Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense?

Abstract

Introduction: The rising disease burden from chronic obstructive pulmonary disease (COPD) requires new approaches.

Method: We suggest an approach based around three elements: inflammometry and multidimensional assessment to identify therapeutic targets and case management to design and implement an individualised treatment programme based on these assessments.

Discussion: This tailored approach to treatment would maximise efficacy, limit cost and permit a better risk-benefit ratio of treatment. The advantages include the ability to add up the benefits of individual therapies leading to a cumulative therapeutic benefit that is greater than each individual therapy alone. We can now design a multifaceted inflammometry intervention for airway diseases based on targeting eosinophilic inflammation, non-eosinophilic pathways and systemic inflammation. COPD is a complex and challenging disease. The use of inflammometry and multidimensional assessment is necessary to identify relevant treatment targets and maximise the scope of therapy while limiting unnecessary use of drugs. An individualised programme of management can be designed and coordinated by using a case manager. This new approach may provide tangible benefits to people with COPD.

Keywords: COPD Pharmacology; Systemic disease and lungs.

Figure 1

Biomarkers of inflammation in the group receiving treatment tailored to inflammation using the inflammation treatment algorithm. (A) Health status measured by St George's Respiratory Questionnaire (SGRQ) improved significantly (lower score) in the intervention group and worsened in the control group, as measured at 3 months. (B) In the group within multidimensional assessment, airway inflammometry and individualised management (MDAIM) that received oral corticosteroids (OCS) sputum eosinophils (%) had normalised post intervention. The solid line represents the upper limit of normal for sputum eosinophils. (C) In the group within MDAIM that received antibiotics as anti-inflammatory agents sputum neutrophils (%) had normalised post intervention. The solid line represents the upper limit of normal for sputum neutrophils. (D) In the group within MDAIM that received statins for systemic inflammation there was a statically significant reduction in serum high-sensitivity C-reactive protein (hs-CRP). The solid line represents the upper limit of normal of hs-CRP.

Figure 2

Venn diagram showing the prevalence of different inflammatory processes in chronic obstructive pulmonary disease. This figure is only reproduced in colour in the online version.