title: Current Controversies in the Pharmacological Treatment of Chronic Obstructive Pulmonary Disease.
abstract: Clinical phenotyping is currently used to guide pharmacological treatment decisions in chronic obstructive pulmonary disease (COPD), a personalized approach to care. Precision medicine integrates biological (endotype) and clinical (phenotype) information for a more individualized approach to pharmacotherapy, to maximize the benefit versus risk ratio. Biomarkers can be used to identify endotypes. To evolve toward precision medicine in COPD, the most appropriate biomarkers and clinical characteristics that reliably predict treatment responses need to be identified. FEV1 is a marker of COPD severity and has historically been used to guide pharmacotherapy choices. However, we now understand that the trajectory of FEV1 change, as an indicator of disease activity, is more important than a single FEV1 measurement. There is a need to develop biomarkers of disease activity to enable a more targeted and individualized approach to pharmacotherapy. Recent clinical trials testing commonly used COPD treatments have provided new information that is likely to influence pharmacological treatment decisions both at initial presentation and at follow up. In this Perspective, we consider the impact of recent clinical trials on current COPD treatment recommendations. We also focus on the movement toward precision medicine and propose how this field needs to evolve in terms of using clinical characteristics and biomarkers to identify the most appropriate patients for a given pharmacological treatment.
authors: 1 Centre for Respiratory Medicine and Allergy, Medicines Evaluation Unit, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom.
authors: Dave
authors: 0000-0001-8918-7075
authors: D
authors: Singh
authors: 2 Cochin Hospital Group, Assistance Publique Hôpitaux de Paris, University Paris Descartes, Paris, France.
authors: Nicolas
authors: N
authors: Roche
authors: 3 University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, United Kingdom.
authors: David
authors: D
authors: Halpin
authors: 4 Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de investigación en Red de Enfermedades Respiratorias, Barcelona, Spain.
authors: Alvar
authors: A
authors: Agusti
authors: 5 Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
authors: Jadwiga A
authors: JA
authors: Wedzicha
authors: 6 Weill Cornell Medical College, New York, New York; and.|7 University of Michigan Health System, Ann Arbor, Michigan.
authors: Fernando J
authors: FJ
authors: Martinez
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005340:Fibrinogen / Q000032:analysis*; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D010641:Phenotype; D057285:Precision Medicine / Q000379:methods / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D015415:Biomarkers; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D005340:Fibrinogen
keywords: biomarkers; chronic obstructive pulmonary disease; endotype; phenotype