Novel anti-inflammatory agents in COPD: targeting lung and systemic inflammation.

Inflammation plays a central role in chronic obstructive pulmonary disease (COPD). COPD related inflammation is less responsive to inhaled steroids compared to asthma. There are three major novel anti-inflammatory approaches to the management of COPD. The first approach is phosphodiesterase inhibitors, such as roflumilast which provides additional clinical benefit either as a single agent or as an additive treatment to long-acting bronchodilators. The second approach involves novel strategies using drugs licensed for other indications, such as statins and macrolides; limited prospective studies on these strategies exist at the moment. A third potential approach involves novel agents whose mechanism of action is closely related to COPD mechanisms and pathophysiology. Such novel treatments are of great interest since they may treat both COPD and co-morbidities. Several novel agents are currently under development and may be of importance in the future.