Developing new treatments for chronic obstructive pulmonary disease (COPD) is extremely challenging. This disease, chronic by definition, becomes apparent only after substantial—and probably irreversible—tissue damage has occurred. The observable phenotype is of a stable disease state whose progression is hard to influence and reversal of which appears almost impossible. Identifying key components of the pathological process, targeting of which will result in substantial clinical benefit, is a significant challenge. In this review the nature of the disease is examined and conceptual information and simple tissue models of inflammation are used to explore the pathological network that is COPD. From the concept of COPD as a disease network displaying the features of contiguous immunity (in which many processes of innate and adaptive immunity are in continual dialogue and evolution), refinements are suggested to the strategies aimed at developing effective new treatments for this disease.
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Funding: IS is funded by a Medical Research Council Senior Clinical Fellowship.
Competing interests: None.
This is a reprint of a paper that appeared in Thorax, August 2007, volume 62, pages 733–8. Reprinted with kind permission of the authors and publisher.