COSMOS
COPD Modification Opportunity Score
COSMOS is an R&D programme seeking medical science advancements for the earlier identification of patients at high risk of disease and to optimize the management of symptomatic COPD. Despite these advancements, an agreed upon patient phenotype or globally accepted criteria for defining early and pre-COPD does not exist.
Summary
The baseline level of science that was known when the R&D programme commenced in 2020 included:
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For those patients with a COPD diagnosis, only 32% of patients with a new COPD diagnosis have undergone official diagnosis testing (e.g.
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Half of smokers who are not defined as COPD in spirometry testing still had COPD Assessment Test (CAT) scores greater than or equal to 10
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42% of patients with normal spirometry had emphysema or airway thickening on CT thorax, lending credence to the fact that use of spirometry alone is not sufficient for detection of early COPD
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Inhaled dual bronchodilator therapy does not decrease respiratory symptoms in symptomatic, tobacco-exposed persons with preserved lung function as assessed by spirometry
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There is no agreed upon patient phenotype or globally accepted criteria for defining early and pre-COPD
The advance in science that this programme will be measured against includes the baseline level of science available and has been further defined by a global working group on pre-COPD (consisting of 30 world leaders in respiratory disease – Competent Professionals). The working group have outlined in the Blue Journal a call to action for scientific research in those with respiratory symptoms, abnormal imaging, and/or lung function without evidence of airflow limitation who may (or may not) develop COPD with time. The outputs of this programme will aim to address the three key themes outlined by Competent Professionals:
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Defining biological mechanisms driving and predicting increased risk of early COPD and pre-COPD
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Early COPD: biological term that indicates that the disease is near its beginning (at any age); requires validated biomarkers to be identified/quantified in clinical practice)
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Pre-COPD: Individuals (of any age) who present chronic respiratory symptoms, with or without structural and/or functional abnormalities, in the absence of airflow limitation (FEV1/FVC > 0.7) who may (or may not) develop persistent airflow limitation (i.e., COPD) over time
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Experimental platform developed for intervening to slow the progress and exacerbation events in patients at risk of developing COPD.
The R&D question with scientific uncertainty was: - Is it possible to advance the identification of early COPD in the initial stages, by developing and validating an agreed-upon data-driven algorithm that has clinical and prognostic relevance where new therapeutic developments can demonstrate true disease modification. In answering this overarching research question, we will explore the following package of work to make appreciable improvements to the current scientific knowledge.
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Is it possible to quantify and categorise levels of pre and/or early COPD in patients with respiratory symptoms, abnormal imaging, and/or lung function without evidence of airflow limitation?
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In those identified as pre and/or early COPD, does a new research platform enable new advancements in therapeutic approaches and interventions to be tested and enable further scientific advancements which changes disease trajectories?
As well as advancing scientific knowledge, there will be physical outputs from the programme by way of several publications and a combined package of medical algorithms that use advanced methodologies to extract insights from integrated data sources by applying new scientific knowledge developed as part of the R&D programme. The programme will aim to apply the new scientific knowledge into existing quality improvement programmes that ultimately aim to advance adherence in patients with COPD.
COSMOS Team and Steering Committee
Our COSMOS programme is also supported and advised by a wider steering committee of competent professionals.
Dr Marc Mirivalitis
Marc Mirivalitis is a Pulmonologist Specialist and Senior Researcher in Respiratory Medicine trained at Vall d’Hebron Hospital in Barcelona. His focus is on clinical research in chronic obstructive pulmonary disease (COPD) and alpha-1 antitrypsin deficiency (AATD) with the objective to find a cure and improve the quality of life of patients suffering these chronic respiratory diseases. He obtained his MD at the Universitat de Barcelona, Barcelona, Spain in 1986 and PhD at the Universitat Autònoma de Bacelona in 1997. He is a trained as specialist in Respiratory Medicine at Vall d'Hebron Hospital. His primary research interests include chronic obstructive pulmonary disease (COPD), alpha-1-antitrypsin deficiency (AAT), lung defence mechanisms and respiratory infections. He served as Secretary General of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) from 1999 to 2003 and was responsible for International Relationships of SEPAR from 2006 until 2012. He was Chair of the Respiratory Infections Group of the European Respiratory Society (ERS) from 2008 to 2011 and was the Guidelines Director of the ERS from 2015 to 2018. He has acted as a consultant and/or chair or author for the development of different international guidelines of COPD, including the American Thoracic Society (ATS)/ERS task force on outcomes in COPD, the ERS/ATS guidelines on diagnostic and treatment of exacerbations of COPD and the ERS statement on management of alpha-1 antitrypsin deficiency. He is also a consultant of the Spanish Ministry of Health for the development of the National Strategy Against COPD (2009 to present) and coordinator of the Spanish National Guidelines for COPD (GesEPOC from 2012). He is the director of the reference center for diagnosis and treatment of AATD in the Hospital Vall d’Hebron.
