Abstract
Although there has been tremendous growth in our understanding of chronic obstructive pulmonary disease (COPD) and its pathophysiology over the past few decades, the pace of therapeutic innovation has been extremely slow. COPD is now widely accepted as a heterogeneous condition with multiple phenotypes and endotypes. Thus, there is a pressing need for COPD care to move from the current “one-size-fits-all” approach to a precision medicine approach that takes into account individual patient variability in genes, environment and lifestyle. Precision medicine is enabled by biomarkers that can: 1) accurately identify subgroups of patients who are most likely to benefit from therapeutics and those who will only experience harm (predictive biomarkers); 2) predict therapeutic responses to drugs at an individual level (response biomarkers); and 3) segregate patients who are at risk of poor outcomes from those who have relatively stable disease (prognostic biomarkers). In this essay, we will discuss the current concept of precision medicine and its relevance for COPD and explore ways to implement precision medicine for millions of patients across the world with COPD.
Abstract
COPD care needs to take into account individual variation in genes, environment and lifestyle. This review outlines the steps required for COPD care to move out of its “one-size-fits-all” approach to precision medicine. http://ow.ly/9UI830nlNb8
Footnotes
Number 4 in the series “Controversies in COPD: What Can be Done to Move the Field Forward?” Edited by D.D. Sin
Conflict of interest: J.M. Leung has nothing to disclose.
Conflict of interest: M. Obeidat has nothing to disclose.
Conflict of interest: M. Sadatsafavi has nothing to disclose.
Conflict of interest: D.D. Sin reports funding for an investigator-initiated project to ascertain genomic determinants of COPD from Merck, honoraria for advisory meetings on COPD from Sanofi-Aventis and Regeneron, funding for clinical trials and investigator-initiated study of the effects of olodaterol on airway inflammation from Boehringer Ingelheim, funding for clinical trials and honoraria for speaking engagements and sitting on COPD advisory boards from AstraZeneca, and honoraria for speaking engagements and sitting on advisory boards from Novartis, outside the submitted work.
No. 1: Kim V, Aaron SD. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur Respir J 2018; 52: 1801261. No. 2: Washko GR, Parraga G. COPD biomarkers and phenotypes: opportunities for better outcomes with precision imaging. Eur Respir J 2018; 52: 1801570. No. 3: Soriano JB, Polverino F, Cosio BG. What is early COPD and why is it important? Eur Respir J 2018; 52: 1801448.
Support statement: D.D. Sin is a Tier 1 Canada Research Chair in COPD and holds the De Lazzari Family Chair at the Centre for Heart Lung Innovation (HLI). M. Sadatsafavi, M. Obeidat and J.M. Leung are Scholars with the Michael Smith Foundation for Health Research; M. Obeidat is a fellow of the Parker B Francis Foundation; M. Sadatsafavi receives salary support from The Canadian Institutes of Health Research.
- Received December 29, 2018.
- Accepted January 12, 2019.
- Copyright ©ERS 2019
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