Several drugs are now in development may be useful in COPD. These include LTB4 antagonists and 5-lipoxygenase inhibitors, PDE4 inhibitors, new antioxidants and neutrophil elastase and MMP inhibitors. It will be difficult to demonstrate the efficacy of such treatments as determination of the effect of any drug on the rate of decline in lung function will require large studies over at least 2years. There is an urgent need to develop surrogate markers, such as analysis of sputum parameters (cells, mediators, enzymes), that may predict the clinical usefulness of such drugs.
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