Current controversies in the pharmacological treatment of chronic obstructive pulmonary disease
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Clinical phenotyping is currently used to guide pharmacological
treatment decisions in chronic obstructive pulmonary disease
(COPD), a personalized approach to care. Precision medicine
integrates biological (endotype) and clinical (phenotype)
information for a more individualized approach to
pharmacotherapy, to maximize the benefit versus risk ratio.
Biomarkers can be used to identify endotypes. To evolve toward
precision medicine in COPD, the most appropriate biomarkers and
clinical characteristics that reliably predict treatment responses need
to be identified. FEV1 is a marker of COPD severity and has
historically been used to guide pharmacotherapy choices. However,
we now understand that the trajectory of FEV1 change, as an
indicator of disease activity, is more important than a single FEV1
measurement. There is a need to develop biomarkers of disease
activity to enable a more targeted and individualized approach to
pharmacotherapy. Recent clinical trials testing commonly used
COPD treatments have provided new information that is likely to
influence pharmacological treatment decisions both at initial
presentation and at follow up. In this Perspective, we consider
the impact of recent clinical trials on current COPD treatment
recommendations. We also focus on the movement toward
precision medicine and propose how this field needs to evolve
in terms of using clinical characteristics and biomarkers to
identify the most appropriate patients for a given pharmacological
treatment.
treatment decisions in chronic obstructive pulmonary disease
(COPD), a personalized approach to care. Precision medicine
integrates biological (endotype) and clinical (phenotype)
information for a more individualized approach to
pharmacotherapy, to maximize the benefit versus risk ratio.
Biomarkers can be used to identify endotypes. To evolve toward
precision medicine in COPD, the most appropriate biomarkers and
clinical characteristics that reliably predict treatment responses need
to be identified. FEV1 is a marker of COPD severity and has
historically been used to guide pharmacotherapy choices. However,
we now understand that the trajectory of FEV1 change, as an
indicator of disease activity, is more important than a single FEV1
measurement. There is a need to develop biomarkers of disease
activity to enable a more targeted and individualized approach to
pharmacotherapy. Recent clinical trials testing commonly used
COPD treatments have provided new information that is likely to
influence pharmacological treatment decisions both at initial
presentation and at follow up. In this Perspective, we consider
the impact of recent clinical trials on current COPD treatment
recommendations. We also focus on the movement toward
precision medicine and propose how this field needs to evolve
in terms of using clinical characteristics and biomarkers to
identify the most appropriate patients for a given pharmacological
treatment.
Date Issued
2016-09-01
Date Acceptance
2016-07-25
Citation
American Journal of Respiratory and Critical Care Medicine, 2016, 194 (5), pp.541-549
ISSN
1535-4970
Publisher
American Thoracic Society
Start Page
541
End Page
549
Journal / Book Title
American Journal of Respiratory and Critical Care Medicine
Volume
194
Issue
5
Copyright Statement
© 2016 by the American Thoracic Society.
Subjects
Respiratory System
11 Medical And Health Sciences
Publication Status
Published