Looking to the future, I believe that the Barnes data^[1] are intriguing.  I think that their results have shown that we need more information and call for large prospective studies to confirm those findings.  We need better methods to collect information, such as data on medication adherence and compliance.  For example, we need to be able to ascertain drug levels, since compliance with therapy affects outcome.  At this point there are not many therapies for which we can confirm compliance except by looking at the device or visually monitoring the patient as they take their medication, and so this is where patient and family education comes in.

I think the results of the Barnes study also show that clinical research and drug development are needed, and that will help us to do targeted therapy, because as more details of the disease process and the different phenotypes are identified, then we will be able to better manage our patients as specific targeted therapy becomes available.

Finally, further patient education regarding the impact of their actions, ongoing tobacco use, and so forth, on their health and the cost associated with it will be important.  Educating those patients may actually lead to more awareness and improved compliance and hopefully lead to improvement of management of their condition.