Abstract
In 1961, Orie and colleagues from the University of Groningen in the Netherlands hypothesized that the various forms of airway obstruction, such as asthma, chronic bronchitis and emphysema, should be considered not as separate entities but as different expressions of one disease entity. In a pulmonary practice patients with a physician diagnosis of chronic obstructive pulmonary disease (COPD) had physiological and biochemical evaluation as part of their routine workup. They were treated with omalizumab if they were symptomatic despite adequate conventional treatment and had an elevated IgE level. Patients with COPD (n=60) who were on treatment with omalizumab for at least 6 months were asked to fill out a questionnaire from which their symptom scores (1-4) and satisfaction scores (1-5) were extracted. There was statistically significant improvement in the amelioration of both symptoms and increase in satisfaction scores (p was less than 0.01) with treatment with omalizumab. This year being the 50th anniversary of the Dutch Hypothesis, it may be appropriate to revisit this issue. Patients with COPD may benefit from evaluation and treatment with monoclonal anti-IgE antibody therapy. Randomized placebo controlled, double blinded trials are needed to help further define the role of anti IgE therapy in patients with COPD. Subsequently, the broad use of biomarkers to evaluate need for monoclonal antibody therapy may need to be reconsidered. To the treating physician and the patient the treatment outcome is more relevant than the actual diagnosis.
- © 2011 ERS
