Reply: Primary and Secondary Prevention of Chronic Obstructive Pulmonary Disease: Where to Next?

From the Editorialists:

We thank Dr. Young and Ms. Hopkins for supporting the National Heart, Lung, and Blood Institute (NHLBI) recent call to action to develop a research agenda for the study of primary prevention of chronic lung disease (CLD) and lung health (1). They refer to building evidence that chronic obstructive pulmonary disease (COPD) pathogenesis could be modified with therapies targeting systemic inflammatory processes. An important first step, they point out, is identification of those at greatest risk of developing COPD, so that risk-mitigation strategies can be tested. This is certainly one approach to pursue in this area of research.

The NHLBI is embarking on a strategic visioning process for heart, lung, blood, and sleep research, and compelling questions and critical challenges related to primary prevention of CLD will be key components of the process. We agree with Dr. Young and colleagues that the time is right for research in CLD primary prevention. As a first step, the scientific community identified a number of gaps, challenges, and opportunities, which have been published as a series of papers from the NHLBI Primary Prevention of Chronic Lung Disease workshop (2–8). A necessary step for the development of primary prevention interventions is to clarify what defines disease onset and/or the presymptomatic stages of disease to identify critical windows for primary intervention. The identification of risk factors for chronic lung disease permits risk stratification of populations for targeted primary prevention strategies to be tested. Robust measures of both lung health and disease need to be developed to provide biologic plausibility for the identification and validation of biomarkers that will distinguish among health, presymptomatic stages of disease, and disease onset. Novel technologies and approaches that can identify early perturbations in lung structure, function, and defense, as well as early integration of mechanistic and clinical studies, are necessary to identify modifiable intervention points in an efficient and timely manner.

We believe that with the joint efforts of the National Institutes of Health and the global research community, optimal and sustained respiratory health is within our reach, with the potential to improve the lives of millions of individuals.