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Foreword

University of Nebraska Medical Center
Omaha, Nebraska

Tim Higenbottam

Chiesi Farmaceutici S.p.A.
Parma, Italy

Alan R. Leff

University of Chicago
Chicago, Illinois

"The Big Three" is the ninth in a series of COPD symposia organized and sponsored by AstraZeneca. All have been held in Lund, Sweden and all have focused on understanding the disorder rather than on any commercial product. This year's symposium explored the relationships among COPD, heart disease, and lung cancer. While cigarette smoking causes a myriad of disorders, these three conditions are far and away the most common causes of mortality due to smoking. More importantly, these "Big Three" are associated with each other more commonly than would be expected by chance. This suggests that the associations depend on shared mechanisms of risk. Should there be shared pathophysiologic mechanisms, then there also may be therapies that could address multiple morbidities. Perhaps more modestly, strategies that have been successful in delineating pathophysiologic mechanisms in one condition may be directly applicable to others. Sharing experience obtained from the application of genetic and genomic strategies that depend on novel bioinformatics approaches may be of particular value in this regard, especially with the likely development of large phenotyping studies in COPD, and this was specifically discussed in the symposium.

The relationships among the "Big Three" also have important clinical implications. Therapy is available for all three conditions. There is consensus that the "silos" of specialty into which patients may fall can lead to underdiagnosis of concurrent conditions. As a consequence, aggressive diagnostic strategies in patients with any of these disorders could be considered. More importantly, while the available therapies are useful, all three conditions need improved treatment. To achieve that goal, the development of novel outcomes, biomarkers, and surrogate measures is highly desirable. The possibility that the "Big Three" may represent opportunities to serve as clinical outcomes for each other, that they may help define biomarkers and advance the development of surrogates is particularly exciting.

Attendance at the Lund Symposia is limited, in large part due to the size of the venue. The relatively limited size, however, also contributes to the animated and in-depth discussions that have come to characterize this series. While it is impossible to capture the complete flavor of these discussions in manuscript form, we hope that those unable to attend will find the manuscripts that follow to be useful and interesting. We have no doubt that the shared risk factors, mechanisms, and treatments for the "Big Three" will be increasingly important topics for research, and hope that this Symposium will contribute to this exciting line of investigation.

FOOTNOTES

Conflict of Interest Statement: S.I.R. has participated as a speaker at programs organized by AstraZeneca (AZ), Boehringer-Ingelheim (BI), GlaxoSmithKline GSK), Otsuka, and Pfizer. He serves on Advisory Boards for Altana, AZ, Dey, GSK, Novartis, Schering-Plough, and Talecris. He has conducted clinical trials for Almirall, Altana, Astellas, Centocor, GSK, Nabi, Novartis, and Pfizer. He has served as a consultant for Adams, Almirall, Altana, AZ, Bend, Biolipox, Centocor, Critical Therapeutics, GSK, ICOS, Johnson & Johnson, Novartis, Ono, Parengenix, Pfizer, Roche, Sankyo, Sanofi, and Schering-Plough. A patent is pending on a method for stem cell differentiation; He is a co-inventor of the patent owned by the University of Nebraska Medical Center. T.H. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript. A.R.L. is the Head of the GlaxoSmithKline Center of Excellence, a grant award through him to the University of Chicago. This is for investigator initiated basic research and is the amount of approximately $500,000 direct costs/year since 2000. He has a grant unrelated to this subject for $75,000 from Merck and Company to investigate the cell biology of neutrophils. This work is in progress. He had a similar grant from Merck to perform studies in eosinophils 2 years previously for the same amount. He has received an honorarium on an occasion in which he chaired or spoke at the Lund Conference for AZ (approximately $2,500). None of his papers or talks related to currently marketed products by any company. Review of his presentations and sumbission at the Lund Conference was supervised by a special reviewer outside of the board of PATS.

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 Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rennard, S. I. Articles by Leff, A. R. Search for Related Content PubMed PubMed Citation Articles by Rennard, S. I. Articles by Leff, A. R.