COPD is a major global health problem, now affecting over 10% of people over 45 years and being the third most common cause of mortality in high-income countries. COPD exacerbations are also one of the common causes for hospital admissions. While the main cause of COPD is smoking in Western countries, in developing countries COPD is commonly seen in non-smokers and is caused by the exposure to biomass fuel smoke in homes.
We now have a better understanding of the underlying mechanisms of COPD, which involves chronic inflammation of the peripheral airways and lung parenchyma, acceleration of the normal ageing process and chronic bacterial colonisation of the airways. A better understanding of the disease has identified new therapeutic targets.
Long-acting bronchodilators have proved to be the most useful treatments for COPD at present, and a combination of a Long Acting Muscarinic Antagonist (LAMA) with a Long Acting ß2 Agonist (LABA) provides optimal bronchodilatation.
We still need treatments that target the underlying inflammatory disease, but corticosteroids are only useful in a few patients because of corticosteroid resistance, and the phosphodiesterase 4 inhibitor roflumilast is limited by its side effects. There appear to be distinct phenotypes of COPD patients that may benefit from these different anti-inflammatory treatments.
Most patients with COPD have comorbidities, and these may be due to shared pathogenetic mechanisms with COPD, such as accelerated ageing and chronic inflammation. The presence of comorbidities may also affect management.
The National Heart and Lung Institute (NHLI) at Imperial College and its associated Royal Brompton Hospital is the largest centre for COPD research in Europe, with some of the most highly cited investigators in the world. We take a multidisciplinary approach to our research and link basic research with clinical measurements and studies.