Personalized medicine for patients with COPD: where are we?

Int J Chron Obstruct Pulmon Dis

Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany.

Published: February 2020

AI Article Synopsis

  • Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation, but predicting individual patient outcomes based solely on lung function is challenging, and therapy guidance is limited.
  • Recent advancements in understanding the diverse influences on COPD patient experiences have led to more personalized diagnostic and treatment approaches, considering both lung function and related health factors.
  • Despite progress, effectively predicting disease progression and response to treatment remains difficult, highlighting the need for a comprehensive management strategy that incorporates predictive, preventive, personalized, and participatory (P4) principles and a systems medicine approach.

Article Abstract

Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro)biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636434PMC
http://dx.doi.org/10.2147/COPD.S175706DOI Listing

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