COPD
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Clinical research in chronic obstructive pulmonary disease (COPD) has been hampered by the lack of validated blood biomarkers. The ideal COPD biomarker would have the following characteristics: (1) it would be a lung specific protein that could be assayed in blood; (2) it would change with disease severity or during exacerbations; (3) it would be specific for COPD; and would be responsive to change with effective treatments. One such candidate is the lung specific protein surfactant protein D (SP-D). In this review, we discuss the evidence supporting SP-D as a COPD biomarker.
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COPD is defined by airflow limitation that is not fully reversible and is usually progressive. Thus, airflow obstruction (measured as FEV(1)) has traditionally been used as the benchmark defining disease modification with therapy. However, COPD exacerbations and extrapulmonary effects are common and burdensome and generally become more prominent as the disease progresses. ⋯ Smoking cessation, lung volume reduction surgery, inhaled maintenance pharmacotherapy, and pulmonary rehabilitation administered in the post-exacerbation period may reduce mortality in COPD. These improvements over multiple outcome areas and over relatively long durations suggest that disease modification is indeed possible with existing therapies for COPD. Therefore, therapeutic nihilism in COPD is no longer warranted.