"It’s as if my lungs can’t expand properly, as if there is some form of external pressure bearing down on them."
This is the reality of living with COPD for millions of people worldwide. As part of the natural ageing process, most people’s lung function starts to slowly decline from a peak in their mid 20s onwards.
However for people with COPD (a chronic disease of the lungs), the rate of deterioration is accelerated to an abnormal level, especially if they continue to smoke. This means they often end up with lungs that are ‘old before their time’ and getting back to a normal quality of life of a similar aged individual is not usually possible.
At diagnosis, patients will often complain of increased breathlessness on climbing stairs or walking, and an inability to keep up with their friends or family members. One of the main goals of COPD management is to try to prevent or slow down this deterioration process to preserve functionality and quality of life for as long as possible.
Seeking new clues on early deterioration in COPD
Medical understanding of COPD has improved significantly in recent years. It is now widely accepted that COPD is not a uniform disease, but effects of the disease can impact people differently. These differences mean that identifying those patients who are at risk of a more rapidly progressing disease can be a real challenge.
Long-term studies traditionally focus on the rate of decline in lung function over several years. But those patients with rapidly progressive disease can often fail to provide long-term data.
At the same time, short-term COPD studies tend to focus on whether medicines have had an overall improvement on a patient’s condition at the end of the study, with little focus on patients who fail to improve or deteriorate.
Consequently, we often lack a full picture on important levels of rapid progression and so we have limited evidence to assess whether a new medicine can improve stability and prevent worsening or deterioration in a patient’s condition at early time points.
At GSK we are tackling this challenge and looking at COPD through a different research lens.
“Our scientists are constantly seeking opportunities to try and identify new patterns and new ways of looking at existing evidence that could help us learn more.”
One way we are doing this is by analyzing our previous studies to see if we can find any clues that will help identify patients who are deteriorating faster than others.
We’re doing this by using a novel concept that investigates the effect of optimizing treatment levels and lung function early, to see if this can bring greater disease stability by reducing the potential for different types of deterioration which alone or together are believed to represent a worsening in a patient’s COPD. These are known as ‘clinically important deteriorations’, or CID.
What does the evidence tell us?
CID analysis focuses on three important areas of COPD stability: preventing worsening in lung function, health-related quality of life, and/or exacerbations (sudden worsening of symptoms).
Analyzing these three areas collectively as an overall assessment of stability is a different approach to traditional clinical studies, and can help us build a more complete profile of our patients.
Based on our ongoing analysis, it can also provide valuable information about the link between these early periods with significant deterioration and longer-term prognosis for these individuals.
“CID is a novel but important clinical assessment. It could help to identify which patients are at risk of having a more rapidly progressing disease, and may indicate what the potential benefits are of intensifying treatment early.
So far we have looked at the evidence retrospectively, but moving forwards we are looking at conducting prospective studies that are focused on the CID endpoint.” Ian Naya, Scientific Director, Global Respiratory Franchise.
CID is just one area we are investigating within our ongoing research in COPD. We continuously strive for new opportunities to evolve our understanding of this complex disease that will help us meet individual patient needs.