Scientific Leadership in Global COPD trials (0:06 – 0:30)
I’m professor Christine Jenkins, I’m head of the respiratory group at the George Institute for global health and I particularly run clinical trials here as a scientific leader. I am also a respiratory physician, I’m also head of the respiratory discipline at the university of Sydney and I chair the lung foundation of Australia.
What is COPD? (0:31 – 1:06)
COPD is a disease that most people know as chronic bronchitis and emphysema, that’s the layperson’s term and what that describes are two things that happen to people with COPD. Their air passages become inflamed and they produce mucus and they develop cough and phlegm as a result of that. But also they lose lung tissue – that’s the emphysema part of it and the sacs that exchange oxygen become destroyed and that causes people to become very breathless.
Who does COPD affect? (1:06 – 1:44)
COPD can affect anybody, usually from their middle adult years, from sometime in their forties where their symptoms might be very mild, but it progressively worsens over time and it affects men and women depending on their particular exposures. Many women are not smokers, they develop COPD from biomass fuel exposure and dusty jobs or smoke exposure and men often, who are cigarette smokers develop COPD.
What are some of the ways COPD can impact carers and loved ones? (1:46 – 2:24)
COPD has a big impact not only for the patient but for their families, supporters and carers. The reason for that is that it causes progressive inability to do everyday tasks. People’s activities of daily living are significantly affected. But the other way they’re affected is that it’s really devastating to see somebody who is breathless and breathlessness at rest especially, which cannot be truly relieved; it’s very distressing to watch as well as to experience.
What is the prevalence of COPD in Asia and around the world? (2:25 – 3:16)
COPD is a very prevalent disease. The WHO predicts that by 2030, COPD will globally be the third leading cause of death behind cardiovascular and cerebrovascular disease. So COPD is growing in prevalence because of the very wide spread exposure particularly to tobacco but still in many countries, to dusty jobs, biomass fuel exposure and significant irritancy that contributes such as air pollution. Air pollution is still a major problem especially in many parts of Asia and along with the other exposures it is contributing to the increase of prevalence in COPD.
Why is Asia an important region for conducting COPD trials? (3:17 – 3:49)
Asia is a really important region for running clinical trials in COPD. The main reason is that there is a big burden of disease and that disease is currently not optimally managed. Many Asian countries have guidelines for COPD management but one of the big challenges is access to good quality education, self-management, primary care and medications.
What have been some of the challenges in COPD trials and what have you done to remedy them? (3:50 – 5:29)
There are real challenges in COPD trials that actually are not specific issues in many other studies; for instance, my experience of asthma trials, some of these problems never arise. One of the big problems for instance for COPD trials is that patients are usually unwell. Simply getting the patients to come back, be able to be at their clinic visits, be able to do all the producers you want them to do, whether it’s to exercise them, whether it’s to measure their lung capacity, whether it’s to fill out their diary cards consistently. Even using electronic diary cards because of the generation of patients, we need to take more time to teach them how to use these really important and valuable ways to measure their disease. Other issues are the fact that because the patients are very symptomatic they often don’t feel the drugs are making a lot of difference. We can measure the difference and particularly in large groups of patients, we can measure exacerbation rates are changing; that’s a key outcome for clinical trials. But in an individual it’s really hard to measure that, so the patients themselves may not know for the sure the drug is affecting them and are often tempted if they have an exacerbation to say ‘oh well it’s not working and I want to pull out’. So it’s really important you’ve got to really encourage the patients to stay in the trial and help them understand why they’re participation is valuable.
Is the future bright for people suffering or at risk of COPD? (5:30 – 6:42)
I think the future is bright for COPD sufferers; although, many would say it’s been very bleak until recently, and there is some truth in that. We, for instance, had difficulty demonstrating that our key medications can change life expectancy. We’ve shown they change the course of the disease, they reduce the episodes of exacerbations that cause hospital admissions and they can improve quality of life, greatly. But actually impacting on longevity is still a massive challenge for COPD interventions. The other big, bright side of this is that there have been a lot of new COPD medications in the last five years. There are new members of each class and there are medications that last for longer and have fewer side effects. So I think the future is really bright and there are other things in the pipeline that are quite exciting but we’ve still got to test them and we’ve got to see for whom they’re best and it’s a rapidly evolving space.