Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission

Daiana Stolz; Takudzwa Mkorombindo; Desiree M. Schumann; Alvar Agusti; Samuel Y. Ash; Mona Bafadhel; Chunxue Bai; James D. Chalmers; Gerard J. Criner; Shyamali C. Dharmage; Frits M.E. Franssen; Urs Frey; Mei Lan Han; Nadia N. Hansel; Nathaniel M. Hawkins; Ravi Kalhan; Melanie Konigshoff; Fanny W. Ko; Trisha M. Parekh; Pippa Powell; Maureen Rutten-van Mölken; Jodie Simpson; Don D. Sin; Yuanlin Song; Bela Suki; Thierry Troosters; George R. Washko; Tobias Welte; Mark T. Dransfield

doi:10.1016/S0140-6736(22)01273-9

Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission

Daiana Stolz, Takudzwa Mkorombindo, Desiree M. Schumann, Alvar Agusti, Samuel Y. Ash, Mona Bafadhel, Chunxue Bai, James D. Chalmers, Gerard J. Criner, Shyamali C. Dharmage, Frits M.E. Franssen, Urs Frey, Mei Lan Han, Nadia N. Hansel, Nathaniel M. Hawkins, Ravi Kalhan, Melanie Konigshoff, Fanny W. Ko, Trisha M. Parekh, Pippa PowellMaureen Rutten-van Mölken, Jodie Simpson, Don D. Sin, Yuanlin Song, Bela Suki, Thierry Troosters, George R. Washko, Tobias Welte, Mark T. Dransfield^*

^*Corresponding author for this work

Peter Gorer Department of Immunobiology

Research output: Contribution to journal › Review article › peer-review

256 Citations (Scopus)

Original language	English
Pages (from-to)	921-972
Number of pages	52
Journal	The Lancet
Volume	400
Issue number	10356
DOIs	https://doi.org/10.1016/S0140-6736(22)01273-9
Publication status	Published - 17 Sept 2022

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10.1016/S0140-6736(22)01273-9

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Stolz, D., Mkorombindo, T., Schumann, D. M., Agusti, A., Ash, S. Y., Bafadhel, M., Bai, C., Chalmers, J. D., Criner, G. J., Dharmage, S. C., Franssen, F. M. E., Frey, U., Han, M. L., Hansel, N. N., Hawkins, N. M., Kalhan, R., Konigshoff, M., Ko, F. W., Parekh, T. M., ... Dransfield, M. T. (2022). Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. The Lancet, 400(10356), 921-972. https://doi.org/10.1016/S0140-6736(22)01273-9

@article{56a4ccd5e18649d2bb09b54419e72d65,

title = "Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission",

author = "Daiana Stolz and Takudzwa Mkorombindo and Schumann, {Desiree M.} and Alvar Agusti and Ash, {Samuel Y.} and Mona Bafadhel and Chunxue Bai and Chalmers, {James D.} and Criner, {Gerard J.} and Dharmage, {Shyamali C.} and Franssen, {Frits M.E.} and Urs Frey and Han, {Mei Lan} and Hansel, {Nadia N.} and Hawkins, {Nathaniel M.} and Ravi Kalhan and Melanie Konigshoff and Ko, {Fanny W.} and Parekh, {Trisha M.} and Pippa Powell and {Rutten-van M{\"o}lken}, Maureen and Jodie Simpson and Sin, {Don D.} and Yuanlin Song and Bela Suki and Thierry Troosters and Washko, {George R.} and Tobias Welte and Dransfield, {Mark T.}",

