title: Understanding COPD: A vision on phenotypes, comorbidities and treatment approach.
abstract: Chronic Obstructive Pulmonary Disease (COPD) phenotypes have become increasingly recognized as important for grouping patients with similar presentation and/or behavior, within the heterogeneity of the disease. The primary aim of identifying phenotypes is to provide patients with the best health care possible, tailoring the therapeutic approach to each patient. However, the identification of specific phenotypes has been hindered by several factors such as which specific attributes are relevant, which discriminant features should be used for assigning patients to specific phenotypes, and how relevant are they to the therapeutic approach, prognostic and clinical outcome. Moreover, the definition of phenotype is still not consensual. Comorbidities, risk factors, modifiable risk factors and disease severity, although not phenotypes, have impact across all COPD phenotypes. Although there are some identified phenotypes that are fairly consensual, many others have been proposed, but currently lack validation. The on-going debate about which instruments and tests should be used in the identification and definition of phenotypes has contributed to this uncertainty. In this paper, the authors review present knowledge regarding COPD phenotyping, discuss the role of phenotypes and comorbidities on the severity of COPD, propose new phenotypes and suggest a phenotype-based pharmacological therapeutic approach. The authors conclude that a patient-tailored treatment approach, which takes into account each patient's specific attributes and specificities, should be pursued.
authors.affiliation: Pulmonology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE (CHLN), Lisbon, Portugal. Electronic address: elsagcfragoso@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Fragoso
authors.affiliation: Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, EPE(CHLO), Lisbon, Portugal. Electronic address: sandra.andre@sapo.pt.
authors.forename: S
authors.initials: S
authors.lastname: André
authors.affiliation: Pulmonology Department, Hospital Prof. Doutor Fernando da Fonseca, EPE, Amadora, Portugal. Electronic address: jpboleotome@gmail.com.
authors.forename: J P
authors.initials: JP
authors.lastname: Boleo-Tomé
authors.affiliation: Pulmonology Department, Hospital de Faro, Centro Hospitalar do Algarve, EPE, Faro, Portugal; Department of Biomedical Sciences and Medicine, Algarve University, Portugal. Electronic address: vandareias@hotmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Areias
authors.affiliation: Pulmonology Department, Centro Hospitalar do Barlavento Algarvio, EPE, Portimão, Portugal. Electronic address: joao.munha@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Munhá
authors.affiliation: Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE (CHLC), Lisbon, Portugal; Nova Medical School, Nova University, Lisbon, Portugal. Electronic address: joaocardoso@meo.pt.
authors.forename: J
authors.initials: J
authors.lastname: Cardoso
mesh_terms: D006801:Humans; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000235:genetics / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: COPD; Comorbidities; Exacerbations; Modifiable risk factors; Phenotypes; Risk factors; Severity; Symptoms