Respiratory diseases are one of the major chronic diseases and considered by the World Health Organization (WHO) to cause 60% of mortality worldwide. Significant research is being carried out on the diagnosis, treatment, management and care of patients with lung conditions. Clinical and scientific research on these specific topics were discussed at the recent British Thoracic Meeting (BTS 2013), where BMC Medicine joined over 2,100 delegates to hear new developments in the field.
Several clinical trials sessions were highlighted including continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA). A systematic review on randomized clinical trials was described by Daniel Bratton from the MRC Clinical Trials Unit in London, showing CPAP treatment reduces OSA severity and sleepiness. However, CPAP therapy does not have a beneficial effect on blood pressure in minimally symptomatic OSA patients unless they use CPAP for more than 4 hours per night. Clinical trials for other conditions such as COPD were also discussed with a pilot study showing neuromuscular electrical stimulation (NMES) and low-intensity symptom-limited exercise (LISLE) being more effective in improving daily living activities and exercise tolerance. However, the cost of equipment and specialized staff for delivery of this individualized therapy must be weighed against the clinical benefits.
Other novel stratified approaches were also emphasized with an excellent presentation by Stuart Elborn, Director of the Centre for Infection and Immunity at Queen’s University Belfast, who described clinical trial evidence for ivacaftor, the first new class of CTFR potentiators for the treatment of patients with cystic fibrosis having the G551D mutation. A phase III trial is currently underway investigating the effect of ivacaftor in combination with another potential therapy, VX-809, in CF patients with the most common mutation Delta F508. Continuing on the theme of therapeutic approaches in lung disease an entire symposium was devoted to the discovery of new treatments for idiopathic pulmonary fibrosis (IPF), a lung condition with a high unmet medical need. Luca Richeldi described phase III trials on Interferon-gamma (IFN-γ), bosentan, macitentan and pirfenidone for the treatment of IPF and emphasized the need for better endpoints and design of clinical trials. Robert Strieter who is the Global Head of Translational Medicine for Respiratory at Novartis Institutes for BioMedical Research, discussed biomarker development and translational research in IPF and how key collaborations with academia, health professionals, pharmaceutical industry and patients would help achieve this.
To mark the 20th anniversary of the Cochrane collaboration various events have taken place including the launch of an article collection on Cochrane Methodology. An entire symposium at BTS 2013 focused on Cochrane respiratory reviews published over the 20 years by describing the achievements of Archie Cochrane in respiratory medicine and how the Cochrane systematic reviews have contributed to British Asthma Guidelines on diagnosis and monitoring. Additionally, several Cochrane reviews have been published on the treatment of COPD and Milo Puhan from the University of Zurich emphasized the need for benefit and harm assessment in clinical trials and showed how this type of analyses on roflumilast (an oral phosphodiesterase-4 (PDE-4) inhibitor) in COPD management would help guide policy decisions and individual patient therapy.
Interestingly, the main themes addressed at BTS 2013 were largely on clinical trials for the treatment of various lung conditions including obstructive sleep apnoea, cystic fibrosis, COPD and idiopathic pulmonary fibrosis. We look forward to the results of some of the ongoing trials which we hope will help treat and manage patients with respiratory diseases. These conditions are of high importance and we are keen to publish research advances on these topics, and if you have any potential submissions you would like us to consider, please get in touch at firstname.lastname@example.org.