From the Special Topic of
Pulmonary Disease (COPD)
According to our Special Topics analysis of COPD
research over the past decade, Professor Jørgen
Vestbo's work ranks at #4 by cites, #11 by papers, and #20
by cites per paper, based on 64 papers cited a total of
3,488 times. Seven of these papers are also on the top 20
papers lists in our topic. In
Essential Science IndicatorsSM from
Reuters, his citation record includes 92 papers, the
majority of which are classified under Clinical Medicine,
cited a total of 3,904 times between January 1, 1999 and
October 31, 2009.
Professor Vestbo is Professor of Respiratory Medicine at the
Respiratory Research Centre of the University of Manchester/Manchester
Academic Health Science Centre in England. In addition, he holds positions
as Professor of Respiratory Medicine at the University of Copenhagen and
Consultant at Hvidovre University Hospital in Denmark.
In this interview, he talks with ScienceWatch.com
about his highly cited COPD research.
Would you tell us a bit about your
educational background and research experiences?
I graduated from the University of Copenhagen in 1984 and was soon involved
in respiratory epidemiology alongside my clinical training in internal
medicine and respiratory medicine. When we planned the respiratory part of
a 15-year follow-up of the Copenhagen City Heart Study cohort in 1992-94 we
planned for a long-term intervention study of inhaled corticosteroids in
COPD nested in this cohort, and this was the starting point for my
involvement in controlled trials in COPD in parallel with continued
epidemiologic research in asthma and COPD.
What first drew your interest to the field of
When I started in respiratory medicine, focus was in asthma but I found
that the possibility of studying risk factors for COPD progression in
epidemiology using measures of decline in lung function was so fascinating.
In addition, it was clear that COPD was such a large burden and also that
management was insufficient, with ample room for improvement.
One of your highly cited clinical papers in our
analysis is the 1999 Lancet paper, "Long-term effect of
inhaled budesonide in mild and moderate chronic obstructive pulmonary
disease: a randomised controlled trial" (Vestbo J, et al.,
353: 1819-23, 29 May 1999). The results of this paper led you
and your coauthors to question the usefulness of long-term inhaled
corticosteroids in COPD. How was this conclusion received by the
research community at large? Is it still an accepted concept, or have
better treatments since come along?
I think we have learned a lot from this and from subsequent studies. We
studied very early COPD in our trial—in fact, many of the patients
were unaware of their disease as they were picked out of a population
survey. In very early COPD we still have no evidence that treatment with
inhaled corticosteroids provides any benefit. In more severe disease,
however, we have shown that treatment with inhaled corticosteroids,
especially if combined with long-acting beta-agonists, can improve lung
function and quality of life and reduce symptoms, frequency of
exacerbations, and rate of progression of disease.
Based on your list of papers, you've done a lot of
studies dealing with prognosis factors for COPD. Would you talk a
little about this aspect of your work?
A lot of what we know about the natural history of COPD and the
identification of risk factors for disease progression has come from
epidemiology. Apart from obtaining information that can be used for
planning health care, both for the individual and generally, prognostic
factors also help us identify markers for disease mechanisms that could
increase our understanding of the disease.
For COPD, we know that presence of mucus hypersecretion is a marker for
disease progression, probably through an increased risk of exacerbations,
and may therefore be a marker of an "inflammatory subgroup." Likewise, loss
of lean body mass is a predictor of poor prognosis but only found in a
minority of patients, potentially indicating a different subset of patients
and a specific disease mechanism. To me, translational research is not just
"from bench to bedside" but also epidemiology and clinical observation
informing the scientists of possible novel areas for more intense research.
In 2006 you published a paper in the European
Respiratory Journal entitled, "Characteristics of the perfect
COPD natural history study," (Vestbo J, 27: 638-9, March 2006). In
terms of highlights, what are these characteristics?
Briefly, it needs to be large to cover all the subtypes of COPD and to last
decades to cover the different phases of disease progression—and will
therefore never be done!
Last year, you came out with a paper entitled
"Adherence to inhaled therapy, mortality and hospital admission in
COPD" in Thorax (Vestbo J, et al., 64: 939-43,
November 2009). Would you tell our readers about this paper?
"A lot of what we know about the natural history of
COPD and the identification of risk factors for disease
progression has come from epidemiology."
We know from cardiovascular studies that adherence to medication is a
strong predictor of mortality and that it basically does not matter which
medication; in fact, often patients adherent to placebo do better than
those who only take some of their active medication. Since inhaled
medications in COPD have some symptomatic benefits we thought that the
effect of adherence would be less obvious in COPD.
However, our analyses of adherence data from the TORCH study showed the
opposite; the association between adherence to treatment and mortality was
very strong. To me, this indicates that there are factors associated with
personality and behavior that strongly influences prognosis—and that
we should do more research in this area as some of this could potentially
be converted to better patient management.
How far would you say COPD research has come in
the past decade? Where do you see it going in the next 10
I think research in the past decade into mechanisms and treatments have
brought COPD out in the open and pointed us in possible directions
regarding pathogenesis and mechanisms of disease progression. I think it
has become apparent that we will need to view COPD as a collection of
different diseases with a number of clinical features in common but with
different underlying mechanisms. I hope the next 10 years will provide us
with sufficient insight into these mechanisms to enable us to use this in
developing novel therapeutics.
Professor Jørgen Vestbo, DrMedSci, FRCP
Respiratory Research Centre
University of Manchester/Manchester Academic Health Science Centre
University of Copenhagen
Hvidovre University Hospital
Jørgen Vestbo's current most-cited paper in Essential
Science Indicators, with 742 cites:
Celli BR, et al., "Standards for the diagnosis and treatment of
patients with COPD: a summary of the ATS/ERS position paper," Eur.
Resp. J. 23 (6): 932-46, June 2004. Source:
Essential Science Indicators from
KEYWORDS: COPD, EPIDEMIOLOGY, INHALED CORTICOSTEROIDS, CONTROLLED TRIALS,
RISK FACTORS, COPD PROGRESSION, LUNG FUNCTION, DISEASE STAGE, LONG-ACTING
BETA-AGONISTS, QUALITY OF LIFE, EXACERBATIONS, PROGNOSIS FACTORS, DISEASE
MECHANISMS, MUCUS HYPERSECRETION, LEAN BODY MASS, ADHERENCE, TORCH STUDY,
COPENHAGEN CITY HEART STUDY.