EPOC: inflamación bronquial y sistémica

[Chronic obstructive pulmonary disease in Archivos de Bronconeumología in 2010]

Chronic obstructive pulmonary disease (COPD) continues to cause concern among health professionals treating respiratory diseases worldwide. The reasons for the increasing tendency in prevalence, morbidity and mortality rates are under constant investigation. Areas of research include identification of new phenotypes, predisposing factors, and physiopathological and epidemiological features that are still not completely known, as well as the systemic behavior of this disease and its relationship with other, associated pathological states. New and encouraging alternative treatments are also being investigated. This unceasing search for scientific knowledge is reflected in the number of studies published in each of the sections of Archivos de Bronconeumología throughout 2010, which deal with most of the pressing issues concerning this disease and which will be summarized in the present article. More than 60% of the contents of the journal's supplements were related to COPD. A monographic issue, produced for training purposes, was published and consisted of three units: the first was entitled "The thousand and one faces of COPD", the second "COPD: from etiopathogenesis to treatment" and the third "COPD: how can patient care be improved?". The authors of these units provide an in-depth and up-to-date analysis of topics relating COPD to various pathological states and include an analysis of the disease in two population groups that have aroused recent interest, namely, women and non-smokers. The third unit of the monograph deals exclusively with the patient.

Significance of the microbiome in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of few chronic disorders with rising mortality and morbidity. It is a highly prevalent disorder, characterized by highly heterogeneous clinical symptoms, health status, and disease progression. COPD is also characterized by an inflammatory/immune response that persists despite smoking cessation and varies by the patient population, method of assessment, and timing of measurement. Bacterial colonization or infection is ubiquitous in patients with COPD and, until recently, has been predominantly assessed using culture-based methodologies. This colonization has been believed to be biologically relevant. It has been estimated that more than 70% of the bacterial species on body surfaces cannot be cultured by standard techniques. As such, advanced culture-independent techniques have been developed that target bacterial genes, such as the 16S ribosomal RNA gene, that function as molecular chronometers. Application of these techniques in patients with COPD has suggested microbial diversity that varies by age, disease severity, and medication use. All of these data provide unique and rapidly evolving insight into the potential role of the respiratory microbiome in disease genesis and expression.

The future of chronic obstructive pulmonary disease treatment--difficulties of and barriers to drug development

Although chronic obstructive pulmonary disease (COPD) is a major global health problem with a rising incidence and morbidity, few pharmacotherapeutic advances have been made over the past several decades. The challenges of development of such agents are multifactorial and include rudimentary understanding of the biological genesis of human disease, inadequate in-vitro and in-vivo models, unvalidated biomarkers, inefficient physiological and clinical endpoints, and variable regulatory review worldwide. Blockade of various inflammatory pathways and mediators is a reasonable therapeutic strategy to alter the natural history of COPD. Substantial heterogeneity is evident with respect to clinical presentation, physiology, imaging, response to therapy, decline in lung function, and survival. Numerous endpoints have been proposed for clinical studies in COPD, with new approaches under study. The novel strategy that seems most promising is the use of biomarkers. We hope that with these approaches novel pharmacotherapies will be developed in the near future.