Individual trajectory-based care for COPD: getting closer, but not there yet

Area of Science:

• Pulmonology
• Precision Medicine
• Pharmacotherapy

Background:

• Chronic obstructive pulmonary disease (COPD) is a significant cause of mortality, influenced by comorbidities.
• Current COPD management emphasizes symptom-based and health status-driven approaches, acknowledging patient heterogeneity.
• A precision medicine strategy is crucial for effective COPD treatment.

Purpose of the Study:

• To highlight the importance of personalized management in COPD.
• To emphasize regular assessment of patient status, treatment efficacy, and risk-benefit profiles.
• To guide therapy adjustments based on evolving patient phenotypes and treatable traits.

Main Methods:

• Systematic investigation of factors interfering with treatment efficacy, such as non-adherence, inhaler misuse, and comorbidities.
• Regular assessment of inhaled corticosteroid benefits versus risks, considering de-escalation.
• Evaluation of patient characteristics defining phenotypes and treatable traits over time.

Main Results:

• Comorbidities significantly impact COPD symptoms, physical activity, and lung function.
• Over-prescription of inhaled corticosteroids necessitates benefit-risk assessment and potential de-escalation.
• The relevance of routine blood eosinophil counts for therapy adjustment remains unclear.

Conclusions:

• COPD management should adopt a precision medicine approach, considering individual patient trajectories.
• Regularly reviewing the benefit:risk ratio is essential for optimizing therapy adjustments.
• Personalized management based on evolving patient traits improves COPD outcomes.