Showing 35 ideas for tag "copd"

Goal 2: Reduce Human Disease

Understanding COPD Manifestations in Subjects without Overt Airflow Obstruction

What is the pathogenesis and appropriate treatment for subjects with chronic respiratory symptoms or imaging abnormalities who do not have overt airflow obstruction (and thus are not currently categorized as having COPD)?

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 currently diagnosed by spirometry, but many other individuals (primarily smokers) have respiratory symptoms and/or imaging abnormalities that suggest lung damage. Identifying subjects with pre-obstruction manifestations of COPD could lead to more effective treatment and prevention.

Feasibility and challenges of addressing this CQ or CC

COPD subjects often develop ongoing inflammation that persists long after smoking cessation. It is unknown when this cycle of inflammation begins or what causes it.

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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32 net votes
47 up votes
15 down votes
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Goal 2: Reduce Human Disease

Diagnosis and Treatment of the Asthma-COPD Overlap Syndrome

Asthma-COPD overlap syndrome is common and associated with increased morbidity and greater healthcare costs. However, ACOS patients are usually excluded from studies of either disease. There is a compelling need for research in order to define objective diagnostic criteria for ACOS.

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

Details on the impact of addressing this CQ or CC

Better diagnostic criteria as well as biomarkers will allow for efficient targeting of specific therapies for ACOS, such as biologic therapies developed for asthma.

Feasibility and challenges of addressing this CQ or CC

Since ACOS subjects are usually excluded from COPD or asthma trials, this will require identification of study populations that did not exclude ACOS and/or enrollment of ACOS subjects into a new study.

Name of idea submitter and other team members who worked on this idea C. Hersh

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30 net votes
31 up votes
1 down votes
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Goal 2: Reduce Human Disease

Early COPD

What does early COPD actually look like. This is defined as severe COPD 30 years prior to its manifestation.

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

Details on the impact of addressing this CQ or CC

Prevention programs in COPD either target smoking or those with established disease. Better understanding the factors that lead to the development of COPD (both in ever and never smokers) is critical to improved disease prevention.

Feasibility and challenges of addressing this CQ or CC

We need to revisit long term studies in novel ways- and look at new cohorts. Better biomarkers need to be developed.

Name of idea submitter and other team members who worked on this idea Dave Mannino

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22 net votes
31 up votes
9 down votes
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Goal 2: Reduce Human Disease

COPD and co-morbidities

Society is ageing and chronic degenerative diseases including COPD are increasingly occurring together.
The critical question is whether certain diseases occur together by chance or are they occurring together because they share pathobiological commonalities and mechanisms? This leads to a series of practical consequences and questions
1. Which diseases are occurring concurrent with COPD more than chance alone would... more »

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

Details on the impact of addressing this CQ or CC

It is entirely possible and actually likely that several diseases manifesting in different organ systems may have shared pathobiological mechanisms. This could be the case of systemic inflammation or abnormal repair, precipitated by interaction with external agents such as pollution or smoking. This would manifest as different diseases affecting different organ systems (as could be the case of COPD and Lung Cancer) using today's taxonomy.
As it stands (taking the COPD Lung Cancer example) each is treated differently and actually strategically and clinically, they are handled as separate entitites. In all reality, if we can identify the diseases that share common pathogenetic mechanism, it is likely that we can develop common biomarker profiles that will detect disease predisposition so that early intervention can be planned.
In addition and equally important, once common co-morbidities can be grouped by pathobiology, plans can be developed by the medical establishment including health authorities to develop common approaches rather than the disjointed separate specialties that today handle each of the different organ systems.
Finally, the potential of aggregation of diseases into common pathobiological fields can reduce health care cost by integrating fields and voiding dispersion of resources.

Feasibility and challenges of addressing this CQ or CC

It is entirely possible to use large throughput data analysis such as system network analysis to determine in a hypothesis free environment, what is the relationship amongst diseases. This analysis, that can be facilitated by the availability of electronic medical records can provide a first glance evidence of commonality amongst certain diseases.
This can be validated in other cohorts and a plan for profiling a representative sample of those cohorts in order to determine their proteomic and metabolomics profile. This will provide insight into the mechanisms responsible for the expression of the diseases and can lead to translational research aimed at identifying the mechanisms for the generation of the syndrome and potential therapeutic targets.
Once proven correct, it will be possible to identify and treat several diseases simultaneously with targeted therapy once appropriate trials have been completed.
The project here presented is already feasible and likely to offer new roads leading to a better taxonomy, identification and treatment of what now represents a puzzle of different pieces poorly interlocked.
Given the magnitude of the population that is and will be even more affected by multiple chronic diseases, this is a field that is ready for prime research efforts.

