Abstract
Worldwide, clinicians face the task of providing millions of patients with the best possible treatment and management of COPD. Currently, management primarily involves short-term ‘here-and-now’ goals, targeting immediate patient benefit. However, although there is considerable knowledge available to assist clinicians in minimising the current impact of COPD on patients, relatively little is known about which dominant factors predict future risks. These predictors may vary for different outcomes, such as exacerbations, mortality, co-morbidities, and the long-term consequences of COPD. We propose a new paradigm to achieve ‘optimal COPD care’ based on the concept that here-and-now goals should be integrated with goals to improve long-term outcomes and reduce future risks. Whilst knowledge on risk factors for poorer outcomes in COPD is growing and some data exist on positive effects of pharmacological interventions, information on defining the benefits of all commonly used interventions for reducing the risk of various future disease outcomes is still scarce. Greater insight is needed into the relationships between the two pillars of optimal COPD care: ‘best current control’ and ‘future risk reduction’. This broader approach to disease management should result in improved care for every COPD patient now and into the future.
Keywords: COPD, care, future, management, risk reduction, today
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Footnotes
All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare:
DSP, PMC, CJ, BJM and TS received financial support for travel to discussions about the submitted work from AstraZeneca (AZ).
DSP has received grants from AZ, GlaxoSmithKline (GSK) and Nycomed.
AA has received research grants and/or honoraria from AZ, Bayer-Schering Pharma, Boehringer-Ingelheim (B-I), Dey Pharmaceuticals, GSK, Lilly Pharmaceuticals, Pfizer, Pneuma Pharmaceuticals and Schering-Plough and has acted as a consultant or advisory board member for AZ, Bayer-Schering Pharma, B-I, Dey Pharmaceuticals, Forest Laboratories, GSK, and Sepracor and has been paid for developing educational presentations for B-I, Dey Pharmaceuticals and GSK.
PMC has been paid for consultancy for AZ, has received honoraria for lectures from AZ, GSK and Nycomed, provided expert testimony for Forest Laboratories and Nycomed and has been an advisory board member for B-I, GSK, Novartis and Nycomed.
CJ has contributed to advisory boards and been paid for lectures and development of educational materials for AZ, B-I, GSK, Novartis, Nycomed, Pfizer and Tyrian.
BJM has contributed to advisory boards for AZ, Dey Pharmaceuticals, Embryon, Forest Laboratories, Johnson and Johnson, Novartis, Nycomed, Respironics, Schering and Sequal, has been paid for consultancy for Astellas, Chiesi and Talecris and has received grants or honoraria for lectures from AZ, B-I, GSK, NABI and Pfizer.
FCS has contributed to advisory boards for AZ, GSK, Merck and PnuemRx and has been paid for consultancy by Pfizer and received grants from B-I, GSK and Pfizer.
TS has contributed to advisory boards for AZ, B-I and Nycomed and received a grant from Novartis and has been paid for lectures or educational presentations by AZ, B-I and Novartis.
TvdM has no support or financial relationships with any organisations that might have an interest in the submitted work.
GE is an employee of AZ and holds shares in the company, and is associated with the University Hospital in Lund, Sweden.