The COPD National Action Plan: Goal 4
Posted on May 05, 2016 |
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.
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?
- Heart disease: $1.31 billion
- Cancer: $6.33 billion
- Chronic lower respiratory disease: $100 million (COPD) + $289 million (asthma)
- Accidents (unintentional injuries): $418 million
- 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
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?