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The Expert - E-Interview: Professor Wisia Wedzicha
respiratory medicine: copd update 5 (2009) 2
The Expert E-Interview Professor Wisia Wedzicha Professor Wisia Wedzicha is Professor of Respiratory Medicine at UCL Medical School, London. She qualified from Oxford University and St. Bartholomew’s Medical College. She has a major interest in the causes, mechanisms and impact of COPD exacerbations. She is also an expert on home ventilatory support in COPD patients. She is Editor-inChief of Thorax and on the Editorial Board of the American Journal of Respiratory and Critical Care Medicine. 1. What do you perceive as the greatest development in COPD care over the last five years? In my opinion most of the major developments in COPD care took place earlier than the past five years, but I would add the caveat that the concept of extra-pulmonary manifestations is important. In particular, the systemic inflammatory component of the disease is associated with a number of complications and co-morbidites. 2. Which trial in COPD would you most like to see performed, but won’t be? With around a third of patients with COPD dying a cardiovascular death, I would love to see a trial of combination therapy in reducing cardiovascular mortality and risk in
1745-0454/$ – see front matter doi:10.1016/j.rmedu.2009.01.003
COPD. However, the numbers required would be large and it is difficult to envisage such a trial being contemplated in the current economic climate. 3. In your opinion, what is the greatest misunderstanding about COPD. That exacerbations are short discrete events with no longer term effects (such as non-recovery and recurrence) and that they can be diagnosed with a single biomarker. We now know that exacerbations are driving disease progression, and contribute both to morbidity and mortality. 4. Can you make a prediction for the future of COPD care? I think that we will see a greater emphasis on finding symptomatic patients in the moderate category (eg GOLD 2 and 3) and treating them. I would also envisage a consolidation of knowledge such that we will be delivering currently available therapies using new models of care tailored to individual patient needs. 5. What do you consider, personally, to be the three most influential papers in COPD research? I would cite the following three papers. TORCH, as the largest trial to date in COPD, and the only one with mortality as a primary end-point. I also think the Lung Volume Reduction work was an important development. And from my own work in exacerbations I feel that our analysis of the utility of biomarkers in diagnosing exacerbations of COPD provided some important insights into the disease.
The Expert E-Interview Professor Wisia Wedzicha Professor Wisia Wedzicha is Professor of Respiratory Medicine at UCL Medical School, London. She qualified from Oxford University and St. Bartholomew’s Medical College. She has a major interest in the causes, mechanisms and impact of COPD exacerbations. She is also an expert on home ventilatory support in COPD patients. She is Editor-inChief of Thorax and on the Editorial Board of the American Journal of Respiratory and Critical Care Medicine. 1. What do you perceive as the greatest development in COPD care over the last five years? In my opinion most of the major developments in COPD care took place earlier than the past five years, but I would add the caveat that the concept of extra-pulmonary manifestations is important. In particular, the systemic inflammatory component of the disease is associated with a number of complications and co-morbidites. 2. Which trial in COPD would you most like to see performed, but won’t be? With around a third of patients with COPD dying a cardiovascular death, I would love to see a trial of combination therapy in reducing cardiovascular mortality and risk in
1745-0454/$ – see front matter doi:10.1016/j.rmedu.2009.01.003
COPD. However, the numbers required would be large and it is difficult to envisage such a trial being contemplated in the current economic climate. 3. In your opinion, what is the greatest misunderstanding about COPD. That exacerbations are short discrete events with no longer term effects (such as non-recovery and recurrence) and that they can be diagnosed with a single biomarker. We now know that exacerbations are driving disease progression, and contribute both to morbidity and mortality. 4. Can you make a prediction for the future of COPD care? I think that we will see a greater emphasis on finding symptomatic patients in the moderate category (eg GOLD 2 and 3) and treating them. I would also envisage a consolidation of knowledge such that we will be delivering currently available therapies using new models of care tailored to individual patient needs. 5. What do you consider, personally, to be the three most influential papers in COPD research? I would cite the following three papers. TORCH, as the largest trial to date in COPD, and the only one with mortality as a primary end-point. I also think the Lung Volume Reduction work was an important development. And from my own work in exacerbations I feel that our analysis of the utility of biomarkers in diagnosing exacerbations of COPD provided some important insights into the disease.