New Frontiers in Chronic Obstructive Pulmonary Disease: Where Are We Heading?

This symposium took place during the 2022 meeting of the European Respiratory Society (ERS). Focusing on new frontiers in chronic obstructive pulmonary disease (COPD), the speakers discussed the current understanding of the heterogeneity of COPD, the spectrum of inflammatory pathways in COPD pathophysiology, and the evolving clinical landscape in COPD. Alvar Agustí, Professor of Medicine at the University of Barcelona, Spain, introduced the concept of a gene, environment, and time (GETomic) perspective of COPD, ending with the trajectome, or range of lung function trajectories, through the lifespan. Stephanie Christenson, Assistant Professor of Pulmonology at the University of California, San Francisco, USA, followed by exploring the role of inflammation in COPD, highlighting that it is a heterogeneous disease with broad inflammatory pathways. This includes types 1, 17, and 2 inflammation; a wide range of immune effector cells beyond eosinophils; and key cytokines such as IL-33, IL-4, IL-13, and IL-5, which mediate the pathophysiology of COPD in response to cigarette smoke and other environmental insults. The need for continued investigation of molecular phenotypes was expanded on further by MeiLan Han, Professor of Medicine at the University of Michigan, Ann Arbor, USA, who explored the knowns and unknowns in the standard-of-care management of patients with COPD, highlighting the evolving understanding and identification of disease endotypes and phenotypes; poor understanding of COPD disease progression; the importance of smoking status in response to currently available treatments; and significant unmet need for additional treatment, even among patients on triple therapy. Dave Singh, Professor of Respiratory Pharmacology at the University of Manchester, UK, then discussed active areas of investigation in the development of additional treatments for patients with COPD.