note = "Funding Information: The Commission has been supported by the University Hospital Basel, Switzerland, the Swiss Respiratory Society, and the Lung Health Center, Heersink School of Medicine, University of Alabama at Birmingham. The European Respiratory Society provided logistic support for meetings during annual conferences. The US National Institutes of Health provided logistic support and space for a meeting of the Commission. We thank the European Lung Foundation for participation, and Sonja Burger for her help with illustrations. Funding Information: Furthermore, there is substantial misalignment between the burden of COPD and the priority afforded to the disease by governmental and other funding agencies. Similar to the low resources dedicated to smoking cessation, the US National Institutes of Health's funding for COPD-specific research is low compared with that for other chronic diseases, such as cardiovascular disease, cancer, and diabetes ( figure 5 ). 43,44 COPD research is also substantially underfunded compared with asthma: asthma received $338 million in funding from the National Institutes of Health in 2020 ($81,500 per US death) whereas COPD received $121 million (less than $800 per US death). The reasons for this discrepancy are complex and difficult to rationalise. Possible explanations include the substantial social stigma that inaccurately characterises COPD as a self-inflicted disease, which is less evident in cardiovascular disease and type 2 diabetes, even though lifestyle factors are important contributors to both illnesses. There has been substantial recent research investment in lung cancer, for which smoking is the most important risk factor, for the development of biologics and immunotherapies, which in many cases offer only an incremental survival advantage. This survival advantage is accepted by regulators as sufficient proof of benefit and thus incentivises investment from the pharmaceutical industry. For a chronic disease such as COPD, incremental or overall survival advantages are far more difficult to show because of the prolonged trajectory of the illness. Funding Information: The Commission has been supported by the University Hospital Basel, Switzerland, the Swiss Respiratory Society, and the Lung Health Center, Heersink School of Medicine, University of Alabama at Birmingham. The European Respiratory Society provided logistic support for meetings during annual conferences. The US National Institutes of Health provided logistic support and space for a meeting of the Commission. We thank the European Lung Foundation for participation, and Sonja Burger for her help with illustrations. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: DS reports a grant from the Swiss National Foundation (SNF 320030_189280), and unrestricted grants from Curetis, AstraZeneca, and Boston Scientifics (paid to their institution); honoraria for participation in data safety monitoring or advisory boards or talks for CSL Behring, Berlin-Chemie Menarini, Novartis, GlaxoSmithKline, AstraZeneca, Vifor, Merck, Sanofi, Merck Sharp & Dohme, Boehringer Ingelheim, and Chiesi; and is the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) representative for Switzerland, the immediate past Education Council Chair of the European Respiratory Society, and President of the Education Committee of the Swiss Respiratory Society. SYA reports grants from the US National Institutes of Health (K08HL145118) and the Pulmonary Fibrosis Foundation (the I M Rosenzweig Junior Investigator Award), and is an owner of Quantitative Imaging Solutions. AA reports unrestricted research grants from GlaxoSmithKline and AstraZeneca; consulting fees from GlaxoSmithKline, AstraZeneca, Sanofi and Merck Sharp & Dohme; and payment for lectures and presentations from GlaxoSmithKline, AstraZeneca, Chiesi, and Menarini. MH reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, Regeneron, United Therapeutics, UpToDate, Altesa Biopharma, Medscape, NACE, and Integrity; has received either in-kind research support or funds paid to their institution from the US National Institutes of Health, Novartis, Sunovion, Nuvaira, Sanofi, AstraZeneca, Boehringer Ingelheim, Gala Therapeutics, Biodesix, the COPD Foundation, and the American Lung Association; has participated in data safety monitoring boards for Novartis and Medtronic (funds paid to their institution); and has received stock options from Meissa Vaccines and Altesa Biopharma. TMP reports an early career development grant (K23HL153672) from the US National Heart, Lung, and Blood Institute. MRvM's department received €2000 from the Clinic for Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel (Basel, Switzerland) for calculating the smoking-attributable burden of COPD reported in the Commission. Her department also received an unrestricted grant of €198 000 from Boehringer Ingelheim to develop a health economic cost-effectiveness model of COPD. BS is supported by a National Institutes of Health grant (U01 HL-139466). JDC reports grants from or contracts with AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Gilead Sciences, Grifols, Insmed, and Novartis, and consulting fees from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Janssen, Grifols, Zambon, Pfizer, Novartis, Chiesi, and Insmed. NMH reports grants from AstraZeneca, and payment or honoraria for presentations, speakers' bureaus, or participation on advisory boards from AstraZeneca, Novartis, and BI-Lilley. MTD reports grants or contracts from the American Lung Association, the US Department of Defense, and the US National Institutes of Health, consulting fees from AstraZeneca, GlaxoSmithKline, Novartis, Pulmonx, and Teva, and support for attending meetings from Pulmonx. YS has received support from the Science and Technology Commission of Shanghai Municipility (200Z2261200). TW has served as an advisory board member or received honoraria for lectures from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, and Novartis, and has received research grants from the German Ministry for Research and Education, GlaxoSmithKline, and AstraZeneca. FMEF reports institutional study grants from AstraZeneca and personal fees for consultancy or presentations from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck Sharp & Dohme, and Novartis. SCD holds investigator-initiated grants from AstraZeneca and GlaxoSmithKline. DDS reports honoraria for speaking engagements for AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. MB reports grants or contracts (to their institution) from AstraZeneca and Roche and consulting fees (paid to their institution) from AstraZeneca, Sanofi, and Roche; honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AstraZeneca, Sanofi, Chiesi, and GlaxoSmithKline; participation on an advisory board from AstraZeneca; and scientific advisor work for ProAxsis and Albushealth. NNH reports grants or contracts (to their institution) from the National Instiutes of Health, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and the COPD Foundation; and participation on data safety monitoring boards or advisory boards for AstraZeneca and GlaxoSmithKline. RK reports grants from the National Heart, Lung, and Blood Institute, the Respiratory Health Association, PneumRx, Spiration, and AstraZeneca, and personal fees from AstraZeneca, CVS Caremark, GlaxoSmithKline, CSA Medical, and Boehringer Ingelheim. GJC has received personal fees from Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Broncus Medical, Chiesi, CSA Medical, Eolo, Gala Therapeutics, GlaxoSmithKline, Helios Medical, Merck, Medtronic, Mereo BioPharma, NGM Biopharmaceuticals, Novartis, Nuvaira, Olympus, Philips, Pulmonx, Respironics, Respivant Sciences, the Implementation Group, Sanofi, Regeneron, Gilead, and Verona. GRW has been supported by the National Heart, Lung, and Blood Institute (grants R01 HL116473 and R01 HL122464). All other authors declare no competing interests. ",

