COPD Update 2015: Zellbiologie goes Clinic? – Wichtige Forschungsergebnisse für den Kliniker

Zusammenfassung

Die COPD ist eine sehr häufige, chronische, nicht ansteckende Erkrankung, die weltweit eine hohe Mortalität und hohe sozioökonomische Kosten verursacht. Ihre klinische Betrachtung wird zunehmend umfassender und beinhaltet unter anderem die Lungenfunktion, die Exazerbationshäufigkeit, die körperliche Leistungsfähigkeit, das Dyspnoeempfinden und Komorbiditäten. Auf der anderen Seite sind unsere therapeutischen Möglichkeiten aber sehr eingeschränkt: Es gibt zwar mehrere gut verträgliche und wirksame, kombinierbare Bronchodilatatoren aus der Gruppe der langwirksamen Beta2-Mimetika und Anticholinergika, aber kaum Medikamente, die ursächlich in der Pathophysiologie angreifen. Als antiinflammatorische Prinzipien stehen nur die inhalierbaren Glukokortikoide und ein oral verfügbarer Inhibitor der Phosphodiesterase 4 zur Verfügung, die jeweils bei einem Teil der Patienten zu einer Verbesserung der Lungenfunktion führen können. Dieser Mangel an wirksamen ursächlichen Therapieprinzipien einerseits und an Biomarkern für eine klare Patientenstratifizierung andererseits liegt zu großen Teilen in unserem limitierten Verständnis der Pathophysiologie begründet. Daher sollen im Folgenden die aktuellen Fortschritte der klinischen und experimentellen Forschung zur COPD mit Bezug zur Praxis zusammenhängend dargestellt werden.

Abstract

The COPD is a very common, chronic, non-contagious disease causing high mortality as well as high socio-economical costs worldwide. Its clinical assessment progressively becomes more comprehensive including the lung function, the rate of exacerbations, the physical capacity, the sensation of dyspnoea, and comorbidities. On the other hand, our therapeutic options are very limited: Although there are several well-tolerated and effective combinable bronchodilators of the group of long-acting beta2-mimetics and anticholinergics, drugs causally affecting pathophysiology are barely available. As anti-inflammatory principles only inhaled glucocorticoids as well as one orally available inhibitor of phosphodiesterase 4 are approved, each improving the course of disease in a subgroup of patients. This lack of effective causative therapeutic principles on the one hand and of biomarkers clearly stratifying patients on the other hand to a large extend are caused by our limited understanding of the pathophysiology. Therefore, this review presents the current progress in clinical and experimental research on COPD with regard to clinical practice.

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