The Mechanisms of Inflammation and Immunity in COPD and Their Relationship to Exacerbations and Disease Progression.

This study is a multi-centre UK based observational study of a cohort of patients with chronic obstructive pulmonary disease (COPD) funded by the MRC, as part of the MRC/ABPI Inflammation and Immunology Initiative in COPD. This consortium brings together key researchers in the COPD research community with long-standing expertise in understanding bacterial infection, inflammation and immunity.

Understanding the role of bacterial and viral infections, which are often the trigger for exacerbations, and the mechanism of tissue re-modelling and repair following exacerbations is extremely important. Exacerbations and the progression of the disease impose a considerable disability on patients and a financial burden on the health service. In additional, pulmonary inflammation in COPD may result in systemic inflammation. This is associated skeletal muscle dysfunction, as well as worsening other common diseases, such as cardiovascular disease.

We now have a much better understanding of the cellular and molecular mechanisms that underlie COPD and cause the chronic inflammatory process, both locally within the lung and systemically. However, current therapy for COPD is inadequate and relies on long-acting bronchodilators, which do not ameliorate the underlying chronic inflammatory process. Currently available anti-inflammatory therapies are incompletely effective. An improved understanding of the complex mechanisms in COPD is required in order to develop future effective treatments, for which there is a pressing need.

Patients will be recruited from existing cohorts of COPD patients, and indirectly through their general practitioner and outpatient clinics. Patients must have COPD, and all patients will be assessed to ensure the correct diagnosis.

Study patients will be phenotyped by lung morphology and function, biomarkers in blood, sputum and urine, bacterial and viral load in sputum, cardiovascular behaviour, co-morbidities and skeletal muscle function. The patients will be followed up over initially 18 months, with a planned extension to 5 years, to accurately determine the relationship between bacterial and viral infections, tissue re-modelling and skeletal muscle dysfunction with exacerbation frequency and disease progression.