Personalising exacerbation prediction strategies in chronic obstructive pulmonary disease

• 作者: Alice M Turner Paul R Ellis
• 来源期刊: 世界呼吸病学杂志
• 学科: 医学
• 关键词: Chronic obstructive pulmonary disease EXACERBATIONS PHENOTYPES Endotypes Precision medicine Clinical
• 年，卷（期）: 2020,（2）
• 页码范围: 11-16
• 页数: 6页
• 分类号: R56

摘要

Chronic obstructive pulmonary disease(COPD)is one of the leading causes of mortality and morbidity worldwide.One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms episodically worsen.Exacerbations accounted for over 140000 hospital admissions in 2012 in the United Kingdom with considerably more exacerbations being treated in primary care.Despite significant research in this area in recent years,treatment of acute exacerbations in the community remains limited to oral glucocorticoids,antibiotics and bronchodilators.One of the issues with unpicking the complexity of exacerbations is trying to find out the exact underlying cause and mechanism that leads to symptoms and lung destruction.Currently symptoms are initially guided by symptoms alone though multiple causes of exacerbations have common presentations.This includes viral and bacterial infections and episodes relating to environmental triggers such as pollen and pollution.There is also evidence that cardiovascular factors can contribute to symptoms of breathlessness that can mimic COPD exacerbations.In this editorial we discuss recent advances in the use of precision medicine to more accurately treat exacerbations of COPD.This includes identification of phenotypes that could help rationalise treatment and more importantly identify novel drug targets.We also consider the future role of precision medicine in preventing exacerbations and identifying COPD patients that are at increased risk of developing them.