The next chapters look at the mechanisms that underlie the lung damage that is present at all
stages of COPD, examining new approaches to using simple biomarkers to understand the
impact of the disease and identify endotypes that might respond to specific treatment. The
cellular and signalling mechanisms that operate in COPD-related inflammation are addressed in
chapter 7 [7]. New insights into the importance of the microbiome in COPD are offered in
chapter 8 [8], while the recent studies that have led us to reappraise the importance of chronic
bronchitis in the natural history of COPD are considered in chapter 9 [9]. The role of the
eosinophil, a marker of T-helper cell 2-mediated inflammation, is reviewed in chapter 10 [10].
Chapter 11 addresses the rapidly changing role of imaging as a way to understand, stratify and
identify COPD, not only when advanced disease is present but at a stage before spirometric
abnormality is present [11]. Finally, advances in computing and bioengineering have led to the
development of new tools that can evaluate lung mechanics and gas exchange noninvasively
during tidal breathing. The potential of this approach as a diagnostic and descriptive tool is the
topic of chapter 12 [12].
As knowledge about COPD and its management has grown, so too has the need to evaluate and
understand this growing body of evidence. Of the resulting treatment strategies, the most
influential has been the Global initiative for Chronic Obstructive Lung Disease (GOLD). In
chapter 13, two of the leaders of this process review how this group operates and its priorities in
decision-making [13]. In chapter 14, the evidence that underpins the use of bronchodilators and
ICS in COPD is reviewed in detail [14], while in chapter 15 the possibility of new
transformative therapies is considered [15]. COPD care is multimodal and there is abundant
evidence that improving physical fitness and mental well-being allows patients with COPD to
live better lives. The changing face of pulmonary rehabilitation and its application in different
economic settings across the world is the topic of chapter 16 [16].
Exacerbations of COPD are crucial drivers of worse health status and deterioration in lung
function. Our knowledge of these events has grown steadily in the last two decades. The latest
understanding of the nature of these episodes and their impact on the patient is reviewed in
chapter 17 [17], while their acute management is addressed in chapter 18 [18]. Patients with
advanced COPD face severe difficulties but in selected cases, these can be alleviated by the use
of noninvasive mechanical ventilation, the topic of chapter 19 [19]. For others, medical lung
volume reduction using a variety of endoscopic approaches can improve their lung function and
health status considerably. This exciting field is the focus of chapter 20 [20].
Our final chapter considers the topics not already addressed that we believe will be important
research areas in the future, together with new trends that are likely to be important in the way
we approach this condition [21].
We hope that taken together the chapters in this issue of the Monograph provide an up-to-date
overview of what is happening in the wide field of COPD research, both at a basic and clinical
level. We are very grateful to our many distinguished contributors for their help in creating what
we hope you will find to be a useful addition to the Monograph series.
References
1 Senek M, Badyda A, Barbaglia S, et al. The patients’ perspective on living with COPD and their priorities for
future research and care. In: Wedzicha JA, Allinson JP, Calverley PMA, eds. COPD in the 21st Century (ERS
Monograph). Sheffield, European Respiratory Society, 2024 pp. 1–15.
2 Calverley PMA. COPD as the new millennium began. In: Wedzicha JA, Allinson JP, Calverley PMA, eds. COPD in
the 21st Century (ERS Monograph). Sheffield, European Respiratory Society, 2024 pp. 16–29.
xii https://doi.org/10.1183/2312508X.10035423
stages of COPD, examining new approaches to using simple biomarkers to understand the
impact of the disease and identify endotypes that might respond to specific treatment. The
cellular and signalling mechanisms that operate in COPD-related inflammation are addressed in
chapter 7 [7]. New insights into the importance of the microbiome in COPD are offered in
chapter 8 [8], while the recent studies that have led us to reappraise the importance of chronic
bronchitis in the natural history of COPD are considered in chapter 9 [9]. The role of the
eosinophil, a marker of T-helper cell 2-mediated inflammation, is reviewed in chapter 10 [10].
Chapter 11 addresses the rapidly changing role of imaging as a way to understand, stratify and
identify COPD, not only when advanced disease is present but at a stage before spirometric
abnormality is present [11]. Finally, advances in computing and bioengineering have led to the
development of new tools that can evaluate lung mechanics and gas exchange noninvasively
during tidal breathing. The potential of this approach as a diagnostic and descriptive tool is the
topic of chapter 12 [12].
As knowledge about COPD and its management has grown, so too has the need to evaluate and
understand this growing body of evidence. Of the resulting treatment strategies, the most
influential has been the Global initiative for Chronic Obstructive Lung Disease (GOLD). In
chapter 13, two of the leaders of this process review how this group operates and its priorities in
decision-making [13]. In chapter 14, the evidence that underpins the use of bronchodilators and
ICS in COPD is reviewed in detail [14], while in chapter 15 the possibility of new
transformative therapies is considered [15]. COPD care is multimodal and there is abundant
evidence that improving physical fitness and mental well-being allows patients with COPD to
live better lives. The changing face of pulmonary rehabilitation and its application in different
economic settings across the world is the topic of chapter 16 [16].
Exacerbations of COPD are crucial drivers of worse health status and deterioration in lung
function. Our knowledge of these events has grown steadily in the last two decades. The latest
understanding of the nature of these episodes and their impact on the patient is reviewed in
chapter 17 [17], while their acute management is addressed in chapter 18 [18]. Patients with
advanced COPD face severe difficulties but in selected cases, these can be alleviated by the use
of noninvasive mechanical ventilation, the topic of chapter 19 [19]. For others, medical lung
volume reduction using a variety of endoscopic approaches can improve their lung function and
health status considerably. This exciting field is the focus of chapter 20 [20].
Our final chapter considers the topics not already addressed that we believe will be important
research areas in the future, together with new trends that are likely to be important in the way
we approach this condition [21].
We hope that taken together the chapters in this issue of the Monograph provide an up-to-date
overview of what is happening in the wide field of COPD research, both at a basic and clinical
level. We are very grateful to our many distinguished contributors for their help in creating what
we hope you will find to be a useful addition to the Monograph series.
References
1 Senek M, Badyda A, Barbaglia S, et al. The patients’ perspective on living with COPD and their priorities for
future research and care. In: Wedzicha JA, Allinson JP, Calverley PMA, eds. COPD in the 21st Century (ERS
Monograph). Sheffield, European Respiratory Society, 2024 pp. 1–15.
2 Calverley PMA. COPD as the new millennium began. In: Wedzicha JA, Allinson JP, Calverley PMA, eds. COPD in
the 21st Century (ERS Monograph). Sheffield, European Respiratory Society, 2024 pp. 16–29.
xii https://doi.org/10.1183/2312508X.10035423