When we're thinking about developing a therapy for bronchiectis, and uh we really needed to start from, from the start with this because there's been so little research into bronchiectis, as, as we were starting to think about developing new therapies, we really had to develop the field in terms of what kind of trials should we be doing, what kind of endpoints are important. It's important to bring it back to the patient and to think what, what is important to a patient. The, the true burden of the disease is captured in exacerbations which are major drivers of morbidity and indeed mortality in the disease. So exacerbations and preventing exacerbations is really important, um, and is uh and is recognized as the most important clinical endpoint, uh, because of their centrality to the, to the burden of disease. But also patients really want to feel better, so symptoms. Uh, daily symptoms, cough, sputum production, these sorts of things are incredibly important. Uh, and as we've worked through clinical trials, we've refined what are the best ways of measuring those things in terms of patient reported outcome measures, uh, daily diaries versus intermittent questionnaires, etc. And then the other thing that patients really want to know is, can treatments prevent me from getting worse, because bronchiexis, is unfortunately a progressive disease, uh, and patients really worry that they ultimately will end up with significant disability. Uh, severe impairment of quality of life and won't be able to live the lives that they want to live, and so as you're designing clinical trials, it's important that we design trials that can, uh, address the endpoints that are important to patients. So, most of the trials that we've designed, particularly those now looking at anti-inflammatories, prioritize measuring exacerbations, the frequency, but also the severity of exacerbations. Measuring quality of life and the patient impact through patient reported outcomes, but also looking at measures of disease progression and examples of that, our lung function, but also other parameters like, like CT imaging, um. Intrinsic in what I'm saying in terms of trying to understand the impact of treatments on disease over a long period of time, is also trials need to be long enough to capture these endpoints over a prolonged period of time, and so phase two trials in bronchiexis are often 6 months or a year duration, uh, and phase 3 trials often 1 year in duration. Um, because it's important to understand these impacts over a long period of time in what is a chronic, uh, disease that patients will live with for decades.
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