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
Randomized Controlled Trial
. 2023 Sep 8:18:1959-1964.
doi: 10.2147/COPD.S428391. eCollection 2023.

Can Treatable Traits Be the Approach to Addressing the Complexity and Heterogeneity of COPD?

Mario Cazzola  1 , Paola Rogliani  1 , Francesco Blasi  2   3
Affiliations
Randomized Controlled Trial

Can Treatable Traits Be the Approach to Addressing the Complexity and Heterogeneity of COPD?

Mario Cazzola et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

The complexity of COPD implies the need to identify groups of patients with similar clinical characteristics and prognosis or treatment requirements. This is why much attention has been paid to identifying the different clinical phenotypes by investigating the clinical expression of the disease, and endotypes by studying the biological networks that enable and limit reactions. However, this approach is complicated because one endotype gives rise to one or more clinical characteristics, and clinical phenotypes can be derived from several endotypes. To simplify the approach, a new taxonomic classification of COPD based on the different causes (or etiotypes) has been proposed, but these etiotypes have not yet been validated. A simpler method is the so-called tractable traits approach, which is free from any designation of the disorder to be treated and does not present the criticality of using etiotypes. A large randomised controlled trial on using the treatable traits approach in COPD is still lacking. Nevertheless, this approach is already applied by following the GOLD strategy. However, its application is complicated because several potentially treatable traits have been identified within the pulmonary domain, the extrapulmonary domain, and the behavioural/risk factor domain. In addition, the hierarchy of the dominant treatable traits has not yet been established, and they change over time both spontaneously and because of treatment. This means that the patients being treated according to the tractable traits approach must be constantly followed over time so that the therapy is focused on their temporal needs.

Keywords: chronic obstructive pulmonary disease; endotypes; etiotypes; phenotypes; treatable traits.

PubMed Disclaimer

Conflict of interest statement

MC participated as a faculty member and advisor in scientific meetings and courses under the sponsorship of Abdi Ibrahim, Alkem, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Cipla, Edmond Pharma, GlaxoSmithKline, Glenmark, Lallemand, Mankind Pharma, Menarini Group, Mundipharma, Novartis, Pfizer, Recipharm, Sanofi, Teva, Verona Pharma, and Zambon. He is or was a consultant to ABC Farmaceutici, AstraZeneca, Chiesi Farmaceutici, Edmond Pharma, GlaxoSmithKline, Lallemand, Novartis, Ockham Biotec, Recipharm, Verona Pharma, and Zambon. PR participated as a lecturer and advisor in scientific meetings and courses under the sponsorship of AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Novartis and Recipharm, outside the submitted work. She also reports that her department was funded by Boehringer Ingelheim, Chiesi Farmaceutici, Novartis, and Zambon. FB reports grants and/or personal fees from AstraZeneca, Chiesi, GSK, Grifols, Insmed, Menarini, OM pharma, Pfizer, Sanofi, Vertex, Viatris, and Zambon outside the submitted work. The authors declare no other conflicts of interest in this work.

References

    1. Barrecheguren M, Miravitlles M. COPD heterogeneity: implications for management. Multidiscip Respir Med. 2016;11:14. doi: 10.1186/s40248-016-0053-4 - DOI - PMC - PubMed
    1. The Lancet. Complexities of care in COPD. Lancet. 2017;389(10069):574. doi: 10.1016/S0140-6736(17)30327-6 - DOI - PubMed
    1. Agusti A. The path to personalised medicine in COPD. Thorax. 2014;69(9):857–864. doi: 10.1136/thoraxjnl-2014-205507 - DOI - PubMed
    1. Woodruff PG, Agusti A, Roche N, Singh D, Martinez FJ. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. Lancet. 2015;385(9979):1789–1798. doi: 10.1016/S0140-6736(15)60693-6 - DOI - PMC - PubMed
    1. Castaldi PJ, Benet M, Petersen H, et al. Do COPD subtypes really exist? COPD heterogeneity and clustering in 10 independent cohorts. Thorax. 2017;72(11):998–1006. doi: 10.1136/thoraxjnl-2016-209846 - DOI - PMC - PubMed

Publication types

MeSH terms