Nicola Hanania, MD: Precision Medicine in Pulmonology

While precision medicine is gaining momentum across the medical spectrum, its use and application in the field of pulmonology may be especially helpful, such as in airway diseases like asthma, chronic obstructive pulmonary disease (COPD), asthma-COPD overlap (ACO), and emphysema.

Nicola Hanania, MD, MS, director of the Airways Clinical Research Center at Baylor College of Medicine, spoke with MD Magazine^® at the 2018 CHEST Annual Meeting in San Antonio, TX,

and described what the landscape of precision medicine looks like in pulmonology, including tools that are needed and the potential benefit they could provide.

MD Mag: What is the landscape of precision medicine in pulmonology?

Hanania: Precision medicine, obviously, is the way to go. It will help us pick the right treatment based on the patient’s genetic, environmental, pharmacogenetic buildup, and the type of disease they have. For many years, we thought asthma and COPD are just, both of which, constitute a one-size-fit-all type of disease, but that’s not the case.

To better understand how 1 drug would work best in 1 patient compared to another, we really need to know mechanisms or endotypes. We are still at the seashore; we don’t have all the tools to do so—tools meaning biomarkers.

In asthma, we have few biomarkers that help us—blood eosinophils, sputum eosinophils, exhaled nitric oxide may be a good predictor as a biomarker, and serum IgE can help is identify the allergic phenotype.

In COPD, we actually are much further behind. Currently, maybe blood eosinophils can help us identify those inhaled steroid responders. We have some radiologic biomarkers in COPD. They’re still in the research arena, but they may also help us better identify some patients who may respond best to certain treatments.

The emphysema studies—such as the valve studies—may also help us identify those who are the best responders to this type of treatment as not every emphysema patient will respond.

We’re still a ways before we say we concluded all our work, but this is something we are striving to achieve besides therapies for these patients. We need the tools to develop, and we certainly need the studies to help us reach that goal.

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