What is chronic obstructive pulmonary disease (COPD)?
La chronic obstructive pulmonary disease or COPD COPD is a chronic inflammatory disease of the bronchi. Little known to the general public, COPD is the 3rd leading cause of death worldwide (>3 million deaths/year). In France, 4 million people are affected (17.000 deaths in 2017). This figure is likely an underestimate due to a high proportion of undiagnosed patients because of its slow and insidious progression, with relatively mild initial symptoms. Smoking is the leading cause of the disease, although multiple factors may be involved. COPD therefore represents a major societal challenge due to high rates of morbidity, disability, and mortality. Ongoing research at thePasteur Institute of Lille aim to better understand the mechanisms of the disease, in order to identify risk factors and therapeutic targets.
How does one contract COPD and what are its main consequences?
Le tabagisme (active and passive) is responsible for the majority of COPD cases. It can also have other causes such as prolonged and/or repeated exposure to particles and harmful gases. It is also a multifactorial disease involving genetic factors, which explains why, with equivalent smoking levels, some people develop the disease (about 1/3 of smokers) and others do not. COPD It manifests as a progressive narrowing of the airways, often accompanied by excessive mucus production. This makes breathing more difficult over time. In the deep lung, the alveoli, which allow gas exchange during respiration, are progressively destroyed, leading to...emphysema (e(damage to the alveoli) and loss of respiratory functionThese bronchial and alveolar lesions are the consequence of chronic inflammation linked to tobacco or other particles.
Symptoms and diagnosis of COPD: recognizing and identifying this chronic disease
COPD manifests itself through clinical signs such as chronic cough, phlegm, shortness of breath (dyspnea)These symptoms, subtle at the beginning of the disease, appear gradually and worsen over time. Impaired respiratory function leads to an inability to engage in physical activity.. This progressive deterioration is punctuated by exacerbations, during which symptoms and lung damage worsen. Infections (bacterial, viral, fungal) are the major causes. The most severe forms can manifest as pneumonia, potentially leading to chronic respiratory failure and, in extreme cases, the patient's death. Faced with these symptoms, particularly in a smoker or someone exposed to a contributing factor, it is advisable to consult a doctor as soon as possible. spirometry will allow for the diagnosis of bronchial obstruction. This measures the patient's lung volumes and bronchial flow ratesThe more obstructed the airways, the lower the exhaled volume. Based on the test results, the severity of the bronchial obstruction will be determined: from stage I (mild) to stage IV (very severe). Other criteria may be assessed, such as the severity of exertional dyspnea (shortness of breath during exertion), the impact on quality of life, and the number of exacerbations in the past year.
COPD is associated with numerous disordersThese comorbidities can affect various organs, leading to muscle atrophy (particularly in the lower limbs), cardiovascular diseases (heart failure, coronary artery disease), and digestive diseases (Crohn's disease). Profound metabolic disturbances (dyslipidemia) can sometimes accompany COPD. increases the risk of death related to cancer (lungpancreas, esophagus, breast). LMost patients do not die from respiratory failure alone, but rather the association with comorbidities such as cardiovascular and musculoskeletal disorders.
COPD: Are there effective treatments?
To date, there is no cure for COPD. However, early intervention slows its progression. Several solutions are available:
- The first measure consists of arrêter de fumer and/or to stop exposure to substances that promote the diseaseDrug treatment relies on the use of bronchodilatorsThis allows the airways to dilate and improve airflow. This treatment is sometimes combined with... corticosteroids in order to reduce local inflammation in cases of repeated exacerbations. In the most severe forms, a long-term oxygen therapy is necessary. Its aim is to improve patient survival. It can be supplemented by ventilation, either non-invasive or invasive.
- The practice of a respiratory rehabilitation associated with a physical activity Regular and appropriate exercise has recently demonstrated its effectiveness, especially when practiced early. It slows the progression of the disease. COPD patients are more sensitive to respiratory infections which represent a very significant aggravating factor. Therefore, it is essential to prevent these episodes. Consequently, the vaccination (flu) and Covid) is recommended annually for patients with COPD. pneumococcal vaccination is also recommended for patients with chronic respiratory failure.
To know more : “Researchers from Lille and Switzerland have developed a new vaccine against pneumococcus”
Research work at the Pasteur Institute of Lille
Within the Lille Infection and Immunity Center, the team OpInFIELD (Opportunistic Infection, Immunity, Environment & Lung Diseases) directed by Philippe Gosset et Muriel Pichavant seeks to understand the mechanisms leading to the exacerbation of COPD. This research aims to to identify new biological markers predictive of the disease and new therapeutic targets " explains Philippe GossetThe team develops both experimental studies (preclinical models, organoids) and clinical studies (patient cohorts), in close collaboration with the University Hospital of Lille (Professor O. Le Rouzic). Combining these two approaches, both experimental and clinical, allows us to remain focused on our initial objectives, namely treating patients " highlighted Muriel PichavantFurthermore, it is essential for us to validate the concepts developed in our experimental models in COPD patients before considering any clinical application. The research team discovered that certain molecules produced by the immune system, called cytokines of the interleukin-20 family, play a key role in the worsening of COPD (chronic obstructive pulmonary disease). This discovery led to a patent application and a collaboration with a private laboratory. We hope to be able to control the activity of these cytokines in order to reduce the incidence of infections, which are the cause of exacerbations. »Enthuses Philippe GossetThe team is also interested in the role of genetic polymorphisms (variations in a person's DNA) in COPD and its exacerbations. Certain polymorphisms of nicotine receptors (the essential component of tobacco addiction) are frequently associated with the development of COPD or cancer in smokers. The team showed that the interaction between the expression of a very common polymorphism of the nicotine receptor and environmental stress accelerated the development of COPD. This work could lead to personalized treatments specifically targeting these mutated receptors in patients carrying these polymorphisms»This work could also help prevent the long-term effects of new forms of smoking or nicotine replacement therapies (e-cigarettes, heated tobacco, oral pouches). As mentioned above, COPD is associated with other conditions. The team OpInFIELD also develops projects related to metabolic dysregulations including obesity and dyslipidemia.
For further : “Podcast “Life” Episode #18 | At Full Lungs”
Contact researchers
muriel.pichavant@pasteur-lille.fr, philippe.gosset@pasteur-lille.fr
OpInFIELD Team (Opportunistic Infection, Immunity, Environment & Lung Diseases)
Pasteur Institute of Lille
Center for Infection and Immunity of LilleINSERM U1019 – CNRS UMR9017Univ Lille Nord de France, CHU Lille
Funding related to the research projects of the OpInfIELD team
ExaCOPD2 Project (INSERM Transfert, Hauts de France Region): Development of human antibodies targeting IL-20 receptors as a therapeutic tool in chronic obstructive pulmonary disease.
PINACHRAECOPD Project (IReSP): Physiopathological contribution of a polymorphism of the human nicotinic receptor during chronic obstructive bronchopneumopathy and its exacerbations.
NicoRPEM Project (Pasteur Network): Characterization and pharmacological modulation of pulmonary nicotinic receptors including α5SNP: a key step towards personalized medicine in COPD patients.
