I cannot remember a time when we had more drugs available for the treatment of lung diseases, especially asthma and COPD. I have talked a great deal over the years (almost 6 to be exact) about COPD. This disease continues to be a major cause of death in the United States and the world, and is the most common disease noted on hospital discharge records, either as a primary disease or a co-morbidity. Having more medications does not necessarily mean we have new pathways of disease to attack. Most of the new medications are more sophisticated copies of older drugs.

We now have many that are a combination, and soon the two-drug combinations will have a three-drug combination added to the armamentarium. A byproduct of this growing list of new named drugs and combinations is uncertainty about which should be given and to whom. One of the very common questions we are asked at the Lung Center by family physicians is “which drug should I give my patient?” Some of the new combinations are approved for use in COPD, and some just in asthma. There is growing data that says some drugs will work better with one genetic type of COPD than another. Unfortunately, testing for many of these types is impractical at this time. Recently, a visiting expert speaking to our group at the Lung Center told us that in ten years we will be able to determine what genetic form of COPD a patient may have with a CT scan and blood test.