Chronic Obstructive Pulmonary Disease

Frank C. Sciurba, M.D. Fernando J. Martinez, M.D.

We are delighted to present this issue of Seminars in Respiratory and Critical Care Medicine, which addresses important clinical and translational topics from leaders in the field of chronic obstructive pulmonary disease (COPD). We appreciate the insight of Dr. Joe Lynch, our senior editor, regarding the timeliness of this topic and for allowing us this opportunity. We are most grateful to our expert contributors, who have provided thoughtful, detailed, state of the art reviews on their respective topics. COPD has, in past years, been neglected by clinicians, scientists, industry, and funding agencies and hence the basic research knowledge and therapeutic initiatives were insignificant compared with other diseases having its prevalence. It is thus no surprise that the recently increased interest in COPD is beginning to bear fruit with respect to new understandings of pathogenesis, epidemiology, clinical impact, outcome assessment, and improved therapeutic options.

In this issue Dr. Ries embraces the growing body of evidence documenting the impact of pulmonary rehabilitation on improvement in symptoms, exercise tolerance, and quality of life, as well as reduction in utilization of health care resources. Drs. Spurzem and Rennard discuss the substantial progress in the understanding of disease pathogenesis. The central role of inflammation in disease development as a response to cigarette smoke and in disease progression, even following smoking cessation, is discussed. The increased molecular, cellular, structural, and mechanical understanding of this disease both in the lung and systemically, is providing targets for pharmaceutical, biological, and device development. Drs. Ranes and Stoller discuss alpha-1 antitrypsin deficiency, a disease which highlights the fact that progress in molecular pathogenesis can lead to early detection and effective therapies to prevent disease progression.

Drs. Martinez and Chang discuss the role for surgical intervention, including lung volume reduction surgery and lung transplantation in patients with more advanced disease, and the impact of recent clinical trials on the selection of patients for these procedures.

In addition, Dr. Sethi offers a scholarly review of the mechanisms, consequences, and treatment of exacerbations in COPD. Dr. Mannino discusses the epidemiology and global impact of this disease. It is clear from this work that the impact of COPD is worthy of an enormous societal effort to curb its dominant cause, tobacco smoking. The ongoing increase in smoking in adolescents and women and overall in third world countries is alarming. Improved education of both physicians and the general public is necessary to increase awareness of the condition as an essential first step toward early detection and diagnosis.

Drs. Coxson and Rogers discuss the advances in radiological assessment of COPD. The improved premortem assessment of airway and parenchymal structure available with new imaging techniques provides important tools to classify disease, which may further clarify prognosis or individual response to specific therapies. Furthermore, these techniques may be used to monitor response to certain therapeutics. Several of our experts highlight advances in disease therapeutics. Drs. Weder and Donohue provide insights into new, long-acting bronchodilators that demonstrate disease impact beyond improvements in peak forced expiratory volume in 1 second (FEV₁). In addition, Dr. Calverley offers a balanced view of the role for inhaled corticosteroids in COPD, declaring those subgroups of patients who have a clear indication for therapy and those in whom the use of these preparations remains controversial.

With the development of new therapies, it is increasingly apparent that our traditional tools are inadequate to fully evaluate prognosis or response to evolving therapeutics. Dr. Cooper discusses the role of traditional and more advanced methods to assess lung function. Drs. patel and Sciurba further discuss some important emerging concepts in functional outcome assessment in COPD that have important implications in future clinical trial design.

We believe that our contributors have provided a well balanced and comprehensive review of the state of the art in the epidemiology, pathogenesis, assessment, and treatment of COPD. We hope that our readers will find these reviews useful in their practice of medicine to better the understanding and care for these patients.