Up to 400,000 people in Denmark have chronic obstructive pulmonary disease (COPD), and up to 50,000 of these are severely ill, with frequent hospitalization and a considerably increased risk of dying.
The people with COPD as a whole need new treatment approaches, and Danish researchers and doctors are now seeking to meet their need through an extensive research project supported by a grant of DKK 10 million from the Novo Nordisk Foundation.
Over the next 5 years, doctors at the Section of Respiratory Medicine of Herlev and Gentofte Hospital will together with colleagues in the COPD:Trial Network, COPTRIN, a nationwide respiratory medicine trial network, conduct several trials that will ultimately result in new international guidelines for treating people with COPD and optimized treatments for various subgroups of people with COPD.
“We try to make life more bearable for people with COPD at our research unit by focusing on two key things: offering better treatments that can control the disease in a novel way and providing treatments with as few side-effects as possible. We can achieve this with the results that will emerge from this research,” explains Jens Ulrik Stæhr Jensen, Clinical Research Associate Professor, Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital.
Corticosteroids will only be used when they help
One part of the research project will focus on finding better ways to treat people with COPD using corticosteroids in inhalation therapy, in which the drug is inhaled into the lungs and reduces respiratory inflammation. This treatment is quite effective in relieving the symptoms of COPD but is also associated with an increased risk of developing pneumonia, which is really serious for people with COPD.
Previous research at Herlev and Gentofte Hospital has shown that only some people benefit from treatment with corticosteroids, especially those with high levels of eosinophilic granulocytes (a type of white blood cell) in the blood. Measuring how many eosinophilic granulocytes each person has may help to guide the treatment.
“We want to give corticosteroids when patients have high levels of eosinophilic granulocytes in the blood and then stop the treatment when levels are low. We thereby estimate that this can reduce the use of corticosteroids for each patient by 60–80%, thereby substantially reducing the risk of side-effects,” says Jens Ulrik Stæhr Jensen.
The trial involves 444 people with COPD.
Results may lead to new international guidelines
No one had carried out an equivalent trial, but many doctors believe that removing corticosteroids from COPD patients with low levels of eosinophilic granulocytes in their blood may benefit them.
Some doctors regulate treatment with corticosteroids on this basis, but others do not believe in this concept.
This trial in Denmark may help to show that varying the use of corticosteroids in accordance with the levels of eosinophilic granulocytes in the blood may reduce the risk of pneumonia and side-effects and that it has no negative effect in exacerbating pathogenic bacteria in COPD.
“The ideal scenario is that we can reduce the risk of pneumonia while retaining the efficacy of corticosteroids at times when they are very effective. If that is the case, it will very likely be incorporated into the international guidelines in this field,” adds Jens Ulrik Stæhr Jensen.
Blood pressure in the lungs may affect COPD
In another part of the research, Jens Ulrik Stæhr Jensen and his colleagues will investigate the effect of varying pressure in the pulmonary circulation of people with COPD.
Higher blood pressure in the lungs of some people with COPD may be associated with disease severity. In this case, treating the high blood pressure with medication to lower blood pressure may be relevant.
The researchers will also investigate whether some groups of people with COPD have an increased risk of developing blood clots in their lungs. If they do and researchers can identify biomarkers associated with an increased risk of developing blood clots, they may start treating these people with anticoagulants.
“This will enable us to prescribe medicine to only the patients who will benefit from it and not prescribe medicine to the people who experience side-effects,” says Jens Ulrik Stæhr Jensen.
New treatment strategies needed
Jens Ulrik Stæhr Jensen explains that COPD patients definitely need improved options with good treatments and treatment strategies with few side-effects. The grant for this project will certainly be useful in this respect.
“This is absolutely amazing, and we will do our utmost to achieve some things that can help this group of people. The calibre of the grant means that we can work towards producing some very reliable results,” says Jens Ulrik Stæhr Jensen.
The grant awarded to Jens Ulrik Stæhr Jensen is one of many grants awarded under the Foundation’s Research Leader Programme, through which the Foundation has awarded a total of DKK 400 million to 41 projects in 2020. Read more here.
About the Novo Nordisk Foundation
The Novo Nordisk Foundation is an independent Danish foundation with corporate interests. It has two objectives: 1) to provide a stable basis for the commercial and research activities of the companies in the Novo Group; and 2) to support scientific, humanitarian and social causes.
The vision of the Foundation is to contribute significantly to research and development that improves the lives of people and the sustainability of society. Since 2010, the Foundation has donated more than DKK 25 billion (€3.3 billion), primarily for research at public institutions and hospitals in Denmark and the other Nordic countries as well as research-based treatment and prevention of diabetes. Read more at www.novonordiskfonden.dk/en.
Christian Mostrup, Senior Programme Lead, +45 3067 4805, [email protected]