUCTION
Despite the enormous global impact of COPD and the increasing invest-
ment in research, there are no current therapies that have been shown to
prevent the inevitable progression of the disease. However, as exemplified
in this volume, there is now an increasing understanding of the cellular
and molecular mechanisms involved in COPD (1) and this has identified
many new targets and will lead to the development of new therapies in
the future (2,3) (Table 1).
A. The Need for Novel Therapies
There have been disappointingly few therapeutic advances in the drug therapy
of COPD, in contrast to the enormous advances made in asthma management
that reflect a much better understanding of the disease (4). Rational therapy
depends on elucidating the cellular and molecular mechanisms that may be
involved. There is a particular need to develop drugs that suppress the under-
lying inflammatory, fibrotic, and destructive processes that underlie COPD
(Fig. 1). As discussed in Chapter 4, the inflammation of COPD is quite differ-
ent from that seen in asthma, indicating that different treatments are likely to
be needed (5,6). An important observation is that the inflammation of COPD
patients is not suppressed by corticosteroids (7-9) and even key inflammatory
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