Update: Future directions for research on diseases of the lung

C. Cannon, N. Dunlap, D. Earle, N. Edelman, K. Fulton, S. Kunkel, J. Neubauer, J. Sheller, G. Turino, J. R. Wright

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations

Abstract

This paper represents the conceptual input of 12 assemblies of the American Thoracic Society and the Scientific Advisory Council of the American Lung Association and the American Thoracic Society to define areas of research that are deemed of special significance to advance the mission of preventing lung disease and improving lung health. The report is presented in four sections. The first, MECHANISMS OF DISEASES, is a predictive perspective focused on cellular and subcellular mechanisms that may predispose or are the cause of cellular and organ dysfunction. Noteworthy in this section are the broad array of mechanisms deemed worthy of further investigation. Many of these mechanisms were not mentioned in the previous document, 'Future Directions of Research in Diseases of the Lung,' published in 1995, which attests to the accelerated pace of new knowledge in this field. These are areas of investigation in which preliminary studies point to conceptual advances that may be applicable to not only lung disease but also to pathophysiologic mechanisms that can affect many cell or organ systems beyond the lung. Elucidation of such mechanisms therefore has the potential of clarifying cellular dysfunction through understanding of subcellular mechanisms that explore the fundamental mechanisms of disease and therefore have the prospect of not only resulting in major advances in understanding disease, but in devising therapy. Examples of such areas include apoptosis, antioxidants, immune responses, the functions of nitric oxide and genetic determinants of disease. Increased understanding of these mechanisms of disease at a fundamental level can benefit all of biological science and provide an opportunity for the discovery of new knowledge, which sets the stage for new discoveries for decades to come. It is also to be noted that the areas of study selected are frequently only starting points that will expand, overlap, and interact with other biologic processes, which leads to an exponential growth in new knowledge. In the second section, DISEASES, certain disease entities have been selected for discussion in which questions have been defined that can guide disease-oriented research. For example, for asthma there are still many questions related to environmental triggers, the nature of the defects in airway biology, and the need for new mechanisms of control. For lung Cancer, it is clear that the thrust is on an effective screening test for early detection, to improve on what is a poor rate of success of therapy. Research into specific disease entities offers the opportunity to translate information derived from the study of basic mechanisms of disease to the clinical manifestations of disease and the search for new methods of prevention and therapy. The third section of the report is SPECIAL APPROACHES to CLINICAL RESEARCH. This section emphasizes the special expertise required for successful clinical research. Research on patients with various disease entities is, and will continue to be, a major need for significant development of new methods of diagnosis and therapy. Clinical research requires a highly disciplined approach to the questions being asked, and this section defines some of those methods of study that require additional development to improve the effectiveness of clinical investigation to answer specific questions in the year to come. As mentioned, improved methods for evaluating clinical outcomes, along with broader application of epidemiologic concepts and patient education as an important therapeutic modality, are examples where significant progress can be made. The fourth section, CUTTING-EDGE THERAPIES, identifies certain areas of study that have reached a sufficient stage of development in which additional resources and added research emphasis can result in real clinical gains in treating disease. The definition of the potential therapeutic role of nitric oxide in various disease settings, along with the development of therapies aimed at correcting genetic defects and a vaccine to prevent the development of AIDS, would have enormous impacts on medical care in the future in all of medical science. The areas of research selected for inclusion in this document represent the best guesses from a number of individuals in research as to where resources should be expanded and expended to achieve the most effective return in the discovery of new knowledge and its application to lung disease. Hopefully, the fields of study mentioned are still sufficiently broad to leave much leeway for the unexpected and the unpredicted in the process of discovery by individual investigators using their own insights, which, as we have learned by experience, very much underlies the process of progress in medical science.

Original languageEnglish (US)
Pages (from-to)320-334
Number of pages15
JournalAmerican journal of respiratory and critical care medicine
Volume158
Issue number1
DOIs
StatePublished - 1998

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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