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New diagnostics allow a good prognosis of which patients with chronic obstructive pulmonary disease (COPD) will benefit from cortisone / Proportion of smooth muscle in the bronchi as an indicator

Researchers at the Medical Center - University of Freiburg have developed a new approach to predict the treatment success of patients with chronic obstructive pulmonary disease (COPD) using inhaled cortisone. The study, entitled "HISTORIC", was presented in mid-September at the annual congress of the European Respiratory Society in Milan with over 20,000 participants. The medical journals New England Journal of Medicine and European Respiratory Journal also named the study as one of the four most important publications of 2023 in the field of respiratory medicine.

"The results of this study mark a new era in the individualized treatment of COPD. Based on the tissue sample, we can now decide more precisely which form of therapy is best suited to each patient," says study leader Prof. Dr. Daiana Stolz, Medical Director of the Department of Pneumology at the Medical Center - University of Freiburg. COPD is the third most common cause of death worldwide after coronary heart disease and stroke. It is estimated that almost three million people are affected in Germany.

Cortisone for COPD therapy still controversial

Patients with asthma are usually treated with inhaled cortisone and bronchodilators. In the case of COPD, a disease that is also accompanied by bronchoconstriction, treatment is carried out with bronchodilator medication. The question of which COPD patients can benefit from inhaled cortisone in the same way as asthma patients has been a controversial topic for two decades.

"Our results now offer a promising approach to clarifying this uncertainty," says Stolz. The study involved 180 COPD patients from whom tissue samples were taken from the bronchi by means of lung endoscopy. In a next step, the proportion of smooth muscle cells in these samples was determined. A high proportion of smooth muscle cells indicates inflammation similar to asthma. The patients received inhaled therapy for one year, which included bronchodilator medication and either cortisone or placebo.

Smooth muscles as a sign of success

The results of the study showed that those COPD patients who were found to have a high proportion of over 20 percent smooth muscle in the tissue samples benefited particularly from inhaled cortisone therapy in terms of lung function, symptoms and quality of life. The combined treatment with two bronchodilator drugs and inhaled cortisone is associated with a reduction in exacerbations and hospitalizations for some COPD patients. Patients are less likely to experience a severe deterioration in their state of health and are less likely to need hospital treatment. Even an improved survival rate can be achieved. However, this therapy also has potential side effects, such as an increased risk of pneumonia. For this reason, it is particularly important to promptly identify which COPD patients benefit from this therapy.

"These results represent significant progress towards personalized medicine in the field of COPD treatment. We are confident that these findings will have a positive impact on the individual care and treatment of our patients," says Stolz.

Original title of the study: Airway smooth muscle area to predict steroid responsiveness in COPD patients receiving triple therapy (HISTORIC): a randomized, placebo-controlled, double-blind, investigator-initiated trial
DOI: 10.1183/13993003.E6201-2023
Link to the study:https://erj.ersjournals.com/content/62/1/2300218