Dr Anita Sharma
Anita Sharma is the Medical Director and founder of Platinum Medical Centre – a multi doctor, holistic family practice that offers comprehensive medical care for the whole family, with a focus on personalised patient centred care. In addition to her expertise in all areas of family medicine (women’s health, child health, mental health) Dr Sharma has high level of expertise in the management of Type 2 Diabetes, Heart Failure, Obesity and Osteoporosis in primary care. She has established dedicated multi-disciplinary clinics for Diabetes, Heart Failure, Osteoporosis, Obesity and Skin cancer medicine at the centre and is committed to high patient satisfaction and exemplary clinical outcomes. Dr Sharma has undertaken training in Integrative Medicine and is a member of the Australian College of Environmental and Nutritional Medicine (ACNEM) , which assists her in offering scientifically validated complementary therapies and lifestyle medicine to her patients. In addition to her commitment to her patients Dr Sharma is passionate about teaching and is a medical educator for the Royal Australian College of General Practitioners (RACGP), clinical lead for Active Learning Modules for Aged Care (frailty and osteoporosis) and Chronic Diseases (Diabetes and Heart Failure), and adviser for various independent medical education companies and Indemnity organisations in Australia. She delivers workshops in both medical and medicolegal topics for these organisations. She is Editor and Reviewer for Medicine Today, an independent, peer-reviewed journal for Australian GPs, specialists and other health professionals. She is the co-author of the RACGP Handbook on Management of Type 2 Diabetes in General Practice and faculty member of National Specific Interest Group for Diabetes (NFSI) RACGP, and regularly contributes to journals both here in Australia and overseas in cardio-metabolic medicine, respiratory diseases, osteoporosis and polycystic ovarian syndrome. Dr Sharma is an accredited trainer and supervisor for General Practice and medical students, and mentors’ doctors all over Australia. She is a speaker for General Practice conferences and workshops and presents various online webinars for independent education companies on a diverse range of primary care medicine topics. She has trained over 1500 doctors in Australia in insulin initiation and intensification, and over 800 doctors in management of Osteoporosis via active learning modules and practical workshops developed through her expertise. Dr Sharma is a certified aviation medical examiner for the aviation industry and is an accredited medical review officer for drug and alcohol assessment for aviation and ground crew. Dr Sharma is an active member of the Queensland Medical Women’s Society (QMWS) and the Queensland Representative to the Australian Federation of Medical Women (AFMW) and in this role champions the professional development and well being of women in medicine. Dr Sharma’s hobbies include travel, reading, music and painting.
Prof Dave Singh
Dave Singh is a distinguished expert in clinical pharmacology and respiratory medicine at the University of Manchester. His research primarily focuses on developing new treatments for asthma and chronic obstructive pulmonary disease (COPD). Singh has served as the principal investigator in over 300 clinical trials and has authored more than 250 publications. He is the Medical Director of the Medicines Evaluation Unit and a member of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee. Additionally, Singh has been recognized with the European Respiratory Society (ERS) Gold Medal for his outstanding contributions to COPD research
Dr Fernando Martinez
Fernando J. Martinez is a prominent pulmonologist specializing in fibrotic lung disease and airway disorders, including asthma and chronic obstructive pulmonary disease (COPD). He currently serves as the Chief of the Division of Pulmonary and Critical Care Medicine at Weill Cornell Medicine and NewYork-Presbyterian Weill Cornell Medical Center. Additionally, he holds the position of Bruce Webster Professor of Internal Medicine in the Joan and Sanford I. Weill Department of Medicine. Dr. Martinez's work focuses on understanding the biological basis of advanced lung diseases and developing personalized treatments to improve patient care. He is also heavily involved in mentoring the next generation of pulmonologists, leveraging the resources of Weill Cornell Medicine’s Clinical and Translational Science Center to foster innovation in the field. Born in Cuba, Dr. Martinez immigrated to the U.S. in 1968. He received his medical degree from the University of Florida and completed his internal medicine residency at Beth Israel Hospital/Harvard Medical School, followed by a pulmonary and critical care medicine fellowship at Boston University. He joined the University of Michigan Medical Center before accepting his current role at Cornell in 2014. His contributions to pulmonary medicine are widely recognized, particularly through his involvement in significant clinical investigations related to emphysema, lung volume reduction surgery, and idiopathic pulmonary fibrosis
Dr John Hurst