Name of idea submitter and other team members who worked on this idea COPD and co-morbidities: Chance or Fate?

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20 net votes
22 up votes
2 down votes
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Goal 2: Reduce Human Disease

Cure COPD

How can the structure and function lost in COPD be restored?

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

Details on the impact of addressing this CQ or CC

The tissue alterations in COPD and their physiologic consequences of those changes are reasonable well described. It is now clear that, like all organs, the lung can repair damaged tissue and that repair processed can be modulated. Strategies for assessing restoration of lost tissue structure and function should be developed, together with the development of clinical measures that can gauge progress of treatment.

Feasibility and challenges of addressing this CQ or CC

Animal studies demonstrate that emphysema can be repaired, at least in some species. Several forms of airways disease in humans are also reversible. Studies of interventions to augment tissue repair are needed with the goal of applying them to clinical interventions.

Name of idea submitter and other team members who worked on this idea COPD Foundation, COPDF MASAC

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18 net votes
20 up votes
2 down votes
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Goal 2: Reduce Human Disease

How can we better understand regional tissue heterogeneity in lung disease?

Many lung diseases (IPF, COPD) are characterized by marked heterogeneity at the tissue level. Unfortunately, most of the tools we currently employ to understand lung disease are unable to elucidate the mechanisms that result in regional heterogeneity. Clinical studies and animal models, while invaluable, generally assume that all lung tissue is similarly affected based on the presence or absence of diagnostic criteria... more »

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

Details on the impact of addressing this CQ or CC

Emerging evidence suggests that diseases such as IPF and COPD have observable phenotypes at the cellular and tissue levels long before the disease is clinically apparent. Thus seemingly healthy patients may have some regions of the lung affected by the same pathophysiologic processes that drive clinically apparent disease. By changing the focus of investigation from the presence or absence of disease in a given patient to the presence of absence of disease in a given region, several advantages emerge: (1) pathophysiologic mechanisms may be investigated earlier in the natural history of a disease, when interventions are more likely to be of benefit; (2) early investigation favors the discovery of distinct disease subgroups that are masked in more severe disease; and (3) a single patient may provide multiple affected and unaffected disease regions, allowing him or her to serve as their own control. Recently, advances in next-generation sequencing have made it possible for the entire transcriptome of a single cell to be analyzed. It is reasonable to believe that in the next 10 years single cell epigenome, proteome, and metabolome profiling will become routine. However, it seems less obvious how these methodologies can be employed to better understand the drivers of regional differences in lung disease. While technically difficult, studies applying high-throughput technologies to the discovery of regional differences will be invaluable to our understanding of lung disease.

Feasibility and challenges of addressing this CQ or CC

To address this critical challenge, at least five technological hurdles will have to be addressed: (1) technologies such as laser capture microdissection which allow for the isolation or cells from specific areas of the lung will need to improve; (2) technologies allowing for culture of multiple cell types on a single artificial substrate (to allow for experimental manipulation of cellular “communities”) will need to emerge; (3) collaborative networks will need to emerge whereby datasets from multiple labs can be integrated; (4) bioinformatics and statistical methods capable of filtering massive “omics” data sets from multiple cell types will need to be refined; and (5) researchers with the skills necessary to distil large descriptive datasets into testable hypotheses will need to be trained. While these hurdles are great, they must be overcome in order to translate the promise of next-generation sequencing techniques into an improved understanding of the drivers of regional heterogeneity in lung disease.

Name of idea submitter and other team members who worked on this idea Bradley Richmond

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9 net votes
26 up votes
17 down votes
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Goal 2: Reduce Human Disease

Precision medicine in non-malignant lung diseases

NIH has a major initiative in Precision Medicine, including whole genome sequencing. In contrast to cancer, mutations with large clinical effects are expected to be uncommon in most non-malignant chronic diseases, such as asthma and COPD. Other data types such as gene expression, biomarkers, and micro RNAs must be combined with clinical and imaging phenotyping to advance Precision medicine in non-malignant lung diseases.... more »

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

Details on the impact of addressing this CQ or CC

The goal is to combine clinical and molecular data to identify subtypes of patients within the major chronic respiratory diseases. Understanding molecular pathways will first lead to more appropriate drug repositioning and eventually novel drug development.

Feasibility and challenges of addressing this CQ or CC

NHLBI has many cohorts of subjects with chronic lung diseases with longitudinal clinical characterization, many with banked biospecimens. It is quite feasible to perform genomic, epigenetic and biomarker assays on these specimens. Based on these results, hypothesis-based targeted profiling can be done in prospective studies.

