Can you tell us about what first got you interested in the field of respiratory medicine, COPD especially?

When I was a young pulmonologist I had the responsibility of the outpatient office of my division (at that time I did not think absolutely to an academic career, and I was focused on care for respiratory patients). I started to visit a large number of patients who were smokers or former smokers and had been diagnosed with asthmatiform chronic bronchitis.

Unfortunately, in the 70s it seemed that everything was asthma and there was little interest for chronic bronchitis and treatment options were very limited.

At this time I was also attending the Institute of Pharmacology of the University of Naples, my hometown, because I wanted to learn more about the medications that I was prescribing to my patients. There I learned the mechanisms of regulation of bronchial tone and I was fascinated by the possibility of inducing relaxation of airway smooth muscle by stimulating beta-adrenergic receptors.

I began to understand that asthmatiform chronic bronchitis was not an intractable clinical condition that the opinion on the irreversibility of bronchial obstruction was only a dogma and we had to treat these patients with bronchodilators on a regular basis. Obviously, I also realized that it was necessary to better understand what asthmatiform chronic bronchitis was and also that there was an urgent need for new therapeutic approaches.

During the course of your career, what changes have you seen in the incidence, treatment, and clinical outcomes of COPD?

A simple fact: at the beginning of my career, COPD patients often suffered from three or four exacerbations per year. They were admitted to the hospital frequently and for a long time and generally died within four to five years.

This is fortunate because the population is becoming older, and consequently there is an increasing prevalence and incidence of COPD.

At present time, it is extremely difficult to find patients who exacerbate once a year, if ever. This change has taken place not only due to improved living conditions and the campaign against smoking, but also because of the progressive improvement in the therapeutic approach. We now have new drugs, improved non pharmacological interventions, the ability to diagnose patients earlier and, therefore, to act earlier.

This is fortunate because the population is becoming older, and consequently there is an increasing prevalence and incidence of COPD.

How significant do you think Open Access research is to the community of respiratory specialists and further afield?

It is important especially for young people who do not yet have the economic capacity for accessing scientific journals in a broad manner and for those that do not operate in this academia. Open Access is the best way for them to update their knowledge.

I can testify that when I find an article that is not accessible through the library of my university, I remain frustrated in my expectations and I have to waste time to retrieve the article.

I am still a lucky person because of my academic position and role in several scientific journals and, at the end, generally I get what I need. Unfortunately, the majority of my colleagues are not so lucky, and often must renounce reading articles that may be critical to their clinical and possibly research activity.

Open access makes it possible to avoid all this and it is above all a great element of democracy in the sciences.

What do you think have been the most important breakthroughs in COPD research in the last 10 years?

I think that the biggest breakthrough in the past 10 years has been the realization that we must personalize the treatment of COPD. In this morbid condition, even more than in others, the concept that we must cure the patient and not the disease is particularly true.

Broadening the concept, we now understand that COPD is not a disease but it is a disorder. We must identify the underlying disease that we tend now to identify with the different phenotypes, allowing a better therapeutic approach to COPD with a trend towards optimizing therapy.

Obviously, we have not yet reached the goal of curing every single phenotype, but we are making better use of the resources at our disposal and allowing our patients a longer and improved health-related quality of life.

And lastly, what do you think will be an important focus of research in the next 10 years?

By now it is becoming increasingly urgent to find a therapeutic approach that actually blocks the progression of the disease and even can allow a return to normal conditions.

I am confident that there will be an ever-increasing interrelationship between all researchers involved in the field of COPD (eg. geneticists, molecular biologists, pharmacologists, clinicians). This will surely dominate COPD if not within 10 years, certainly in a not too far future.

I am confident that there will be an ever-increasing interrelationship between all researchers involved in the field of COPD

It is likely that in the next decade there will be a progress in biological therapy of COPD and probably also a real advance in knowledge of the genetics of this disorder in its different facets.

Moreover, I am sure that we will better understand the systematic nature of this disorder, which would affect both the progression of COPD and also that of its specific comorbidities.

COPD Research and Practice publishes basic and clinical research and review articles relating to the development, progression and treatment of chronic obstructive pulmonary disease (COPD) and related disorders.