John Hurst is a prominent figure in respiratory medicine. He currently serves as a Professor of Respiratory Medicine at University College London (UCL) and a Consultant Physician at the Royal Free London NHS Foundation Trust. Dr. Hurst's clinical and research work focuses primarily on chronic obstructive pulmonary disease (COPD), with a particular interest in improving diagnosis and management in low-resource settings. Dr. Hurst is also the COPD Lead for the Royal College of Physicians National Asthma and COPD Audit Programme and the Chief Editor of the European Respiratory Monograph. He is a member of the editorial boards for both the American Journal of Respiratory and Critical Care Medicine and the European Respiratory Journal. Additionally, he chairs the Multi-Morbidity Working Group of the Global Alliance for Chronic Diseases (GACD)
Dr Luis Alves
Luís Alberto Marques Alves is a retired professor from the University of Porto, where he specialized in Contemporary History, History of Education, and Didactics of History. He completed his undergraduate studies in History in 1979, earned his PhD in 1999, and obtained his habilitation in 2007. Dr. Alves has been an active researcher at CITCEM (Transdisciplinary Research Centre Culture, Space, and Memory), focusing on various historical and educational topics. He has published extensively on the history of education and related fields
Dr Mark Dransfield
Mark Dransfield is currently serving as a professor of medicine at the University of Alabama at Birmingham (UAB). He is the director of the Division of Pulmonary, Allergy, and Critical Care Medicine and holds the Ben Vaughan Branscomb Chair of Medicine in Respiratory Disease. Dransfield earned his medical degree from the University of North Carolina at Chapel Hill, followed by residency in internal medicine and fellowship training in pulmonary and critical care medicine at UAB, where he also served as Chief Fellow. Dr. Dransfield's research primarily focuses on chronic obstructive pulmonary disease (COPD). He has led multiple clinical trials and observational studies sponsored by prestigious institutions such as the National Institutes of Health (NIH), the Department of Defense, and the American Lung Association. Additionally, he chairs the Lancet Commission on COPD, which aims to eradicate the disease globally. He has served as the medical director of the UAB Lung Health Center since 2009 and has been involved in innovative treatments for emphysema, such as bronchoscopic lung volume reduction. Dr. Dransfield has also published over 300 research papers and is the editor-in-chief of the COPD: Journal of the COPD Foundation.
Dr Rongchang Chen
Rongchang Chen is the director of the Shenzhen Institute of Respiratory Diseases at Shenzhen People's Hospital. His expertise lies in respiratory and critical care medicine, and he has made significant contributions to the management of various respiratory diseases, including COPD and COVID-19. Dr. Chen has an extensive research background and has authored numerous publications on non-invasive ventilation and other respiratory therapies. He is affiliated with several prestigious institutions, including the State Key Laboratory of Respiratory Disease and the National Clinical Research Center for Respiratory Disease.
Dr Shigeo Muro
Shigeo Muro is a Professor in the Department of Respiratory Medicine at Nara Medical University in Japan. His department specializes in the treatment of a wide range of respiratory diseases, including lung cancer, pneumonia, bronchial asthma, COPD, interstitial pneumonia, pulmonary fibrosis, and sleep apnea syndrome. The department focuses on patient-centered care, employing cutting-edge technology to provide specialized, community-based medical services and conducting clinically-oriented research.
Dr Tonya Winders
Tonya Winders is the President and CEO of the Global Allergy & Airways Patient Platform (GAAPP). She has over 25 years of experience in the respiratory and immunology healthcare industry. Throughout her career, she has held various leadership roles, focusing on sales, marketing, and managed markets access. In addition to her role at GAAPP, she also serves as the Executive Director of the Alliance to Prevent Legionnaires Disease and is President of the Board of Prevent Legionnaires. Winders is active in several expert panels, including the ERS International Respiratory Coalition and GINA international guidelines.
Prof David Halpin
David Halpin trained at Oxford & St Thomas Hospital Medical School: completing a D.Phil. in the Department of Human Anatomy, Oxford, before finishing his clinical training at St Thomas. He completed his postgraduate training in respiratory medicine at the Brompton Hospital. Professor Halpin is a Fellow of Royal College Physicians, Member British Thoracic Society, European Respiratory Society & American Thoracic Society. Professor Halpin continues to undertake research in respiratory medicine & has published widely. He lectures frequently around the world on COPD. Until recently Professor Halpin was an Associate Editor of Thorax. Professor Halpin is one of the 10 Directors of the WHO/NIH Global Initiative for Obstructive Lung Disease (GOLD) and a member of the GOLD Science Committee. Professor Halpin was the Chairman and Clinical Expert for the COPD Guideline Development Group of the National Institute of Clinical Excellence (NICE) in the UK. Until 2015 Professor Halpin was also Respiratory Clinical Lead for the NHS in the South West.
