Goal 2: Reduce Human Disease

Clinical trials of AAT augmentation therapy

Alpha-1 antitrypsin augmentation therapy is widely used for PI ZZ subjects, but randomized clinical trials of AAT augmentation therapy have not been adequately powered to assess the efficacy of this treatment. A clinical trial using COPD exacerbation frequency as the primary outcome, rather than decline in lung function, in PI ZZ subjects with moderate-to-severe COPD could provide definitive evidence for the utility of ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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Goal 2: Reduce Human Disease

Physical activity of COPD patients

How can we increase physical activity in our COPD patients?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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3 net votes
3 up votes
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Goal 2: Reduce Human Disease

Low-dose and non-ionizing imaging for chronic lung disease

Critical Challenge

Submitted by (@str0001)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Imaging plays a crucial role in the initial evaluation of patients with suspected or surveillance of those with confirmed diffuse chronic lung disease. Attention towards developing alternative non-ionizing imaging technologies and evaluating the efficacy of radiation dose saving techniques will impact a large patient population.

Feasibility and challenges of addressing this CQ or CC :

Imaging, particularly computed tomography (CT) plays a major role in the evaluation of diffuse pulmonary disease. High resolution CT (HRCT) characterizes parenchymal patterns of lung disease, identifies areas amenable to biopsy, and aids in decisions pertaining to workup and therapy of lung disease. With multidetector CT technology, volumetric HRCT enables evaluation of the entire lung volume for diffuse lung disease. The utility of CT needs to be balanced with the exposure of patients to ionizing radiation, particularly younger-aged individuals who are more sensitive to ionizing radiation. In CT, dose-saving techniques enable imaging of the parenchyma at ultra-low dose levels. Additionally, an understanding of low radiation-dose CT techniques that preserve the diagnostic ability for diffuse lung disease, while maintaining the precision of quantitative measures, is needed. Magnetic resonance imaging (MR) is underutilized as an imaging tool given respiratory motion and limitations in spatial resolution. A need exists to develop and apply MR imaging techniques with spatial resolution approaching that of high resolution CT. Promising advances in the MR technology has occurred, and continued development and application will provide alternative and non-ionizing options for imaging patients with diffuse lung disease affecting both the parenchyma and airways.

Name of idea submitter and other team members who worked on this idea : Society of Thoracic Radiology

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8 net votes
10 up votes
2 down votes
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Goal 2: Reduce Human Disease

What defines COPD disease severity?

What defines COPD disease severity?

a. Spirometric classification is inadequate

b. Patient-centered outcomes should be central to this classification

c. The need for suitable instruments

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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4 net votes
4 up votes
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Goal 3: Advance Translational Research

What strategies improve implementation of COPD therapy, palliation, and dyspnea management

Chronic obstructive pulmonary disease (COPD) affects over 12-24 million individuals in the U.S. where it is responsible for ~ 800,000 hospitalizations per year, and recently became America’s 3rd leading cause of death. The lag between clinical practice and treatment options described by efficacy studies to improve the quality of life, functional status, and survival in patients with COPD make it ideal for efforts in patient-centered ...more »

Submitted by (@richard.mularski)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : Richard Mularski MD MSHS MCR

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20 net votes
29 up votes
9 down votes
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Goal 2: Reduce Human Disease

Understanding Pathobiology of Exacerbations

COPD exacerbations contribute to poor quality of life, lung function and functional decline. In addition, they are costly to the patient and to health care cost. However, they remain defined exclusively on symptoms and constitute a “soft” endpoint. Actually, the number of exacerbations has become the GOLD standard to establish the risk of outcome (exacerbations). However, a mild episode that only requires outpatient ...more »

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Outcome measured: Level of health care resource utilization: ambulatory therapy, hospitalization to ward and non-invasive ventilation and admission to ICU for ventilatory failure.

Analysis: To evaluate the level of accuracy of the re-classification of the episode and to relate the level of biomarker change to the severity of the episode.

Feasibility and challenges of addressing this CQ or CC :

Study Plan

A change in paradigm can be explored using an approach similar to that developed in the field of cardiovascular disease for coronary artery disease. This can be seen in the table from the article (Celli B and Barnes P J. Exacerbations of COPD. 2007;29:1224), which shows the basis for the proposal where we would add the biomarkers described above.

