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| The View From Here Disease Focus: COPD Smoking cessation is still the cornerstone of chronic COPD management, considering that cigarette smoking is the single most important risk factor for the development of the disease. However, a recent worldwide epidemiologic study documented a fairly high prevalence of stage II or more COPD in individuals who had never smoked. This finding raises important questions about the role of other unidentified factors. Therefore, a better understanding of alternative factors that contribute to COPD is crucial. An intriguing possibility is the presence of a chronic systemic inflammatory syndrome that is suggested by the importance of complex risk factors (e.g. smoking, obesity, hypertension) in development, not only of primary disease (i.e. COPD, chronic heart failure or metabolic syndrome) but also of systemic and complex abnormalities affecting other organs that are induced by smoking or by interaction of major risk factors. If this is the case, a more comprehensive approach to COPD management and its co-morbidities might provide an opportunity to modify the natural history of COPD, allowing for identification of novel targets for treatment However, many clinicians do not agree with this hypothesis and prefer to consider that the most obvious explanation for the presence of systemic inflammation in COPD patients is that, somehow, this pulmonary inflammation is ‘spilling over’ into the systemic circulation. Whatever the case is, it is obvious that, if we wish to become better at determining why and which patients benefit from treatment, it is mandatory to define the outcomes that must be considered. It is also necessary to define the minimally important differences in these outcomes, characterize the various clinical phenotypes of COPD and investigate biomarkers of disease activity or surrogate markers as predictors of outcome. Enjoy the read! Mario Cazzola |
At present, therapeutic interventions for patients suffering from stable COPD can result in substantial clinical benefit. Although the TORCH study failed in its primary endpoint (statistically significant decrease in mortality), it has been documented that COPD is not inexorable and that aggressive efforts to reduce its burden can now be instituted.