Allergy Asthma Respir Dis.  2018 May;6(3):141-148. 10.4168/aard.2018.6.3.141.

Precision medicine for the best treatment of chronic obstructive airway disease

• Cho YS

• KMID: 2412516
• DOI: http://doi.org/10.4168/aard.2018.6.3.141

Abstract

Bronchial asthma and chronic obstructive pulmonary disease (COPD) are 2 representative diseases of chronic obstructive inflammatory airway diseases, and both show a wide range of heterogeneity in their clinical features. Although one end of typical asthma and the other end of COPD are clearly different, both diseases share lots of similarities in biological aspects and clinical manifestations. Currently, 2 different guidelines exist for asthma and COPD management, respectively, and in many clinical situations it is not easy to manage patients especially who have both features and show refractoriness to available medications. Since the features of the diseases are remarkably diverse in terms of clinical courses, prognosis and responses to therapeutic drugs, there have been vigorous efforts to classify appropriate subtypes in order to improve management of the diseases. However, dichotomous thinking about asthma and COPD precludes precise classification of the diseases in the real world. In this article, thus, chronic obstructive airway disease (COAD) ranging from asthma particularly in adults to COPD is proposed as 1 target subject to analyze precise classification based on exact phenotyping and endotyping of the diseases. In the current article, the reasonable precision medicine approach is also suggested based on treatable traits of COAD to achieve the best treatment for COAD patients.

Keyword

Chronic obstructive airway disease; Asthma; Chronic obstructive pulmonary disease; Precision medicine; Treatable traits

MeSH Terms

Adult
Asthma
Classification
Humans
Population Characteristics
Precision Medicine*
Prognosis
Pulmonary Disease, Chronic Obstructive*
Thinking

Figure

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  Fig. 1. This figure shows stepwise approach for asthma treatment based on 2017 Global Initiative for Asthma guideline. ICS, inhaled corticosteroid; SABA, short acting beta-agonist; LTRA, leukotriene receptor antagonist; LABA, long acting beta-agonist; tio, tiotropium; oma, omalizumab; mepo, mepollizumab; theoph, thepophyl-line. Adapted from the Global Initiative for Asthma.1

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  Fig. 2. This figure shows classification of chronic obstructive pulmonary disease (COPD) according to 2017 Global Initiative for Chronic Obstructive Lung Disease guideline for COPD. CAT, COPD assessment tool; mMRC, modified medical research council questionnaire. Adapted from Global Initiative for Chronic Obstructive Lung Disease.10

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  Fig. 3. This figure shows pharmacologic treatment algorithms by Global Initiative for Chronic Obstructive Lung Disease grade. ICS, inhaled corticosteroid; LABA, long acting beta-agonist; LAMA, long acting muscarinic receptor antagonist; FEV1, forced expiratory volume in 1 second. Adapted from Global Initiative for Chronic Obstructive Lung Disease.10

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  Fig. 4. This figure suggests treatable traits and precision medicine. COPD, chronic obstructive pulmonary disease; COAD, chronic obstructive airway disease.

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