Description
The National Heart, Lung, and Blood Institute convened a meeting of investigators on June 29-30, 2009 in Bethesda, Maryland. The purpose was to discuss potential new therapeutic interventions in COPD that may improve disease progression, survival and patient quality of life. New basic research findings in disease pathogenesis were analyzed for their translational potential. Clinical research findings were assessed for their possible implications for mechanistic understanding of disease pathogenesis and progression including poly-morbidities. The group identified research needs and formulated research recommendations to foster rapid advancement in disease preemption and personalized therapy.
In the seven years since the last NHLBI workshop that broadly assessed basic and clinical research in COPD and formulated research recommendations, NHLBI has implemented a number of initiatives ranging from studies of basic mechanisms to trials of therapies. During this period, there has been substantial progress in COPD research. Studies have significantly advanced pathogenetic understanding of the disease, demonstrated effectiveness of treatments, expanded the intellectual and practical resources of the scientific community, and identified a wide range of potential therapeutic targets. Notwithstanding the enormous progress accomplished in basic and clinical research, COPD remains the fourth leading cause of death in this country and is projected to be the third by 2020. This burden of disease is paralleled by an extraordinary economic toll in direct and indirect costs to our society. The most basic questions remain unanswered and were addressed by the group: Why does only a minority of smokers develop clinically significant COPD? Why is there great heterogeneity in the presentation of COPD? Which pathogenetic pathways are critical, and can they be modulated therapeutically? Why does the disease continue to progress even after smoking cessation? How can the lung injury of COPD be reversed? In addition, new questions of great importance have emerged. What is the relevance to human disease of the new pathways identified? What is the value of current animal models? What is the validity of the current phenotypic measures and their role in guiding clinical practices? Is there value in early diagnosis and treatment? What is the origin of co-morbid conditions and how are these best managed? Does the combined pharmacological-physical-nutritional-psychological intervention have a role in the management of the disease? What new therapeutic strategies should be tested? Which are the best approaches to interventions in a community setting? These represent the topics that were addressed at the meeting in order to help NHLBI to make informed decisions on how to prioritize research in the next phase of the fight against COPD.