year = "2022",

month = sep,

day = "17",

doi = "10.1016/S0140-6736(22)01273-9",

language = "English",

volume = "400",

pages = "921--972",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier",

number = "10356",

}

Stolz, D, Mkorombindo, T, Schumann, DM, Agusti, A, Ash, SY, Bafadhel, M, Bai, C, Chalmers, JD, Criner, GJ, Dharmage, SC, Franssen, FME, Frey, U, Han, ML, Hansel, NN, Hawkins, NM, Kalhan, R, Konigshoff, M, Ko, FW, Parekh, TM, Powell, P, Rutten-van Mölken, M, Simpson, J, Sin, DD, Song, Y, Suki, B, Troosters, T, Washko, GR, Welte, T & Dransfield, MT 2022, 'Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission', The Lancet, vol. 400, no. 10356, pp. 921-972. https://doi.org/10.1016/S0140-6736(22)01273-9

TY - JOUR

T1 - Towards the elimination of chronic obstructive pulmonary disease

T2 - a Lancet Commission

AU - Stolz, Daiana

AU - Mkorombindo, Takudzwa

AU - Schumann, Desiree M.

AU - Agusti, Alvar

AU - Ash, Samuel Y.

AU - Bafadhel, Mona

AU - Bai, Chunxue

AU - Chalmers, James D.

AU - Criner, Gerard J.

AU - Dharmage, Shyamali C.

AU - Franssen, Frits M.E.

AU - Frey, Urs

AU - Han, Mei Lan

AU - Hansel, Nadia N.

