Wednesday, February 27, 2013

COPD as a Syndrome

Typically, in medical journals, we don’t like to include a lot of formula or mathematical expressions in articles. However I recently read a paper where a mathematical expression is used to describe the COPD as a syndrome. It is a good use of mathematical expression in this case.

John J. Reilly “COPD and declining FEV1 – time to divide and conquer?” (NEJM 359:15: 1616-1618 OCT 2009)

“In fact, COPD in the singular is probably a misnomer. It is more appropriate to view COPD as a syndrome that encompasses a variety of obstructive diseases that share a common exposure but differ in terms of mechanism of disease and response to therapy. This concept is expressed in the mathematical notation

In which COPDn represents subgroups of COPD. As a reflection of this recognized heterogeneity, investigator have developed new classification systems, such as the BODE index, which evaluates the body-mass index, the degree of airflow obstruction and dyspnea, and exercise capacity to create a 10-point scale in which higher scores indicate a higher risk of death. In addition, investigators have attempted to define other homogeneous subgroups of patients with COPD. “

For many complicated diseases, when we have a better understanding about the disease, we will see that one specific disease may have many different manifestations or phenotypes – so called ‘heterogeneity’. When designing a clinical trial for a disease with heterogeneity, it may be difficult to show the treatment effect on the patient population as a whole. The drug may only be effective on one of many specific sub-populations. The difficult is usually in finding this specific sub-population. The newly issued FDA guidance “Enrichment Strategies for Clinical Trials to Support Approval of Human Drugs and
Biological Products” is attempting to address this issue. 

3 comments: said...

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Unknown said...

I had COPD for 9 years. My first symptoms were dry cough, chest tightness and shortness of breath. My first chest x-ray only showed bronchitis. Finally I went to a pulmonologist and was diagnosed with COPD.i have used all the medication yet they don’t work, last year December I was told by a formal emphysema patient to use totalcureherbalfoundation@ gmail. com  herbal treatment which I really did,i was surprise the herbal products effectively get rid of my COPD totally. When you get where you cannot breathe it may be too late. Good luck to each and every one that will be trying their herbal treatment .