Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and death among older adults. For many patients, disease flare-ups, known as exacerbations, are unpredictable and difficult to prevent. These episodes not only accelerate lung function decline but also lead to frequent hospitalizations and diminished quality of life. Despite decades of research, there are still no widely effective strategies to prevent exacerbations, in part because the underlying biological mechanisms remain poorly understood.
Christopher Mosher, MD, assistant professor in the Division of Pulmonary, Allergy, and Critical Care Medicine, is determined to change that. He recently received the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76) from the National Institute on Aging, part of the NIH, to launch a five-year, $1.2 million project titled Investigating Senolytic Properties in Pulmonary Rehabilitation and metformin in COPD Exacerbations (INSPIRE-COPD-E).
Mosher’s research will build on his previous NIH-funded work, examining how pulmonary rehabilitation— a structured, exercise-based program already considered safe and effective — can improve outcomes for patients with COPD. With this award, he will expand the study cohort, extend follow-up, and add a control group to better clarify how pulmonary rehabilitation reduces flare-ups.
At the same time, Mosher is testing whether an existing diabetes medication, metformin, could be repurposed as a preventative therapy for COPD exacerbations. Often described as a promising “gerotherapeutic,” metformin is inexpensive and has shown beneficial effects on several hallmarks of aging. His study will evaluate the safety and feasibility of using metformin in older adults with COPD who do not have diabetes—a key step before moving into larger clinical trials.
“This award provides crucial support for both my research and my career development,” Mosher said. “By investigating pulmonary rehabilitation and metformin, we hope to identify modifiable biological targets that can ultimately reduce COPD exacerbations and improve outcomes for older adults.”
Beyond its clinical potential, the project aims to generate new insights into how aging-related inflammation and immune changes contribute to COPD outcomes. The findings may inform drug discovery, therapeutic repurposing, and broader strategies at the intersection of pulmonology and geroscience.
Mosher emphasizes that this award reflects not only his own vision but also the contributions of a wide network of mentors, collaborators, and patients. He credits his primary research mentor, Dr. Scott Palmer, and members of the Palmer Lab, including Courtney Frankel, Megan Neely, and Sidra Qayyum; his geriatrics mentor, Dr. Ken Schmader; and Beeson team colleagues, including Drs. William Kraus, David Murdoch, Virginia Kraus, and Kim Huffman. He also highlights support from the Duke Molecular Physiology Institute, the Murdoch Lab, and Duke Clinical Research Institute, as well as guidance from grant writing coach Dr. Irina Mokrova and the Duke Aging Center and Pulmonary division’s mock grant reviews.
Mosher notes the invaluable role of his mentor, Dr. Neil MacIntyre, and the Duke Cardiopulmonary Rehabilitation Center team, including Erica Rao and Rebecca Byrd, along with the patients who participated in earlier studies, in making this new award possible.
“Our patients’ dedication to research is what allows us to push the science forward,” he said.
With INSPIRE-COPD-E, Mosher is laying the groundwork for new strategies to prevent COPD exacerbations—advancing both pulmonary medicine and the science of aging.