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
VO 7
IS 4
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/7/4/00451-2021.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 the 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 investigated before escalation is considered. Several comorbidities are known to impact symptoms, physical and social activity and lung function. The possible long-term side-effects 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 clear. 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 optimised therapy adjustments.In the current era of precision medicine, COPD management needs to be regularly adjusted based on the patient's personal clinical trajectory, i.e. the evolution of their treatable traits over time. https://bit.ly/3kxVgC7