Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that affects millions of people worldwide. Ranked as the third leading cause of death globally by the World Health Organisation, COPD accounted for 3.23 million fatalities in 2019 with 90% of COPD deaths in those under 70 years of age occurring in low- and middle-income countries. COPD is a multifaceted respiratory condition that generally encompasses chronic bronchitis and emphysema, both of which are characterized by persistent airflow limitation. While it may not be as widely discussed as some other health conditions, COPD has a significant impact on the lives of those diagnosed with it.

Risk Factors

COPD's primary causative factor is prolonged exposure to noxious particles or gases, with cigarette smoke and air pollution being the most significant contributors. The inhaled toxins trigger an inflammatory response in the airways, leading to chronic bronchitis and emphysema. Genetic factors, environmental pollutants, occupational exposures, and respiratory infections contribute to the development and progression of COPD. Insults to the developing lung during foetal life and the first few years of postnatal life are also now considered significant risk factors for the development of COPD.

Challenges

Despite being first recognised over two hundred years ago by Badham and Laënnec and despite its prevalence, there is no cure for COPD, with current medications merely providing symptom relief and failing to alter the trajectory of the disease. Current COPD management focuses on symptom relief, prevention of exacerbations, and improving overall lung function. Pharmacological interventions include bronchodilators (beta-agonists and anticholinergics) and anti-inflammatory medications (corticosteroids). Oxygen therapy, pulmonary rehabilitation, and surgical interventions, such as lung volume reduction or transplantation, are also used in advanced cases.

COPD research has traditionally encountered several barriers that have impeded progress in understanding the disease and developing effective treatments. COPD research has classically been hampered by the lack of awareness of the disease, arduous experimental models, the heterogeneity of clinical traits making it difficult to design clinical trials, as well as difficulties in diagnosis. In the past, funding for research on COPD disease mechanisms has been disproportionately low considering the significant global impact of the condition.

Science and Precision Medicine is the Key

To move closer towards a cure for COPD, it is crucial to understand the pathophysiological alterations associated with the development and progression of COPD. Some of the hallmark features of COPD include dysregulated inflammation, accelerated ageing, susceptibility to infection, metabolic dysfunction, and impaired regeneration. Rapid progress in high-throughput single-cell and spatial genomic, metabolomic, and proteomic technologies, along with sophisticated ex-vivo cell culture methods like human organoids and organs-on-chip, coupled with innovative computational tools, has unlimited potential to uncover new insights into disease mechanisms and therapeutic approaches for COPD. Targeted anti-inflammatory agents, regenerative medicine, and precision medicine tailored to individual genetic profiles are promising and rapidly growing fields. Early detection of COPD risk, combined with personalized treatment strategies, also holds potential for more effective disease management.

The Future

Continued scientific exploration and collaboration across disciplines are indispensable for unravelling the intricacies of COPD and developing innovative solutions for better patient care. COPD is included in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) and the United Nations 2030 Agenda for Sustainable Development. The COPD National Action Plan in the USA developed in 2018 at the request of Congress acts as a blueprint for a multifaceted, unified fight against COPD. In Europe, The European Commission launched the Healthier together EU non-communicable diseases (NCD) initiative to reduce the burden of major NCDs and improve citizens’ health and well-being in which chronic respiratory diseases is highlighted as a top five priority.  Many successful European funded (e.g.  EU PAL-COPD, TOLIFE, EUREST-PLUS, CADSET ALEC and PredictCOPD) and USA funded initiatives (e.g. SPIROMICS, COPDgene, SOURCE and RURAL) are leading the way forward for COPD research globally. Similarly, the COPD Foundation, the Global Initiative for COPD  (GOLD), the Speak up for COPD campaign and the recently established Advanced COPD Research International Network (COPD-iNET), amongst others, all strive to create awareness, to improve the lives of all people affected by COPD and to ignite novel research directions and therapeutic avenues paving the way to eliminate COPD.

On World COPD Day 2023, we envision a future where impactful COPD research, characterized by collaborative initiatives involving researchers, funding agencies, policymakers, and advocacy groups, will lay the groundwork for prolonging lives and enhancing the health of millions affected by COPD. Respiratory Research invites and supports the submission of Original Research Articles on COPD from global contributors.