Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Sep 21;6(3):00322-2019.
doi: 10.1183/23120541.00322-2019. eCollection 2020 Jul.

Treatment of severe stable COPD: the multidimensional approach of treatable traits

Marlies van Dijk  1   2 , Christiaan T Gan  1   2 , T David Koster  1   2 , Peter J Wijkstra  1   2 , Dirk-Jan Slebos  1   2 , Huib A M Kerstjens  1   2 , Hester van der Vaart  1   2   3 , Marieke L Duiverman  1   2
Affiliations
Review

Treatment of severe stable COPD: the multidimensional approach of treatable traits

Marlies van Dijk et al. ERJ Open Res. .

Abstract

Now that additional treatment options for severe chronic obstructive pulmonary disease (COPD) have emerged in recent years, patients with severe COPD should not be left in the rather hopeless situation of "there is nothing to improve" any more. Inertia or fatalism is a disservice to our patients. Ranging from advanced care planning to quite intense and demanding therapies such as multidisciplinary pulmonary rehabilitation, (endoscopic) lung volume reduction, chronic noninvasive ventilation and lung transplantation, caregivers should try to provide a personalised treatment for every severe COPD patient. In this review, we aim to describe the multidimensional approach to these patients at our centre along the lines of treatable traits leading to specific additional treatment modalities on top of standard care.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: M. van Dijk has nothing to disclose. Conflict of interest: C.T. Gan has nothing to disclose. Conflict of interest: T.D. Koster has nothing to disclose. Conflict of interest: P.J. Wijkstra reports grants and personal fees from Phillips; grants, personal fees and other from RESMED; grants from Vitalair; grants from VIVISOL; grants from Goedegebuure; personal fees from Synapse; and personal fees from Bresotec, all outside the submitted work. Conflict of interest: D-J. Slebos reports grants, nonfinancial support and other from PulmonX, CA, USA; grants and nonfinancial support from PneumRx/BTG, CA, USA; grants and nonfinancial support from Nuvaira, MN, USA; and nonfinancial support and other from CSA Medical, MA, USA, all outside the submitted work. Conflict of interest: H.A.M. Kerstjens has nothing to disclose. Conflict of interest: H. van der Vaart has nothing to disclose. Conflict of interest: M.L. Duiverman reports research grants and speaking fees from Philips BV, RESMED Ltd and Vivisol BV, and a research grant from Fisher and Paykel Ltd, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Overview of treatable traits in advanced COPD with possible treatment options. AATD: α1 antitrypsin deficiency; LVRS: lung volume reduction surgery; LTOT: long-term oxygen therapy; LTx: lung transplantation; NIV: noninvasive ventilation; ICS: inhaled corticosteroids.
FIGURE 2
FIGURE 2
HRCT scan showing severe emphysema predominantly in the lower lobes and moderate central and peripheral bronchopathy with mucus plugging. Both major fissures appear to be complete.
See this image and copyright information in PMC

References

    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD, 2018 https://goldcopd.org - PubMed
    1. Agusti A, Bel E, Thomas M, et al. . Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J 2016; 47: 410–419. doi:10.1183/13993003.01359-2015 - DOI - PubMed
    1. Agusti A, Celli B, Faner R. What does endotyping mean for treatment in chronic obstructive pulmonary disease? Lancet 2017; 390: 980–987. doi:10.1016/S0140-6736(17)32136-0 - DOI - PubMed
    1. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med 2019; 381: 1257–1266. doi:10.1056/NEJMra1900500 - DOI - PubMed
    1. McDonald VM, Fingleton J, Agusti A, et al. . Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report. Eur Respir J 2019; 53: 1802058. doi:10.1183/13993003.02058-2018 - DOI - PubMed

LinkOut - more resources