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Chronic Obstructive Pulmonary Disease
identify persons with early COPD, but the recommendations for those In the commercial realm, many new medications are in various stages
with early disease vary only slightly from those for unaffected of development, including once-daily LABAs and antimuscarinics.
smokers. All patients should stop smoking and consideration should Other medications include inhibitors of inflammation by various
be given to immunisation and the use of SABDs. mechanisms. Inhibitors of apoptosis and derivatives of vitamin
A show some promise to slow or reverse the development of
One could argue that it would be valuable to screen asymptomatic emphysema. Procedures for advanced-stage disease are being
smokers only if it improved the rate of smoking cessation. There is developed further. Lung volume reduction surgery improves survival,
little evidence to address that, but what evidence exists shows little lung function, and quality of life for a limited subset of patients. Other
benefit in terms of smoking cessation.
23
In fact, smokers whose lung options for bronchoscopic lung volume reduction are being
function is normal may feel that their belief that they are are not developed, including valves, stents and endobronchial glues. These
harmed by smoking is justified. It is clear that spirometry is essential may be available for clinical use in the near future.
to the diagnosis and treatment of COPD, but the indications for
spirometry remain unclear for asymptomatic smokers. Conclusion
COPD is readily treatable, mostly by primary practitioners. Nihilism is
Smoking cessation is key to prevention in COPD, whether it is primary, inappropriate. Simple steps have the greatest public health impact:
secondary or tertiary. Discussion of smoking cessation methods is smoking cessation, immunisation and clean air laws are great examples.
beyond the scope of this article. Some of the science of smoking Guideline-based management is well established and needs to be more
cessation was developed by the Lung Health Study. New methods and broadly implemented. More complex disease management is available
medications have been developed since then. The politics and law for more advanced disease. It improves symptom control and reduces
related to public tobacco use are also beyond our scope, but the exacerbation frequency. Research is rapidly advancing our understanding
public health benefits of clean air laws are enormous and exceed of the disease and helping to develop new therapeutic approaches. ■
most people’s expectations in many locations.
24,25
Lorenzo W Klein is a second-year Fellow in Pulmonary
Prospects are abundant in COPD research. In the US, the NHLBI
and Critical Care Medicine at the Mayo Clinic,
funds an extensive number of studies in basic mechanisms of Rochester. His research interests are chronic
disease through its RO1 and other funding mechanisms. The COPD
obstructive pulmonary disease (COPD), non-tuberculous
mycobacterial lung disease and vasculitis. During
Clinical Research Network currently has three active clinical trials
medical school and residency he had the opportunity to
studying: the use of a macrolide to reduce the frequency of work with several great chest physicians worldwide,
exacerbations; the use of zileuton to accelerate recovery from
which ignited his love for this field.
severe AECOPD; and antibody responses to two pneumococcal
Paul D Scanlon is a Professor of Medicine at the Mayo
vaccines in those with COPD. Additional trials are in development.
Clinic, Rochester, where he is Director of the Pulmonary
The Lung Tissue Research Consortium is collecting surgical discard Function Labs, the Pulmonary Clinical Research Unit
tissue from persons with COPD and interstitial diseases for use in
and the Mayo Clinic Center for Humanities in Medicine.
His research interests include chronic obstructive
basic research. The Long-term Oxygen Treatment Trial is a trial to
pulmonary disease (COPD), asthma and occupational
assess the efficacy of supplemental oxygen in patients with COPD lung diseases.
and moderately severe hypoxaemia. Similar research-funding
agencies exist in other countries.
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28 EUROPEAN RESPIRATORY DISEASE
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