New frontiers in the treatment of COPD

Dec. 03, 2021

Chronic obstructive pulmonary disease (COPD) is a chronic lung condition characterized by shortness of breath, cough and sputum production due to both airway and parenchymal lung damage. "It is increasingly recognized that patients with COPD have different phenotypes, and treatment can be tailored to the patient phenotype," says Megan M. Dulohery Scrodin, M.D., Pulmonary and Critical Care Medicine at Mayo Clinic in Rochester, Minnesota. "The cornerstone of COPD treatment begins with inhaler selection."

A wide variety of inhaler and nebulizer options exist to treat patients with COPD based on symptom and exacerbation history. Long-acting muscarinic antagonists, long-acting beta-agonists and inhaled corticosteroid treatments are available in both inhaler and nebulizer forms. Azithromycin and roflumilast are available to reduce exacerbating COPD symptoms.

"Pulmonary rehab continues to be an important therapy to improve shortness of breath and quality of life. In addition to these standard treatments, we now have many advanced treatment options available through our practice and research teams," says Dr. Dulohery Scrodin.


Bronchoscopic lung volume reduction is a Food and Drug Administration-approved treatment for patients with the emphysema phenotype of COPD that have significant hyperinflation. For selected patients, one-way endobronchial valves can be placed in the airway that cause collapse of a single lobe. The goal of the collapse is to reduce the lung volume and improve respiratory muscle use. This procedure is considered for patients with significant emphysema and obstruction (forced expiratory volume, or FEV1, ≤ 45%, FEV1/forced vital capacity, or FVC, < 0.7) who have significant shortness of breath. Evaluation for bronchoscopic lung volume reduction includes pulmonary function testing, echocardiogram, high-resolution chest CT imaging, six-minute walk and arterial blood gas. For patients who meet selection criteria, the procedure can improve shortness of breath and quality of life. Bronchoscopic lung volume reduction is available at Mayo Clinic sites in Arizona, Florida and Minnesota.

Chronic bronchitis

Chronic bronchitis is associated with significant cough and sputum production. Bronchial rheoplasty is a new procedure in clinical trial that uses pulsed electric fields to ablate goblet cells in the large airways to reduce excess mucus production and inflammation. Early studies of bronchial rheoplasty have demonstrated improvements in quality of life and symptom burden. Mayo Clinic's campuses in Rochester, Minnesota, and Jacksonville, Florida, are both enrolling patients in a study to evaluate the RheOx bronchial rheoplasty system for treatment of symptoms from chronic bronchitis. Patients must have a history of COPD with significant cough and mucus production.

COPD exacerbation

COPD exacerbation is a common cause of morbidity and mortality. Inhaler therapy, azithromycin and roflumilast have all been shown to reduce COPD exacerbation. Some patients continue to exacerbate despite these therapies. Monoclonal antibody treatment targeted at interleukin (IL)-5 (mepolizumab, reslizumab), IL-5 receptor (benralizumab) and IL-4/IL-13 (dupilumab) have been found to improve asthma symptoms and reduce asthma exacerbation.

"There is now interest in determining if targeted monoclonal antibody treatment could reduce COPD exacerbation, says Dr. Dulohery Scrodin. Mayo Clinic's campus in Rochester, Minnesota, is currently enrolling patients with frequent exacerbation despite triple inhaler therapy in a study that randomizes patients to dupilumab versus placebo. Patients can be considered for the study if they have a history of recurrent COPD exacerbation despite triple inhaler therapy and an eosinophil count ≥ 300 cells.

Mindful Breathing Laboratory

"Pulmonary rehab has been shown to improve shortness of breath and quality of life. Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD management do recommend pulmonary rehab for all patients with COPD," says Dr. Dulohery Scrodin. "Despite the benefit, access to pulmonary rehab limits patient participation." The Mayo Clinic Mindful Breathing Laboratory has open clinical research studies evaluating home pulmonary rehab for patients with COPD. These studies use technology and health coaching to allow patients to complete pulmonary rehab in their own home.

For more information

Clinical trials. A Study to Evaluate RheOx Bronchial Rheoplasty System to Treat Chronic Bronchitis in Adults with COPD. Mayo Clinic.

Clinical trials. A Study to Assess the Effectiveness, Safety and Tolerability of Dupilumab in Patients with Moderate-to-severe Chronic Obstructive Pulmonary Disease (COPD) with Type 2 Inflammation. Mayo Clinic.

2021 Gold Reports. Global Initiative for Chronic Obstructive Lung Disease.

Mindful Breathing Laboratory: Robert P. Benzo. Mayo Clinic.