COPD: Precision Medicine Breaks Old Rules

Tailoring treatment of patients with breathing problems to rigid protocols for treating chronic obstructive pulmonary disease or asthma is an outmoded approach, an international group of researchers conclude in an essay in the European Respiratory Journal.

Instead, precision medicine and new technology offer a more individualized approach. That change is based on evaluation of the underlying traits and causal, mechanistic pathways of each person’s lung impairment. Newer tools -- CT scanning, identifying cellular and molecular markers and microbiome analysis and others -- allow more pinpointed treatment than the use of just symptomatic assessments, such as lung function measurements and airway hyper-responsiveness, they said.

“The limitations of the umbrella terms asthma and COPD, and the assumptions that are made when these terms are applied, are increasingly apparent,” wrote lead author Alvar Agusti MD, “Here, we proposed a precision-medicine strategy for chronic airway diseases in general, and asthma and COPD in particular, that is based on the presence of what we call ‘treatable traits.”

Agusti works at the Respiratory Institute, Hospital Clinic, IDIBAPS at the University of Barcelona in Spain.

As examples of “treatable traits”, the authors listed airway smooth muscle contraction, lost of elastic recoil, and airway mucosal edema among others. A focus on reliable biomarkers for a trait such eosinophilic fairway inflammation, for example, could “provide a better perspective on risk and the likely response to treatment with corticosteroids,” Agusti wrote.

Additional benefits of paying attention to biomarkers include more effective and economical use of current treatments and the possible development of new drugs for lung diseases, they suggested.

“Progress in new drug discovery has been slower in airway disease than other specialty areas,” the paper said. “Although several explanations are possible, the most important factors are outmoded disease concepts and poor targeting of treatment.”

This precision medicine approach also is needed because of the lack of progress in treating asthma and COPD, the authors said.

For example, they noted an increased hospitalization rate for patients with COPD and the continuation of significant symptoms and life impairment for the majority of treated asthma patients.

The study also argued that when traditional diagnostic categories drive treatment they do not take into account new genetic, molecular or imaging information. Also, they do not work as well for non-stereotypic cases of asthma and COPD. These non-sterotypical cases include adult-onset asthma, asthma-COPD overlap syndrome, smoking asthmatics, or asthmatics with fixed airflow limitations.