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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Goal 3: Advance Translational Research

Palliative and hospice care for COPD patients

Does palliative care and/or hospice care as practiced across communities improve end-of-life care for COPD – specifically, does it reduce the burden of symptoms, improve HRQoL and satisfaction, reduce utilization in last 6 months of life (i.e. hospital visits, cost, invasive ventilation use, etc), improve the end-of-life experience, and increase the concordance of place of death to expressed patient preferences?

Submitted by (@k.willard)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

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12 net votes
16 up votes
4 down votes
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Goal 3: Advance Translational Research

Best Practices for implementation of guidelines in COPD community care

How can guideline recommendations be implemented into community practice in a way that is feasible, usable, relevant, and cost-effective? (examples are use of care management, translation of chronic care model, and EMR based tools)

Submitted by (@swilliams1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : Stephanie Williams, Community Program Manager, COPD Foundation

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9 net votes
11 up votes
2 down votes
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Goal 3: Advance Translational Research

Epidemiology of Chronic Lung Disease

Develop large epidemiologic cohorts of subjects with various types of chronic lung diseases with long-term follow-up of elements of disease progression and of related co-morbidities. These cohorts should be the substrate for comprehensive studies of genetics, omics, and biomarkers, as well as for clinical trials.

Submitted by (@jdc000)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

Detailed, high quality epidemiology of the major chronic lung diseases is seriously lacking. Very few cohorts of subjects at risk for or with chronic lung diseases have been established and as a result human data for understanding risk elements that determine disease progression and the development of new treatments for chronic lung diseases is substantially behind other fields. For example, COPD has become the third leading cause of death and is the only leading cause of death and disability that has increased in frequency consistently over the past several decades.

Feasibility and challenges of addressing this CQ or CC :

Multiple cohorts of Chronic Lung Diseases need to be established and support maintained for a large portion of the life of the cohort subjects in order to acquire the type of human data needed to address this challenge. An example of this challenge is that we know that GOLD 3 and GOLD 4 subjects have major disability and a markedly increased death rate, yet we know little about the elements that cause or are associated with risk of a GOLD 2 subject to progress to a GOLD 3 or GOLD 4 state.

Name of idea submitter and other team members who worked on this idea : Ed Silverman, James Crapo and the COPDGene Executive Committee

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20 net votes
37 up votes
17 down votes
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Goal 3: Advance Translational Research

COPD risk categories and resource utilization

Can a tool be developed to group patients into risk categories for resource utilization?

Submitted by (@jimandmarynelson)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

COPD is usually blamed on smoking - first-hand smoke, second-hand smoke, and third-hand smoke. In reality, smoking is a major contributing factor. However, many other factors may lead to destruction of the breathing mechanisms in human lungs. Premature birth, exposure to industrial or agricultural chemicals, breathing dirty air, and a genetic factor known as Alpha-1 Antitrypsin Deficiency, as well as other factors may lead to COPD. In addition, COPD encompasses emphysema, chronic bronchitis, and certain types of incurable asthma, normally a combination of two or more of these disorders.

Each category of COPD requires its individual research approach.

Name of idea submitter and other team members who worked on this idea : Mary E. Nelson, caregiver, Arizona State Advocacy Captain, Copd Foundation

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19 net votes
21 up votes
2 down votes
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Goal 2: Reduce Human Disease

Disease modifying COPD therapy

Disease modifying COPD therapy

a. Should we be starting therapy earlier in the course of disease?

b. Is there a survival benefit of oxygen therapy for exercise-induced hypoxemia?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : American Thoracic Society member

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2 net votes
2 up votes
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Goal 3: Advance Translational Research

Novel Treatments for COPD

COPD is a major health problem leading to 140,000 deaths in the United States. Treatments are supportive, but there is a compelling need for treatments that modify the progression of the disease and that prevent exacerbations. There needs to be a research infrastructure that unites basic, translational, and clinical researchers to develop new approaches. Although this challenge had been met in the past with the now ...more »

Submitted by (@rwise0)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Name of idea submitter and other team members who worked on this idea : Robert A. Wise

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16 net votes
23 up votes
7 down votes
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