Personalizing COPD care: Phenotypes, endotypes, GETomics, the trajectome, syndemics and treatable traits

Our understanding and management of chronic obstructive pulmonary disease (COPD) has changed significantly over the past few years. We now recognize that COPD is a complex and heterogeneous condition that requires personalized and precise management. Here we review these recent novel concepts, including those of Phenotypes (i.e., the observable characteristics of an individual), Endotypes (i.e., the biologic mechanism(s) underlying a given phenotype), GETomics (i.e., a new paradigm that incorporates of the time axis (age) into our understanding of different gene-environment interactions through the life time), the Trajectome (i.e., the range of potential lung function trajectories that exists in the general population, including normal, low and supra-normal trajectories with different clinical implications), Syndemics (i.e., a term that refers to the fact that most COPD patients suffer of other co-occurrent diseases (multimorbidity) that share mechanisms and risk factors), and Treatable Traits (i.e., specific endo-phenotypes that contribute to the clinical presentation and prognosis of the patient that deserve specific and personalized treatment), and discuss how to best transfer them into clinical practice (e.g. lung tracker). Collectivelly, these concepts have radically changed our understanding of COPD and can facilitate a more personalized and precise clinical management of the patients that suffer such a frequent and impactful disease.