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Department of Pharmacy and Health Services, University of Washington, Seattle, Washington; and Section of Public Health and Health Policy, University of Glasgow, Glasgow, Scotland, United Kingdom
Correspondence and requests for reprints should be addressed to Andrew Briggs, D.Phil., Section of Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, Scotland, UK. E-mail: a.briggs{at}clinmed.gla.ac.uk
Chronic obstructive pulmonary disease (COPD) is a global problem, now ranked as the fifth leading cause of death in the world. COPD-related mortality is increasing, in contrast to the falling mortality described with other major diseases such as heart disease and stroke (1). Unfortunately, given the changing population demographics and increased prevalence of smoking in the developing world, the global health and economic burden of COPD will continue to increase for some time. Although the disease remains incurable, prevention measures can reduce its incidence and existing patients can be successfully treated to reduce morbidity, but there is a clear need to define optimal therapeutic approaches to improving survival in COPD.
Improving survival was the central theme when an international group of scientists, physicians, and other health care providers, as well as policy makers, met in Rome in November 2005, under the sponsorship of GlaxoSmithKline. The objective of this meeting was to evaluate clinical, epidemiologic, and economic aspects of the management and treatment of COPD, with a particular focus on current research aimed at improving survival for patients with COPD. The faculty conveyed their perspectives on contemporary issues surrounding COPD, and as joint chairs of this meeting, it is our pleasure to introduce this collection of papers that reflect the proceedings of the meeting.
In the first paper, David Halpin and Marc Miravitlles discuss the burden of COPD to society, in terms of impairment of quality of life for patients and their families, and health systems generally, in managing exacerbations of the disease. The substantial morbidity associated with COPD highlights the need for better evaluation and diagnosis, but the highest priority is defining interventions that delay progression and alleviate the clinical and economic burden of disease. In the second paper, Don Sin and Paul Man review the relevant epidemiologic and pathophysiologic processes that affect mortality in COPD and critically examine the emerging evidence in relation to the potential effect of current COPD therapy on mortality. In the third paper, Maureen Rutten-van Mölken and Todd Lee review the use of economic models to estimate the lifetime burden of disease and cost-effectiveness of treatments for COPD, reflecting on the need to extrapolate beyond the limited follow-up and setting of clinical trial data. This aim acknowledges the need, in the current political and economic climate, to move beyond simply showing that a treatment is clinically safe and efficacious, and to show interventions are likely to represent good value-for-money in the context of health service provision, especially with the many competing demands on resources. The fourth paper, by Scott Ramsey and Richard Hobbs, looks at potential risk factors for adverse outcomes in COPD and the lessons that can potentially be learned from cardiovascular medicine—in particular, the communication of large, long-term mortality studies that may change practice because of improved patient survival. The final paper, by Klaus Rabe, develops this link to risk factors in COPD by reviewing the current clinical guidelines for COPD management and by examining how current research can become implemented into clinical practice.
Within these presentations, a recurring theme was the need for large mortality studies over a long time frame and sufficiently powered to allow an accurate assessment on survival and hence contribute to an improved management approach to COPD. Fortunately, two large studies are underway, which will provide an important contribution to the knowledge base in COPD, and these studies were highlighted. The TORCH (TOward a Revolution in COPD Health) survival study (2) is aiming to determine the impact of inhaled corticosteroid and long-acting bronchodilator (salmeterol/fluticasone propionate), alone or in combination, on mortality in patients with COPD. The UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) study (3) is a 4-year trial, currently in progress to prospectively evaluate the effect of tiotropium on lung function decline and disease progression in patients with COPD. It is our hope that these proceedings are helpful in highlighting the research background against which the potential value of any future treatment options can be assessed, and that the issues raised, particularly on the transfer of key findings in clinical trials into evidence-based guidelines and then into clinical care, will contribute to improved care and survival for COPD sufferers.
The papers that follow reflect the content of the main scientific presentations, but capture only part of the lively discussions relating to this important and rapidly evolving topic. We would like to thank all attendees for their active participation in the workshop and their contribution to this supplement: A. Briggs, H. Glick, D. Halpin, R. Hobbs, C. Jenkins, T. Lee, M. Levine, G. Liu, M. Miravitlles, M. Neville, K. Rabe, S. Ramsey, M. Rutten-van Mölken, D. Sin, M. Spencer, S. Sullivan, R. Taylor, G. Viegi, and T. Welte.
FOOTNOTES
Conflict of Interest Statement: S.D.S. received $5,000 for serving on an advisory board for Schering-Plough between 2004 and 2006 and received $3,000 from AstraZeneca for consulting between 2004 and 2006. A.B. has acted as a consultant to GlaxoSmithKline (GSK) and has received research funding from GSK in relation to COPD and its treatment.
(Received in original form April 10, 2006; accepted in final form April 20, 2006)
REFERENCES
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