AU - Hawkins, Nathaniel M.

AU - Kalhan, Ravi

AU - Konigshoff, Melanie

AU - Ko, Fanny W.

AU - Parekh, Trisha M.

AU - Powell, Pippa

AU - Rutten-van Mölken, Maureen

AU - Simpson, Jodie

AU - Sin, Don D.

AU - Song, Yuanlin

AU - Suki, Bela

AU - Troosters, Thierry

AU - Washko, George R.

AU - Welte, Tobias

AU - Dransfield, Mark T.

N1 - Funding Information: The Commission has been supported by the University Hospital Basel, Switzerland, the Swiss Respiratory Society, and the Lung Health Center, Heersink School of Medicine, University of Alabama at Birmingham. The European Respiratory Society provided logistic support for meetings during annual conferences. The US National Institutes of Health provided logistic support and space for a meeting of the Commission. We thank the European Lung Foundation for participation, and Sonja Burger for her help with illustrations. Funding Information: Furthermore, there is substantial misalignment between the burden of COPD and the priority afforded to the disease by governmental and other funding agencies. Similar to the low resources dedicated to smoking cessation, the US National Institutes of Health's funding for COPD-specific research is low compared with that for other chronic diseases, such as cardiovascular disease, cancer, and diabetes ( figure 5 ). 43,44 COPD research is also substantially underfunded compared with asthma: asthma received $338 million in funding from the National Institutes of Health in 2020 ($81,500 per US death) whereas COPD received $121 million (less than $800 per US death). The reasons for this discrepancy are complex and difficult to rationalise. Possible explanations include the substantial social stigma that inaccurately characterises COPD as a self-inflicted disease, which is less evident in cardiovascular disease and type 2 diabetes, even though lifestyle factors are important contributors to both illnesses. There has been substantial recent research investment in lung cancer, for which smoking is the most important risk factor, for the development of biologics and immunotherapies, which in many cases offer only an incremental survival advantage. This survival advantage is accepted by regulators as sufficient proof of benefit and thus incentivises investment from the pharmaceutical industry. For a chronic disease such as COPD, incremental or overall survival advantages are far more difficult to show because of the prolonged trajectory of the illness. Funding Information: The Commission has been supported by the University Hospital Basel, Switzerland, the Swiss Respiratory Society, and the Lung Health Center, Heersink School of Medicine, University of Alabama at Birmingham. The European Respiratory Society provided logistic support for meetings during annual conferences. The US National Institutes of Health provided logistic support and space for a meeting of the Commission. We thank the European Lung Foundation for participation, and Sonja Burger for her help with illustrations. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: DS reports a grant from the Swiss National Foundation (SNF 320030_189280), and unrestricted grants from Curetis, AstraZeneca, and Boston Scientifics (paid to their institution); honoraria for participation in data safety monitoring or advisory boards or talks for CSL Behring, Berlin-Chemie Menarini, Novartis, GlaxoSmithKline, AstraZeneca, Vifor, Merck, Sanofi, Merck Sharp & Dohme, Boehringer Ingelheim, and Chiesi; and is the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) representative for Switzerland, the immediate past Education Council Chair of the European Respiratory Society, and President of the Education Committee of the Swiss Respiratory Society. SYA reports grants from the US National Institutes of Health (K08HL145118) and the Pulmonary Fibrosis Foundation (the I M Rosenzweig Junior Investigator Award), and is an owner of Quantitative Imaging Solutions. AA reports unrestricted research grants from GlaxoSmithKline and AstraZeneca; consulting fees from GlaxoSmithKline, AstraZeneca, Sanofi and Merck Sharp & Dohme; and payment for lectures and presentations from GlaxoSmithKline, AstraZeneca, Chiesi, and Menarini. MH reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, Novartis, Pulmonx, Teva, Verona, Merck, Mylan, Sanofi, DevPro, Aerogen, Polarian, Regeneron, United Therapeutics, UpToDate, Altesa Biopharma, Medscape, NACE, and