Precision medicine in COPD: where are we and where do we need to go?

Abstract

Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death worldwide in 2015. Current treatments for patients ease discomfort and help decrease disease progression; however, none improve lung function or change mortality. COPD is heterogeneous in its molecular and clinical presentation, making it difficult to understand disease aetiology and define robust therapeutic strategies. Given the complexity of the disease we propose a precision medicine approach to understanding and better treating COPD. It is possible that multiOMICs can be used as a tool to integrate data from multiple fields. Moreover, analysis of electronic medical records could aid in the treatment of patients and in the predictions of outcomes. The Precision Medicine Initiative created in 2015 has made precision medicine approaches to treat disease a reality; one of these diseases being COPD.

FIGURE 1

Diagram of the interrelationships between the exposome (the totality of human environmental exposures, from conception onwards), genome (the genetic background of the individual), the endotype (biological networks that enable and restrict reactions) and the clinical phenotype (final clinical expression of the disease, e.g. symptoms, exacerbations, response to treatment, rate of disease progression or death). Reproduced from [6] with permission from the publisher.

FIGURE 2

Benefit–risk balance and its individual determinants with personalised chronic obstructive pulmonary disease (COPD) treatment choices. When a clinician is deciding which pharmacological treatment options to prescribe to a patient, they have to consider expected benefits (determined by individual presentation and underlying mechanisms of disease) and possible risks (which depend on individual risk factors and comorbidities). LABA: long-acting β₂ agonists; LAMA: long-acting muscarinic antagonists; ICS: inhaled corticosteroids. Reproduced from [6] with permission from the publisher.

FIGURE 3

Interventional bronchoscopic and surgical treatments for chronic obstructive pulmonary disease (COPD). Overview of therapeutic algorithm used to treat patients with COPD and emphysema. BLVR: bronchoscopic lung volume reduction; LVRS: lung volume reduction surgery; EBV: endobronchial valve; LVRC: lung volume reduction coil. Reproduced from [38] with permission from the publisher.

FIGURE 4

Flow chart of chronic obstructive pulmonary disease (COPD) therapy as a function of risk and clinical phenotype. ICS: inhaled corticosteroids; LABA: long-acting β₂ agonist; LAMA: long-acting muscarinic antagonist. ^#: treatments presented in order of suggested preference. Reproduced from [40] with permission from the publisher.

FIGURE 5

Integrated electronic health records (EHR), clinical, multiOMICs analysis to guide basic mechanisms and identify new treatment options for patients with chronic obstructive pulmonary disease. FDA: US Food and Drug Administration.