Should we start pharmacological treatment in asymptomatic patients with chronic obstructive pulmonary disease (COPD)?
Jadwiga Wedzicha: Starting pharmacological therapy in a COPD patient who is asymptomatic is a very interesting question. We know that the disease develops before patients have symptoms. I think it then depends on treatment. We have two types of treatment. We have symptomatic treatment, which is with bronchodilators. Patients are unlikely to take a treatment that they do not see a benefit from early. I think that this is probably the major limitation to starting treatment early. I believe the earlier we start with bronchodilators, the better is your chance of preserving lung function, though that has not been shown in clinical trials.
On the other hand, the other group of therapies would be anti-inflammatories, disease-modifying agents. At the moment we are very short on disease-modifying agents in COPD. I think if we have disease-modifying agents that are safe and could be used very early on in disease, then that is a very strong possibility. Indeed, the industry is currently very interested in understanding the pathophysiology and the mechanisms of early COPD – this is COPD in younger people as it develops – to see if there can be any interventions. If we have an effective intervention, like statins, which are also given to asymptomatic people, then I think there is a possibility we could really understand and treat this disease much earlier.