Clinical Consensus in COPD – the experts’ reflections on the conference and the future of COPD
Global COPD leaders gathered in London on 2–3 March 2007 for Clinical Consensus in COPD. In his invitation to the conference, Chairman Peter Calverley, from the University of Liverpool in the UK, said it aimed “to bring together the COPD healthcare community and to work towards a consensus on all aspects of diagnosis and treatment of this public enemy disease.”
MedWire Reporter Cher Thornhill asks Bartolome Celli and Peter Barnes to reflect on the conference and the future of COPD, and reports on the major outcomes of the conference.
Bartolome Celli is Professor of Medicine at Tufts University in Boston, Massachusetts, USA. He is Co-Chairperson of the American Thoracic Society Committee that established the Standards for the Diagnosis and Treatment of patients with COPD, past Chairman of the Clinical Assembly of the ATS, and past President of the Massachusetts Thoracic Society and New England College of Chest Physicians.
Peter Barnes is a member of the conference leadership committee and Professor of Thoracic Medicine at the National Heart & Lung Institute, Imperial College London, and Honorary Consultant Physician at Royal Brompton Hospital, London, UK. He has published over 1000 peer-review papers on respiratory topics and is a member of the Scientific Committee of GINA and GOLD Guidelines committees.
The program for the conference included sessions in four areas:
• burden of disease
• therapeutic approaches
• exacerbations
• extrapulmonary manifestations
What is the highlight of this conference for you?
BC: The highlight of the conference is the fact that about 900 people showed up to continue talking about COPD so there is a tremendous interest in the area of COPD. Finally the disease is getting the attention it deserves. To me that’s number one.
Second, that we have changed the way in which we see the disease from one in which there is little we can do, to one where we have many avenues of therapy that are highly effective.
What are the most pressing issues in COPD at the moment?
PB: I think the important issues are the need to have better recognition of the disease and the epidemiology studies showing that there’s a higher prevalence in every country where surveys have been conducted.
I think it’s underestimated by GPs. And they often don’t use spirometry to confirm the diagnosis. So probably they’re putting less importance on COPD than other diseases like cardiovascular diseases.
BC: Popularization of the concept of COPD, and that it’s easily diagnosable through spirometry. I believe a good campaign of education for the public and a good campaign of education for the patients - and their decisions will result in much more diagnoses at an earlier stage.
“We don’t recognize the important role COPD has in contributing to deaths from other diseases.” Peter Calverley.
Do you think COPD will be taken more seriously in the near future?
PB: I think there’s a lot more interest in COPD now. I mean it’s like asthma was about 10 years ago when there was a very poor level of knowledge, but that’s really changed a lot now. So I would think that there will be a much better understanding of COPD and better recognition.
What kind of changes do you think might happen in the next 5-10 years?
BC: I think spirometry will be more of a household name. COPD will be known as SARS is known, as HIV is known, as AIDS is known. I believe COPD will become such a term with people.
If they have problems, they will say ‘look doctor, will you test if I do have COPD,’ just as they do now for SARS, AIDS, flu. People know those terms because they’ve read them. I think that will happen. And normally too we will have many more cases diagnosed because people will use spirometry much more frequently.
“We can now say that we can treat COPD and it is treatable and preventable.” Bartolome Celli.
What other issues still need to be addressed?
BC: Well the most important one is patient conscience that they can press government to obtain benefits. I think that’s number one for patients.
PB: A recognition that comorbidites are important so that in managing COPD it’s important to take account of associated disease and the systemic components of the disease.
What does the future hold for COPD patients?
BC: The future is bright. We will have more therapies. I think there are a great deal of smart individuals and laboratories working hard to develop these compounds, new ideas. And I think with the joint effort of many more people we’ll have very good answers for our patients.
Critical Themes
• Continuing under-diagnosis. The problem of denial among patients and under-recognition and under-use of spirometry by primary care providers was highlighted.
• Asthma, COPD overlap. Roland Buhl (Mainz University Hospital, Germany) advised that patients who present with symptoms of both diseases and prove difficult to diagnose, should be treated for asthma.
• The shortfall in approaches to COPD versus other big killers. Speakers drew parallels between the diagnosis of COPD and congestive heart failure, an acute exacerbation of COPD and a heart attack, and the palliative care of COPD compared with cancer patients.
• Countering nihilistic attitudes. The belief that COPD patients are condemned and that it’s their own fault because they smoke was acknowledged and countered, while hailing recent treatment advances.
• The potential for statins to treat COPD. Following a recent epidemiological study linking statin therapy with reduced mortality, speakers called for large, specific intervention studies to test the theory further.
• Tackling corticosteroid resistance. Barnes said he believed theophylline could overcome steroid resistance in COPD and provide the answer for the global epidemic.
To view the full program and copies of the speakers’ presentations, visit the Clinical Consensus in COPD website.