Next generation of anti-inflammatory therapy for COPD?

Symptomatic treatment of chronic obstructive pulmonary disease (COPD) by next-generation bronchodilators has improved considerably over the past decade: Long-acting beta-agonists and long-acting muscarinic antagonists (also as combined fixed-dose inhalation) are now available for long-term maintenance. However, there has been very little progress in developing anti-inflammatory drugs that specifically target inflammation in COPD [1]. More than 10 years ago, several inflammatory pathways and potential drugs in early-phase development for COPD were summarised in two well-known review articles [2, 3]. However, of the drug candidates listed there, only the oral phosphodiesterase-4 inhibitor roflumilast made it to regulatory approval; its anti-inflammatory effects resulted in a reduction of exacerbations and modest improvements in lung function [1, 4]. Other drugs either failed to show a clear benefit, or drug development was stopped because of safety concerns [5]. This has made the past decade disappointing for the development of novel anti-inflammatory therapies in COPD [1].