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AUTHOR COMMENTARIES - From Special Topics

Chronic Obstructive Pulmonary Disease (COPD) - Published: January 2010
Interview Date: March 2010
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Jørgen Vestbo Jørgen Vestbo
From the Special Topic of Chronic Obstructive 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 Thomson 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 COPD?

Figure 1 Click figure to enlarge and read description.
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Professor Vestbo overseeing pulmonary function testing... Continue...
Figure 2 Click figure to enlarge and read description.
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Professor Vestbo (right) reviewing chest CTs... Continue...

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[9167]: 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[3]: 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[11]: 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 years?

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
Manchester, England
and
University of Copenhagen
Copenhagen, Denmark
and
Hvidovre University Hospital
Copenhagen, Denmark

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 Clarivate Analytics.

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.

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Special Topics : Chronic Obstructive Pulmonary Disease (COPD) : Jørgen Vestbo Interview - Special Topic of Chronic Obstructive Pulmonary Disease (COPD)