Targeting disease activity to predict and prevent damage in obstructive airway diseases

The discovery of clinically accessible biomarkers that identify patients with obstructive airway disease who are at risk of adverse outcomes, along with the availability of highly effective targeted treatments, has increased interest in earlier targeted intervention and disease modification. In this review, I argue that the time is ripe to move the focus from disease entities that require disease-related damage ("too late disease") to a new framework in which the focus is on the identification of high disease activity ("high-risk disease"). I review the evidence in favor of this approach and identify gaps in this evidence. Finally, I discussed opportunities to operationalize this new approach.