Current controversies in the pharmacological treatment of chronic obstructive pulmonary disease

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Title: Current controversies in the pharmacological treatment of chronic obstructive pulmonary disease
Author(s): Singh, D
Roche, N
Halpin, D
Agusti, A
Wedzicha, JA
Martinez, FJ
Item 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.
Publication Date: 1-Sep-2016
Date of Acceptance: 25-Jul-2016
URI: http://hdl.handle.net/10044/1/41997
DOI: https://dx.doi.org/10.1164/rccm.201606-1179PP
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.
Keywords: Respiratory System
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Airway Disease
Faculty of Medicine



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