The PRAXIS Nexus The PRAXIS Nexus

The COPD National Action Plan: Goal 4

Posted on May 05, 2016   |   
4 Comments   |   
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We know we can always count on this engaged and dedicated community to provide feedback on new ideas and forming initiatives – and so it has been with our recent PRAXIS Nexus posts on the COPD National Action Plan! In the past several weeks, you have given us your insight into ways we might collectively approach the first three goals of the COPD National Action Plan (see Goals 1, 2 & 3), goals designed to chart the course of COPD care, research and policy.

COPD Clinical research

In this post, we will take a deeper look at COPD National Action Plan Goal 4 (of 6):

Increasing and sustaining research to better understand prevention, pathogenesis, diagnosis, treatment and management of COPD.

The Funding Environment

Having an appreciation of the environment in which COPD-related research is pursued may help our thinking about the question. In the federal sphere, funding for respiratory research is substantially lower than it is for other leading causes of death in the United States. In the Center for Disease Control’s February 2016 report of total funding made available by research, condition and disease category, the National Institutes of Health (NIH) allotted $100 million to COPD research in 2016.

While that sounds like a considerable amount of support for a disease that ranks third among leading causes of death in the U.S., COPD stands at 141st out of 265 conditions (i.e., in the lower half of programs funded by NIH). Where do the other top causes of mortality rank in NIH funding?

  1. Heart disease: $1.31 billion
  2. Cancer: $6.33 billion
  3. Chronic lower respiratory disease: $100 million (COPD) + $289 million (asthma)
  4. Accidents (unintentional injuries): $418 million
  5. Stroke: $300 million

While it might not be readily apparent from these abbreviated numbers, chronic lower respiratory disease receives almost $6 billion less in research support than the next most common cause of death (cancer).

Down to the Basics

COPD Clinical research

A refresher discussion of a few terms used in the goal itself may also be helpful. As you may know, pathogenesis includes the biological or physiological mechanisms that lead to the development of a disease. In COPD, pathogenic research might include an examination of the exaggerated inflammatory response seen in COPD patients; increased production of proteinases or inactivation of antiproteinases; and oxidative stress. Given that a definitive understanding of the pathogenesis of COPD does not exist, what else might our community do to better understand the mechanisms behind these respiratory diseases?

As we mentioned in an earlier post, treatment is tackling the underlying cause or symptoms of diseases. Whether a healthcare provider or person with COPD, you are very familiar with the medications, including bronchodilators and steroids, oxygen therapy, surgery and pulmonary rehabilitation used to treat COPD and its symptomatology. But it may also help to think here of the common comorbidities with which people with COPD often contend, including depression and anxiety, cardiovascular disease and obstructive sleep apnea. How can we work to ensure research efforts adequately and thoroughly address all of these treatment issues?

Last, management extends beyond the treatment of conditions themselves to an array of influential factors in helping the person manage his or her condition. As you know, in COPD, management approaches include prophylactic influenza and pneumococcal vaccines, the use of patient engagement and self-management tools (e.g., the COPD Action Plan) and support groups to improve quality of life, as well as the prevention of exacerbations through regular, multidisciplinary follow-up care.

The Big Question

We look forward to reading your thoughts in the comments – how can the COPD community increase and sustain research to better understand the prevention, pathogenesis, diagnosis, treatment and management of COPD?

4 Comments



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  • The NHLBI will also be present at at the 2016 American Thoracic Society in San Francisco, particularly at the booth on Sunday 5/15 and Monday, 5/16, noon to 1pm to listen to comments about the National Action Plan. Everyone is urged to stop by and give their thoughts. I know I will and suspect Jean will as well. We hope there are LOTS of folks who stop by and tell National Institutes of Health how important the COPD National Action Plan is and how to make it as robust a working document as possible.
    Reply
  • Thank you for sharing that info, Val!
    Reply
  • A few more specifics about the NHLBI booth at ATS: they will be at booth 312 in the Exhibit Hall. Dr. Tony Punturieri, COPD Program Director, will be at the booth at the hours Val indicated (on Sunday, May 15, and Monday, May 16, from noon to 1 p.m. PST). Team members will also be present during general exhibit hours.
    Reply
  • I think we need to expand our pool of participating COPD patients. Doing so will look at other etiologies for understanding prevention, pathogenesis, and management, especially relating to comorbidities. I suggest looking into the data collection formats that 'The Nurses' Health Studies' have done since 1976 and now are on Study 3. This was originally conducted by researches at Harvard School of Public Health and Brigham & Women's Hospital in Boston with 238,000 dedicated nurse participants. While 'Lifestyle' is listed it is not defined. But they are still tracking many of the original participants. They may already have some valuable data to share. They are funded by NIH...... It is now all web based with a survey every 6 months.......perhaps we could collaborate with them?

    http://www.nhs3.org/index.php/our-story

    Pathogenic research has to be an international collaboration. There are a number of major international COPD Journals. It is up to our pulmonology physicians to lead the way and develop protocols, studies, best locations for trials, etc. So many of the articles today rehash the same items that have appeared for the past 25 years with recommendations for more studies (that never get done or suggest effective treatments.) As for management, local PCPs/family physicians need to be repeatedly educated about current guidelines!
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