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

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

Introduction

University of Michigan Health System, Ann Arbor, Michigan

Chronic obstructive pulmonary disease (COPD) has become increasingly recognized as a chronic disorder with major global implications. As such, increasing mortality has been documented worldwide. Similarly, the important negative implication of COPD for health care systems has become acknowledged. Finally, and most importantly, the negative impact of COPD on patients' quality of life and activity has become the focus of intensive investigation. This impetus has thrust the agenda for the optimal assessment and management COPD onto the world stage. To aid in achieving these goals, a group of experts with wide-ranging expertise met in October 2006. The purpose of this meeting was to identify important areas of COPD research, to briefly review the current knowledge in these key areas, and to provide insight into important questions that require active investigation.

The group identified a series of discrete arenas that allowed focused discussion and the preparation of separate manuscripts. In this symposium, an insightful discussion of the current definitions of COPD and their epidemiologic impact is provided by Mannino and Braman. The authors describe current estimates of overall COPD burden while highlighting where deficiencies exist in the available data. They expand the discussion by delving into evolving data surrounding the role of comorbidity in COPD. Criner and Mahler provide a detailed discussion of standard physiological assessments but also define evolving novel physiological parameters that are increasingly used to define disease severity and impact. Important patient-reported measures are also introduced as is the incorporation of these data into the multidimensional assessment of COPD. Finally, they introduce the potential impact of disease-modifying therapies on these parameters. The latter arena, currently the basis of several large, controlled trials, is likely to be a paradigm shift in future therapy. Curtis and colleagues provide a comprehensive review of COPD pathogenesis. This rapidly evolving field suggests a crucial role for chronic lung inflammation in disease genesis and progression. Agusti expands these concepts by exploring a crucial component of COPD, that is, its systemic nature. Importantly, the clinical impact of these systemic manifestations is highlighted as are potential therapeutic approaches. Areas for future investigation are clearly delineated.

Therapeutic approaches were explored in varying fashion by the group. Hanania and Donohue describe the role of bronchodilators in COPD. They provide a focused review of the various available agent classes and their current role in COPD pharmacotherapy. Importantly, they introduce a series of novel bronchodilators that are in late stages of development or that have been approved for use. Finally, they define concepts regarding optimal delivery of these compounds in patients. Make and colleagues tackle a complex and controversial field, the role of inhaled corticosteroids in COPD. They carefully describe the mechanisms of action and the available clinical data on lung function, symptoms, and quality of life. They provide insight into the controversial area of exacerbation frequency modulation by inhaled corticosteroids and the potential impact of combination therapy. Appropriately, they introduce the potential implications of the TORCH (Towards a Revolution in COPD Health) trial by presenting data that have been presented at international meetings. Bailey and Tashkin extend the discussion of pharmacotherapy by introducing several novel approaches that are under active development. These range from unique approaches to smoking cessation to clever and targeted approaches to optimize bronchodilation and decrease inflammation. Zuwallack provides a discussion highlighting the importance of integrated care for the patient with COPD, particularly as it relates to pulmonary rehabilitation. Finally, Anzueto and colleagues approach the important area of acute exacerbation of COPD. The impact, pathogenesis, and potential therapeutic approaches to these episodes are detailed. Priorities for future research are clearly provided.

The work of this group provides an up-to-date evaluation of key clinical and scientific areas in COPD. It provides a focused assessment of the current state of knowledge while providing guidance for future investigation.

FOOTNOTES

Conflict of Interest Statement: F.J.M. is a consultant for Altana Pharma and has received compensation greater than $10,000. He has been a member of several advisory boards, CME committees, and the Speaker's Bureau for Boehringer Ingelheim, Pfizer, and GlaxoSmithKline. His total compensation per company is greater than $10,000. In addition, he is on an advisory board for Novartis and speaker's bureau for Sepracor and Astra, receiving less than $10,000 per company. He has been an investigator for industry-sponsored studies for GlaxoSmithKline and Actelion.

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