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Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the USA.1 Its defining feature is limitation of expiratory airflow, which is usually relentlessly progressive. Current therapies have meaningful, but limited benefits. For those who have resting hypoxaemia, supplemental oxygen improves survival. Rehabilitation can improve health status and exercise performance. However, neither of these treatments alters lung function or the rate at which it declines. Volume reduction surgery, by removing the most dysfunctional parts of the lung, can reduce exacerbations2 and improve lung function, performance, symptoms and survival, but only in a subset of patients, and the effects are limited, both in magnitude and in duration.3 4 Currently available pharmacotherapy, including bronchodilators and combinations of bronchodilators and inhaled corticosteroids, modestly improve airflow and symptoms and reduce exacerbations.5 6 Statistically significant effects in slowing the rate at which lung function is lost have been reported with pharmacotherapy,7 but the clinical importance of the benefits achieved remain uncertain.
With this background, a major goal for novel therapy in COPD is to alter the natural history of the disease.
The classic study of Fletcher and colleagues8 provided the basis for current understanding of the natural history of COPD and has guided attempts at altering its course. The ‘British Postal Worker's Study’ included 792 men who were evaluated for a period of eight years. Based on this study, Fletcher and colleagues suggested that normal individuals lost lung function at an accelerating rate with age. Individuals who were exposed, for example, to cigarette smoke, and who were susceptible, experienced an accelerated rate of decline in lung function. A portion of these would eventually be diagnosed with COPD. To their credit, Fletcher and colleagues recognised that their ‘model’ was an extrapolation based on a limited data …
This is a reprint of a paper that first appeared in Thorax, August 2011, Volume 66, pages 643–645.
Competing interests SIR has served as a consultant or participated in advisory boards for: ABIM, Able Associates, Adelphi Research, Almirall, APT, Aradigm, Argenta, AstraZeneca, BI (ACCP), Biostrategies, BoomCom, Britnall and Nicolini, Capital Research, Chiesi, Clinical Advisors, CommonHealth, Complete Medical Group, Consult Complete, COPDForum, DataMonitor, Decision Resources, Defined Health, Dey, Dunn Group, Easton Associates, Enterprise Analysis, Equinox, Forest, Fulcrum, Gerson Lehman, GSK, Guidepoint, Hoffman LaRoche, IMS, Informed, Inspire, Insyght, KOL Connection, Leerink Swan, M. Pankove, MDRx Financial, MedaCorp, Medimmune, Mpex, Novartis, Nycomed, Oriel, Otsuka, Pearl, Pennside Partners, Pfizer, Pharma Ventures, Pharmaxis, Pick Research, Prescott, PwC, Propagate, Pulmatrix, Pulmonary Reviews, Quadrant, Reckner Associates, Recruiting Resource, Reviews and Trends in COPD/Convergent Health Solutions, Roche, Sacoor, Schering, Schlesinger Medical, Scimed, Smith Research, Sudler and Hennessey, Talecris, Theravance, UBC, Uptake Medical, Vantage Point. He has received lecture fees from: AAAAI, Am Col Osteopathic Physicians, Asan Medical Center, ATS, AstraZeneca, California Soc Allergy, Convergent Health Solutions for Reviews and Trends in COPD, COPD Foundation, Creative Educational Concepts, Dey, Duke, France Foundation, Information TV, University of California-Los Angeles, Network for Continuing Education, Novartis, Nycomed, Otsuka, Pfizer, Sarasota Mem Hospital, Spanish Thoracic Society, University of Washington, University of Alabama-Birmingham, University of Pittsburgh, University of British Columbia, University of California-Davis, VA Sioux Falls. He has received industry-sponsored grants from: AstraZeneca, Biomarck, Centocor, GlaxoSmithKline, Mpex, Nabi, Novartis, Otsuka, Pfizer. JV has received fees for consulting and presenting on issues on COPD treatment from: GSK, AstraZeneca, Pfizer, Boehringer-Ingelheim, Novartis, Talecris, Chiesi, Hofmann-La Roche and Nycomed – none of which provide a cure for COPD, unfortunately.
Provenance and peer review Not commissioned; externally peer reviewed.
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