HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rennard, S. I. Search for Related Content PubMed PubMed Citation Articles by Rennard, S. I.

Chronic Obstructive Pulmonary Disease

Linking Outcomes and Pathobiology of Disease Modification

University of Nebraska Medical Center, Omaha, Nebraska

Correspondence and requests for reprints should be addressed to Stephen I. Rennard, M.D., Department of Internal Medicine, University of Nebraska Medical Center, 600 South 42nd St., Omaha, NE 68198-5300. E-mail: srennard{at}unmc.edu

ABSTRACT

Recent guidelines define chronic obstructive pulmonary disease (COPD) as a preventable and treatable disease characterized by airflow limitation and systemic consequences. Airflow limitation in COPD worsens over years as assessed by the forced expiratory volume in one second (FEV₁). Regardless, while it is likely that cardiovascular and other systemic components also worsen as COPD progresses, there are no accepted or validated outcomes to measure such pathophysiologic changes as they relate to COPD disease progression. It is clear that health status in COPD is more closely related to levels of patients' physical functional capacity than it is to changes in FEV₁. Furthermore, the relative contributions of pathoanatomic changes such as small airways fibrosis and pulmonary emphysema to declining airflow remain unknown. These features may even progress at different rates in the same individuals. Although stopping smoking is the only intervention shown to alter the relentless progression of COPD, the resultant slowing of FEV₁ decline takes several years to evince and requires at least 1,000 subjects to demonstrate annual therapeutic benefits of as little as 20 ml. The FEV₁ cannot distinguish between peribronchiolar fibrosis and emphysema and it is feasible that, as techniques are developed and validated, lung imaging methodologies may become important and sensitive outcomes measures of time- and age-dependent lung structural changes in COPD. The development of biomarkers of lung damage, pulmonary inflammation, and systemic disease will be essential to our further understanding of the natural history of COPD and the discovery of new, effective treatments for its progression.

Key Words: biomarkers • disease progression • imaging techniques • systemic disease

This article has been cited by other articles:

				K. Sahlander, K. Larsson, and L. Palmberg Altered innate immune response in farmers and smokers Innate Immunity, February 1, 2010; 16(1): 27 - 38. [Abstract] [PDF]

				R. E Morty, M. Konigshoff, and O. Eickelberg Transforming Growth Factor-{beta} Signaling across Ages: From Distorted Lung Development to Chronic Obstructive Pulmonary Disease Proceedings of the ATS, December 1, 2009; 6(7): 607 - 613. [Abstract] [Full Text] [PDF]

				S. I. Rennard and J. Vestbo Natural Histories of Chronic Obstructive Pulmonary Disease Proceedings of the ATS, December 15, 2008; 5(9): 878 - 883. [Abstract] [Full Text] [PDF]

				M. E. Bakker, H. Putter, J. Stolk, S. B. Shaker, E. Piitulainen, E. W. Russi, and B. C. Stoel Assessment of Regional Progression of Pulmonary Emphysema With CT Densitometry Chest, November 1, 2008; 134(5): 931 - 937. [Abstract] [Full Text] [PDF]

				A. R. Froese, K. Ask, R. Labiris, T. Farncombe, D. Warburton, M. D. Inman, J. Gauldie, and M. Kolb Three-dimensional computed tomography imaging in an animal model of emphysema Eur. Respir. J., December 1, 2007; 30(6): 1082 - 1089. [Abstract] [Full Text] [PDF]

				N. Roche Where current pharmacological therapies fall short in COPD: symptom control is not enough Eur. Respir. Rev., September 1, 2007; 16(105): 98 - 104. [Abstract] [Full Text] [PDF]

				R. A. McIvor Future options for disease intervention: important advances in phosphodiesterase 4 inhibitors Eur. Respir. Rev., September 1, 2007; 16(105): 105 - 112. [Abstract] [Full Text] [PDF]

				H. A. C. van Helvoort, Y. F. Heijdra, R. C. C. de Boer, A. Swinkels, H. M. H. Thijs, and P. N. R. Dekhuijzen Six-Minute Walking-Induced Systemic Inflammation and Oxidative Stress in Muscle-Wasted COPD Patients Chest, February 1, 2007; 131(2): 439 - 445. [Abstract] [Full Text] [PDF]