the holy grail in COPD in preventing decline in lung function....

the holy grail in COPD in preventing decline in lung function. There is currently no drug that has been shown to do this. The problem with designing a trial is that not all patients are rapid decliners. Some have lost function early in life so never got to 100% in the first place and the rate of decline is the same as in the normal non smoking population. Some do decline rapidly and have persistent small airway inflammation that can not be turned off with currently available treatment (the inflammation persists even if they stop smoking) . Some are frequent exacerbators who have a 30% chance of a CVS event with 3 months of exacerbation (likely due to generally vascular inflammation plaque rupture and thrombosis). Patient selection in any phase 2 trial will be critical. Not all copd patients are the same.