RT Journal Article SR Electronic T1 Individual trajectory-based care for COPD: getting closer, but not there yet JF ERJ Open Research JO erjor FD European Respiratory Society SP 00451-2021 DO 10.1183/23120541.00451-2021 A1 Nicolas Roche A1 Philippe Devillier A1 Patrick Berger A1 Arnaud Bourdin A1 Daniel Dusser A1 Jean-François Muir A1 Yan Martinat A1 Philippe Terrioux A1 Bruno Housset YR 2021 UL http://openres.ersjournals.com/content/early/2021/09/16/23120541.00451-2021.abstract AB Chronic obstructive pulmonary disease (COPD) is a main cause of death due to interplaying factors, including comorbidities that interfere with symptoms and response to therapy. It is now admitted that COPD management should be based on clinical symptoms and health status, and should consider the heterogeneity of patients’ phenotypes and treatable traits. This precision medicine approach involves a regular assessment of the patient's status and of expected benefits and risks of therapy. The cornerstone of COPD pharmacological therapy is inhaled long-acting bronchodilation. In patients with persistent or worsened symptoms, factors likely to interfere with treatment efficacy include the patient's non-adherence to therapy, treatment preference, inhaler misuse and/or comorbidities, which should be systematically sought before escalation is considered. Several comorbidities are known to impact symptoms, activity and lung function in vicious circles. The possible long-term risks of inhaled corticosteroids contrasting with their over-prescription in COPD patients justify the regular assessment of their benefits and risks, and de-escalation under close monitoring after a sufficient period of stability is to be considered. While commonly used in clinical trials, the relevance of routine blood eosinophil counts to guide therapy adjustment is not fully clarified. Patients’ characteristics, which define phenotypes and treatable traits and thus guide therapy, often change during life, forming the basis of the concept of clinical trajectory. The application of individual trajectory-based management of COPD in clinical practice therefore implies that the benefit:risk ratio is regularly reviewed according to the evolution of the patient's traits over time to allow optimized therapy adjustments.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Roche reports other from Boehringer Ingelheim, during the conduct of the study; grants and personal fees from Boehringer Ingelheim, grants and personal fees from Novartis, personal fees from GSK, personal fees from AstraZeneca, personal fees from Chiesi, grants and personal fees from Pfizer, personal fees from Sanofi, personal fees from Zambon, outside the submitted work; .Conflict of interest: Dr. Devillier reports other from Boehringer Ingelheim, during the conduct of the study; personal fees from Astra Zeneca, personal fees from Chiesi, personal fees from Menarini, personal fees from GlaxoSmithKline, personal fees from Mundipharma, personal fees from Mylan / Meda Pharma, personal fees from Novartis, personal fees from Sanofi, outside the submitted work; .Conflict of interest: Dr. Berger reports other from Boehringer Ingelheim, during the conduct of the study; grants, personal fees and other from GSK, grants, personal fees and other from AstraZeneca, grants, personal fees and other from Boehringer Ingelheim, grants, personal fees and other from Novartis, grants, personal fees and other from Chiesi , other from Almirall, personal fees and other from Sanofi , personal fees from Circassia, other from AB Sciences, other from Amgen, personal fees from Teva, other from Janssen, grants from Pierre Fabre, personal fees from Pfizer, outside the submitted work; .Conflict of interest: Dr. Bourdin reports grants, personal fees, non-financial support and other from GSK, grants, personal fees, non-financial support and other from Astra Zeneca, grants, personal fees, non-financial support and other from Boehringer Ingelheim, personal fees, non-financial support and other from Novartis, personal fees, non-financial support and other from Chiesi , non-financial support from Teva, personal fees, non-financial support and other from Sanofi Regeneron, grants, personal fees, non-financial support and other from Actelion / Janssen, other from United Therapeutics, other from Pulsar, personal fees, non-financial support and other from Roche, outside the submitted work; .Conflict of interest: Dr. Dusser reports grants, personal fees and other from Boehringer Ingelheim, during the conduct of the study; grants, personal fees and other from Boehringer Ingelheim, grants, personal fees and other from AstraZeneca, grants, personal fees and other from Pfizer, grants, personal fees and other from Novartis, grants, personal fees and other from Chiesi, grants, personal fees and other from Dey Pharma, outside the submitted work; .Conflict of interest: Dr. Muir reports other from Boehringer Ingelheim, during the conduct of the study; .Conflict of interest: Dr. Martinat reports other from Boehringer Ingelheim, during the conduct of the study; .Conflict of interest: Dr. Terrioux reports other from Boehringer Ingelheim, during the conduct of the study; personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from GSK, personal fees from Menarini, personal fees from Novartis, personal fees from Vitalaire, personal fees from Zambon, outside the submitted work; .Conflict of interest: Dr. Housset reports other from Boehringer Ingelheim, during the conduct of the study; personal fees from Chiesi, personal fees from GSK, personal fees from Novartis, personal fees from Boehringer Ingelheim, personal fees from Menarini, personal fees from Astra-Zeneca, outside the submitted work; .