University of Tasmania
Browse
146817 - fully integrated pathophysiological insights in COPD.pdf (618.4 kB)

Fully integrating pathophysiological insights in copd: An updated working disease model to broaden therapeutic vision

Download (618.4 kB)
journal contribution
posted on 2023-05-21, 02:48 authored by Eugene WaltersEugene Walters, Shukla, SD, Mahmood, MQ, Ward, C
Our starting point is that relatively new findings into the pathogenesis and pathophysiology of airway disease in smokers that lead to chronic obstructive pulmonary disease (COPD) need to be reassessed as a whole and integrated into "mainstream" thinking along with traditional concepts which have stood the test of time. Such a refining of the accepted disease paradigm is urgently needed as thinking on therapeutic targets is currently under active reconsideration. We feel that generalised airway wall "inflammation" is unduly over-emphasised, and highlight the patchy and variable nature of the pathology (with the core being airway remodelling). In addition, we present evidence for airway wall disease in smokers/COPD as including a hypocellular, hypovascular, destructive, fibrotic pathology, with a likely spectrum of epithelial-mesenchymal transition states as significant drivers of this remodelling. Furthermore, we present data from a number of research modalities and integrate this with the aetiology of lung cancer, the role of chronic airway luminal colonisation/infection by a specific group of "respiratory" bacteria in smokers (which results in luminal inflammation) and the central role for oxidative stress on the epithelium. We suggest translation of these insights into more focus on asymptomatic smokers and early COPD, with the potential for fresh preventive and therapeutic approaches.

History

Publication title

European Respiratory Review

Volume

30

Issue

160

Pagination

1-15

ISSN

0905-9180

Department/School

Tasmanian School of Medicine

Publisher

European Respiratory Society

Place of publication

United Kingdom

Rights statement

Copyright The authors 2021 This version is distributed under the terms of the Creative Commons Attribution NonCommercial Licence 4.0.

Repository Status

  • Open

Socio-economic Objectives

Treatment of human diseases and conditions

Usage metrics

    University Of Tasmania

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC