TY - JOUR
T1 - Personalized medicine for patients with COPD
T2 - where are we?
AU - Franssen, Frits M. E.
AU - Alter, Peter
AU - Bar, Nadav
AU - Benedikter, Birke J.
AU - Iurato, Stella
AU - Maier, Dieter
AU - Maxheim, Michael
AU - Roessler, Fabienne K.
AU - Spruit, Martijn A.
AU - Vogelmeier, Claus F.
AU - Wouters, Emiel F. M.
AU - Schmeck, Bernd
AU - SysMed-COPD consortium
N1 - Funding Information:
We would like to apologize to all colleagues whose excellent contributions to the field of personalized COPD medicine could not be included in this text due to space constraints. Part of this work has been funded by German Ministry for Education and Research (BMBF) (ERACoSysMed2 SysMed-COPD-FKZ 031L0140, JPIAMR Pneumo-AMR-Protect-FKZ 01KI1702, e:Med CAPSYS-FKZ 01X1304E/ 01ZX1304F) to BS and by a Kootstra Talent Fellowship from the Center for Research Innovation, Support and Policy (CRISP) of Maastricht University Medical Center + to BJB. ZonMW (ERACoSysMed
Funding Information:
90030355) funded the Dutch consortium partners to FMEF and EFMW. Austrian Science Fund FWF (ERACoSysMed I 3736-B30) funded the Austrian consortium partner SI. NB and FKR were funded by the Norwegian Research Council grant number 284045.
Funding Information:
We would like to apologize to all colleagues whose excellent contributions to the field of personalized COPD medicine could not be included in this text due to space constraints. Part of this work has been funded by German Ministry for Education and Research (BMBF) (ERACoSysMed2 SysMed-COPD-FKZ 031L0140, JPIAMR Pneumo-AMR-Protect-FKZ 01KI1702, e:Med CAPSYS-FKZ 01X1304E/ 01ZX1304F) to BS and by a Kootstra Talent Fellowship from the Center for Research Innovation, Support and Policy (CRISP) of Maastricht University Medical Center + to BJB. ZonMW (ERACoSysMed 90030355) funded the Dutch consortium partners to FMEF and EFMW. Austrian Science Fund FWF (ERACoSysMed I 3736-B30) funded the Austrian consortium partner SI. NB and FKR were funded by the Norwegian Research Council grant number 284045.
Publisher Copyright:
© 2019 Franssen et al.
PY - 2019
Y1 - 2019
N2 - Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro) biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.
AB - Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro) biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.
KW - chronic obstructive pulmonary disease
KW - personalized medicine
KW - systems medicine
KW - review
KW - CHRONIC OBSTRUCTIVE PULMONARY
KW - FORCED OSCILLATION MEASUREMENTS
KW - MACHINE LEARNING ALGORITHMS
KW - DECISION-SUPPORT-SYSTEMS
KW - LUNG-FUNCTION
KW - PHYSICAL-ACTIVITY
KW - ACUTE EXACERBATIONS
KW - AIRWAY-OBSTRUCTION
KW - QUANTITATIVE-ANALYSIS
KW - PRECISION MEDICINE
U2 - 10.2147/COPD.S175706
DO - 10.2147/COPD.S175706
M3 - (Systematic) Review article
C2 - 31371934
SN - 1178-2005
VL - 14
SP - 1465
EP - 1484
JO - International journal of chronic obstructive pulmonary disease
JF - International journal of chronic obstructive pulmonary disease
ER -