Dr Katherine Hickman
Katherine Hickman is a GP partner in Bradford and a respiratory health expert. She qualified from Leeds University in 2000 and initially pursued a Medicine Rotation, earning her MRCP, before transitioning into General Practice. Dr. Hickman is currently a GP Partner in Bradford. Dr. Hickman holds several prominent roles, including being the Respiratory Lead for West Yorkshire Integrated Care Board (ICB), the Primary Care Clinical Lead for the National Respiratory Audit Programme (NRAP), and the Executive Chair of the Primary Care Respiratory Society (PCRS). She has also contributed to various respiratory health initiatives and collaborates globally to improve respiratory health.
Dr Mukesh Singh
Mukesh Singh is a General Practitioner at the Horse Fair Practice Group in Rugeley, Staffordshire, UK. He is a Senior Partner at the practice and has been with them since 2004. Dr. Singh completed his medical education at Banarus Hindu University in India, where he qualified in 1992. He holds multiple qualifications including an MBBS (Bachelor of Medicine and Bachelor of Surgery), an MD (Doctor of Medicine), and a DFFP (Diploma Faculty of Family Planning and Reproductive Medicine). Dr. Singh serves as the Respiratory Lead for the Staffordshire Integrated Care System (ICS) and is a GP with Special Interest (GPwSI) in respiratory illnesses. He is also a tutor at Keele University Medical School and a trainer for the West Midlands Deanery. His professional interests focus on the early and accurate diagnosis of respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD), especially within the community. He has been actively involved in practice-based research and frequently presents his findings at national and international conferences.
Prof Mona Bafhadel
Professor Mona Bafadhel currently serves as the Chair of Respiratory Medicine at King's College London, where she leads research on airways disease, particularly focusing on chronic obstructive pulmonary disease (COPD) and its exacerbations. Prior to this role, she was a Professor of Respiratory Medicine at the University of Oxford, contributing significantly to the understanding and management of COPD. Prof. Bafadhel's research has had a profound impact on clinical practice, especially her work on the role of peripheral blood eosinophils in COPD, which has influenced both national and international treatment guidelines. Her innovative approach to defining and managing COPD exacerbations has led to the coining of the term "COPD Crisis," highlighting her contribution to evolving clinical terminology and practice. Among her notable achievements, Prof. Bafadhel was awarded the prestigious Goulstonian Lectureship from the Royal College of Physicians in 2019, making her the first ethnic minority woman to receive this honor in the college's history since 1639.
Dr James Chalmers
James Chalmers is a Professor and Consultant Respiratory Physician at the School of Medicine, University of Dundee. His laboratory works primarily on the interaction between neutrophils and bacteria during acute and chronic airway infections. Major areas of research with relevance to AMR include phase 1 and phase 2 studies of non-antibiotic alternative therapies for respiratory infections, the development of diagnostics to reduce antibiotic use by more accurately identifying bacterial infections and work to understand the selective drivers of antimicrobial resistance in chronic airways diseases such as bronchiectasis and cystic fibrosis where multidrug resistant Gram-negative infections are common. His work is funded by the Wellcome Trust, Medical Research Council, Scottish Government, EU and the pharmaceutical industry.
Dr Tom Wilkinson
Tom Wilkinson is a Professor of Respiratory Medicine at the University of Southampton, Faculty of Medicine, and an Honorary Consultant in Respiratory Medicine at University Hospitals Southampton. He is also the Associate Dean for Enterprise at the university. Dr. Wilkinson's extensive training includes education at the University of Cambridge, Barts and The London School of Medicine, and a PhD from UCL where he studied disease mechanisms driving infective exacerbations of COPD. Dr. Wilkinson's research focuses on understanding the mechanisms contributing to respiratory infections and exacerbations in patients with chronic lung diseases such as COPD. He leads the Southampton COPD research group and is the Respiratory and Allergy theme lead for the National Institute for Health and Care Research (NIHR) Biomedical Research Centre in Southampton. His work has led to the development of novel treatments and vaccines, including human challenge studies using live respiratory viruses and T cell vaccines. He has authored over 150 papers and received multiple awards, including the UK NHS Innovation of the Year and the European Respiratory Society's Maurizio Vignola Award for Innovation in Research. Additionally, he is actively involved in clinical leadership roles, including being the clinical director for the National UNIVERSAL Respiratory Viral Research Programme and the national clinical lead for the Royal College of Physicians' COPD audit programme.