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12 net votes
15 up votes
3 down votes
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Goal 2: Reduce Human Disease

Prevent the Development of COPD

What can be done to prevent the development of COPD in individuals at increased risk. Quitting smoking before the development of COPD can prevent COPD development. What can be done to prevent COPD for individuals with other identified ris factors

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

Details on the impact of addressing this CQ or CC

Several risk factors have been identified that identify individuals at risk for developing COPD including low birth weight, poor maximally attained lung function and the presence of asthma. Strategies to prevent COPD development in these individuals are needed.

Feasibility and challenges of addressing this CQ or CC

The Lung Health Study demonstrated that smoking cessation prevents COPD progression. Studies of similar size and duration should be organized to address other risk factors.

Name of idea submitter and other team members who worked on this idea COPD Foundation, COPDF MASAC

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15 net votes
18 up votes
3 down votes
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Goal 2: Reduce Human Disease

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

Critical Challenge

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

Quantitative imaging biomarkers for chronic lung disease

Critical Challenge

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

Details on the impact of addressing this CQ or CC

Methods for stratifying patients with diffuse lung disease are crucial for predicting their clinical course and directing appropriate therapies accordingly. Currently imaging markers for prognostic stratification are limited, due to observer variability in characterizing the type and degree of computed tomography (CT) abnormalities. A reproducible method for categorizing varying diffuse lung diseases on CT imaging is needed, particularly in combination with other biomarkers in a multidisciplinary approach. With lung cancer screening, the characterization and stratification of patients with varying COPD phenotypes and interstitial lung disease are essential to aid in management of the large number of patients who currently satisfy criteria for CT lung cancer screening.

Feasibility and challenges of addressing this CQ or CC

Currently the classification of diffuse lung disease on CT is based upon visual evaluation and qualitative or semi-quantitative evaluation of CT data. Diffuse lung disease manifests with varying CT findings and distribution within the lung. Computer-assisted tools for quantifying airways and parenchymal disease have been developed. More-sophisticated quantitative computer image-analysis methods, such as those that address three-dimensional spatial orientation, are possible given advances in computer capabilities yet remain in need of further development. Advances in magnetic resonance imaging (MR) technology, positron emission tomography (PET), and PET/MR will increase the ability to characterize diffuse lung disease quantitatively. The ability of such technology to differentiate subtypes within more frequently occurring and clinically-significant diffuse lung disease is feasible. Such tools would impact a large population, particularly given the potential need to phenotype emphysema and smoking-related interstitial pneumonias in those undergoing CT screening.

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

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7 net votes
9 up votes
2 down votes
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Goal 2: Reduce Human Disease

Imaging indicators of metabolic syndrome and cardiopulmonary disease

Critical Challenge

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

Details on the impact of addressing this CQ or CC

Obesity and metabolic syndrome affect a large portion of the population and affects multiple organ systems. Identifying obesity phenotypes by imaging will impact the significant healthcare issue presented by MetS and could provide a reliable, non-invasive index of disease severity, guide prevention and intervention response.

Feasibility and challenges of addressing this CQ or CC

Metabolic syndrome, abnormal metabolism, may be potentially linked to obesity and cardiopulmonary disease. Theories exist but are in need of clarification. The relationship between metabolic syndrome and multiple other diseases including chronic obstructive lung disease, coronary atherosclerosis, and obesity warrants further investigation and can be elucidated through imaging. Advances in computed tomography (CT) and magnetic resonance imaging (MR) enable assessment of the cardiopulmonary manifestations, with promising MR techniques to complement high-resolution imaging data achievable with chest CT and coronary CT angiography. Assessment of CT and MR techniques in combination with three-dimensional quantitative analysis of manifestations of metabolic syndrome such as fat deposits derived from different adipocytes (white fat versus brown fat) such as in the subcutaneous, visceral, epicardial, and perivascular regions is feasible with current technology and may enable differentiation of those with varying risks of cardiovascular and pulmonary disease. The association of imaging parameters, metabolic syndrome, and associated diseases are in need of investigation, and knowledge gained may prove crucial for identifying those at risk for metabolic syndrome and at higher risk for complications in the large population of our country affected by obesity.

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

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6 net votes
10 up votes
4 down votes
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Goal 2: Reduce Human Disease

Cardovascular risk and Microparticles in GOLD Class A/B COPD?

Can Measuring CD31+EMPs predict loss of lung function, provide potential bio marker for accelerated lung function loss, and predict increased risk for atherosclerosis leading to increased risk for cardiovascular events?

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

Details on the impact of addressing this CQ or CC

Fosters primary prevention and secondary prevention interventions to affect disease development and progression. Potentially, advances the understanding of the link between advancing loss of lung function, a novel biomarker assay to assess exacerbations and their link to increased cardiovascular events found in patients with COPD.

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4 net votes
8 up votes
4 down votes
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