Advanced COPD: Pathogenesis, Evaluation, and Treatment

 

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Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a major worldwide health problem that plagues men and women of all races with extraordinary pulmonary and nonpulmonary manifestations of the disease. The last decade has seen extraordinary efforts by the National Institutes of Health (NIH), professional medical societies, other funding agencies, and the medical industry in studying the pathogenesis, treatment, and prevention of COPD. For example, in just the past 7 years, several large clinical trials have evaluated the role of lung volume reduction surgery (LVRS) on survival in severe emphysema (National Emphysema Treatment Trial), the effects of long-acting bronchodilators on survival, the rate of decline in lung function, and the frequency of acute exacerbations (TORCH and UPLIFT trials), or the effects of long-term oxygen therapy in mild to moderate hypoxemia. These trials represent a transformation in the scientific approach to examining new therapies in COPD by being large and using disease-modifying end points as the primary end points (survival, exacerbation frequency) rather than just changes in lung function. These efforts plus those by committed scientists, the NIH, and the World Health Organization to disseminate knowledge about the prevention and treatment of COPD via the Global Initiative for Chronic Obstructive Lung Disease (GOLD) have done much to reverse the nihilistic attitudes that COPD is progressive, debilitating, and untreatable.

This issue of Seminars in Respiratory and Critical Care Medicine brings together a collection of recognized researchers and educators in the field of COPD to provide current information regarding the pathogenesis, evaluation, prevention, and treatment of COPD. Dr. Cornwell and colleagues review the pathogenesis of inflammation and repair in advanced COPD. Dr. Patel and colleagues review the potential value of biomarkers in the diagnosis and staging of COPD. Dr. Washko reviews the role of diagnostic imaging in COPD and emphysema and explores its potential role in providing structural information on airway and lung parenchyma in COPD pathogenesis and response to treatment.

The changing epidemiology and impact of severe exacerbation in COPD patients who require hospitalization is reviewed by Drs. Chenna and Mannino. Dr. MacNee examines the important consequences of COPD on right heart function.

The old concept that patients with COPD respond poorly to teatment has been replaced with cautious optimism as several forms of therapy have been shown to improve outcome. A comprehensive review of available treatment options in patients with advanced disease is presented by Dr. Bourbeau, who provides insight into the prevention of hospitalization for COPD. Drs. Ohar and Donohue review the use of bronchodilators and inhaled corticosteroids in COPD. Dr. Make and colleagues review the use of supplemental oxygen in COPD. Dr. Sandhaus discusses the implications of α-1 antitrypsin deficiency in the general COPD population and provides guidance as to whom to test and whom to treat. Finally, Drs. Criner and Mamary review the use of LVRS in select patients with advanced emphysema, and Drs. Todd and Palmer review the role of lung transplantation.

The guest editors acknowledge all of the efforts of the contributing authors in making this issue comprehensive and informative. We also acknowledge and greatly appreciate the editorial assistance and efforts of Dr. Lynch, Ms. Maldonado, and Ms. Kaufman in the development and completion of this issue.

Gerard J CrinerM.D. 

Department of Medicine, Division of Pulmonary and Critical Care Medicine

Temple University School of Medicine, 745 Parkinson Pavilion, 3401 North Broad St., Philadelphia, PA 19140

Email: crinerg@tuhs.temple.edu