This chronic inflammatory disease of the bronchi, characterized by narrowing of the airways, wet cough and difficulty breathing, affects nearly four million French people: 2/3 of patients suffering from COPD are unaware of their illness and the average age of those suffering from COPD is 65 years. On the occasion of World COPD Day which took place on November 21, the scientific community is mobilizing to raise awareness among the population at risk, and to provide information on prevention measures and new treatments. Decryption with Dr Laurent Nguyen, pulmonologist at the Saint-Augustin clinic in Bordeaux.
Better identified patients
According to the Palomb cohort study (early 2023), of the 1.3 million people treated for COPD, the proportion of women has increased in recent years to reach 37% of patients, or 17% more in 20 years. The explanation: they smoke more knowing that smoking is responsible for 85% of COPD cases. Another revelation: thanks to the IQVIA database, referencing drugs dispensed in pharmacies, other concomitant pathologies have been identified: these are cardiovascular disease, diabetes, followed by anxiety and depression (especially among women). These comorbidities have repercussions on general health and quality of life. This awareness encourages more thorough examinations in cases of COPD.
A new conclusive treatment
The announcement last spring of the arrival of Dupixent (dupilumab) (Sanofi), in the form of an injection every two weeks, raised a lot of hope. Already used against asthma and eczema, this monoclonal antibody has just proven its effectiveness to reduce COPD exacerbations by 30%. A great advance, however, reserved for patients experiencing several serious attacks per year, despite their basic treatment, and presenting a certain type of excess white blood cells. Its marketing authorization for COPD is pending.
Triple therapy for severe COPD
In terms of basic treatment, attention is focused on triple therapies. They combine a Beta-2 mimetic (from the salbutamol family, or Ventolin) to open the bronchi, an anticholinergic (another bronchodilator), and an inhaled corticosteroid. According to the Gold 2023* report, the combined use of the three drugs must today be essentially offered to patients with more than two serious attacks per year especially when they require hospitalization. Since corticosteroids increase the risk of pneumonia, doctors must evaluate the benefit-risk balance, particularly in patients who experience recurrent pneumonia.
Better support
The best way to limit symptoms is to stop the causes of COPD. Smoking in the first place, as well as exposure to pollutants (in the professional context for example). Treatment by a tobacco specialist is strongly encouraged. Also proposed: the practice of physical activity supervised by the sports system on prescription, respiratory rehabilitation and complete vaccination against pulmonary infections (Covid, flu, pneumococcus and the latest: respiratory syncytial virus).
Climate and pollution, is there a link with this disease?
Certain atmospheric conditions aggravate the symptoms of COPD and require the greatest rigor in taking treatments. In winter, the link between the increase in emergency room consultations for worsening COPD symptoms and peaks in fine particle pollution, nitrogen dioxide and ozone, was measured within the framework of the BEPoPi study (2018). During heatwaves, each increase of one degree, increases by 2% the risk of worsening symptoms of COPD.
*Global Initiative for chronic Obstructive Lung Disease
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