Integrity; has received either in-kind research support or funds paid to their institution from the US National Institutes of Health, Novartis, Sunovion, Nuvaira, Sanofi, AstraZeneca, Boehringer Ingelheim, Gala Therapeutics, Biodesix, the COPD Foundation, and the American Lung Association; has participated in data safety monitoring boards for Novartis and Medtronic (funds paid to their institution); and has received stock options from Meissa Vaccines and Altesa Biopharma. TMP reports an early career development grant (K23HL153672) from the US National Heart, Lung, and Blood Institute. MRvM's department received €2000 from the Clinic for Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel (Basel, Switzerland) for calculating the smoking-attributable burden of COPD reported in the Commission. Her department also received an unrestricted grant of €198 000 from Boehringer Ingelheim to develop a health economic cost-effectiveness model of COPD. BS is supported by a National Institutes of Health grant (U01 HL-139466). JDC reports grants from or contracts with AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Gilead Sciences, Grifols, Insmed, and Novartis, and consulting fees from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Janssen, Grifols, Zambon, Pfizer, Novartis, Chiesi, and Insmed. NMH reports grants from AstraZeneca, and payment or honoraria for presentations, speakers' bureaus, or participation on advisory boards from AstraZeneca, Novartis, and BI-Lilley. MTD reports grants or contracts from the American Lung Association, the US Department of Defense, and the US National Institutes of Health, consulting fees from AstraZeneca, GlaxoSmithKline, Novartis, Pulmonx, and Teva, and support for attending meetings from Pulmonx. YS has received support from the Science and Technology Commission of Shanghai Municipility (200Z2261200). TW has served as an advisory board member or received honoraria for lectures from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, and Novartis, and has received research grants from the German Ministry for Research and Education, GlaxoSmithKline, and AstraZeneca. FMEF reports institutional study grants from AstraZeneca and personal fees for consultancy or presentations from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Merck Sharp & Dohme, and Novartis. SCD holds investigator-initiated grants from AstraZeneca and GlaxoSmithKline. DDS reports honoraria for speaking engagements for AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. MB reports grants or contracts (to their institution) from AstraZeneca and Roche and consulting fees (paid to their institution) from AstraZeneca, Sanofi, and Roche; honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from AstraZeneca, Sanofi, Chiesi, and GlaxoSmithKline; participation on an advisory board from AstraZeneca; and scientific advisor work for ProAxsis and Albushealth. NNH reports grants or contracts (to their institution) from the National Instiutes of Health, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and the COPD Foundation; and participation on data safety monitoring boards or advisory boards for AstraZeneca and GlaxoSmithKline. RK reports grants from the National Heart, Lung, and Blood Institute, the Respiratory Health Association, PneumRx, Spiration, and AstraZeneca, and personal fees from AstraZeneca, CVS Caremark, GlaxoSmithKline, CSA Medical, and Boehringer Ingelheim. GJC has received personal fees from Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Broncus Medical, Chiesi, CSA Medical, Eolo, Gala Therapeutics, GlaxoSmithKline, Helios Medical, Merck, Medtronic, Mereo BioPharma, NGM Biopharmaceuticals, Novartis, Nuvaira, Olympus, Philips, Pulmonx, Respironics, Respivant Sciences, the Implementation Group, Sanofi, Regeneron, Gilead, and Verona. GRW has been supported by the National Heart, Lung, and Blood Institute (grants R01 HL116473 and R01 HL122464). All other authors declare no competing interests.

PY - 2022/9/17

Y1 - 2022/9/17

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U2 - 10.1016/S0140-6736(22)01273-9

DO - 10.1016/S0140-6736(22)01273-9

M3 - Review article

C2 - 36075255

AN - SCOPUS:85138067585

SN - 0140-6736

VL - 400

SP - 921

EP - 972

JO - The Lancet

JF - The Lancet

IS - 10356

ER -

Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission

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