Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma–COPD Overlap

Alcázar‐Navarrete, Bernardino; Miñán, Francisca Castellano; Díaz, Pilar; Rodríguez, Oliverio Ruiz; Palacios, Pedro Romero

doi:10.1016/j.arbr.2018.06.007

Cited by 10 publications

(7 citation statements)

References 33 publications

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“…Although it is possible that blood eosinophil counts may help clinicians estimate the likelihood of a beneficial preventive response to ICS, there is insufficient evidence to recommend that blood eosinophils should be used to predict future exacerbation risk on an individual basis in COPD patients [56]. Rather, different approaches have been proposed to wisely use blood eosinophils count for treatment selection including the clinical context [57], the persistence over time [58] or the combination with exhaled biomarkers [59,60]. Third, since the definition is not settled, there are no clinical trials that have evaluated the efficacy and safety of COPD and asthma-related therapies [61].…”

Section: Will We Be Able To Solve the Asthma-copd Overlap Dilemma?mentioning

confidence: 99%

Ten Research Questions for Improving COPD Care in the Next Decade

Lόpez-Campos

Rodríguez

Quintana‐Gallego

et al. 2019

COPD: Journal of Chronic Obstructive Pulmonary Disease

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With the 60th anniversary of the CIBA symposium, it is worth evaluating research questions that should be prioritized in the future. Coming research initiatives can be summarized in main areas. 1. From epidemiology the impact of new forms of electronic cigarettes on prevalence and mortality of COPD will be sought. 2. The study of the disease endotypes and its relationship phenotypes will have to be unraveled in the next decade. 3. Diagnosis of COPD faces several challenges opening the possibility of a change in the definition of the disease itself. 4. Patients' classification and risk stratification will need to be clarified and reassessed. 5. The asthma-COPD overlap dilemma will have to be clarified and define whether both conditions represent one only chronic airway disease again. 6. Integrating comorbidities in COPD care will be key in a progressively ageing population to improve clinical care in a chronic care model. 7. Non-pharmacological management have areas for research including pulmonary rehabilitation and vaccines. 8. Improving physical activity should focus research because of the clear prognostic impact. 9. Pharmacological therapies present several challenges including efficacy and safety issues with current medications and the development of biological therapy. 10. The definition, identification, categorization and specific therapy of exacerbations will also be an area of research development.During the next decade we have a window of opportunity to address these research questions that will put us on the path for precision medicine.

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Section: Will We Be Able To Solve the Asthma-copd Overlap Dilemma?mentioning

confidence: 99%

Ten Research Questions for Improving COPD Care in the Next Decade

Lόpez-Campos

Rodríguez

Quintana‐Gallego

et al. 2019

COPD: Journal of Chronic Obstructive Pulmonary Disease

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“…Allerdings ist die Zahl der Eosinophilen im Blut nicht spezifisch, da sie eine schwache Korrelation mit der eosinophilen Entzündung aufweist und die Eosinophilie bei COPD-Patienten andere Ursachen haben kann [31, 32, 33]. Es wurden verschiedene Ansätze vorgeschlagen, denen zufolge sich die Eosinophilenzahl im Blut sinnvoller für die Auswahl der Behandlung nutzen lässt, indem der klinische Kontext [34], die Persistenz im Zeitverlauf [35] oder die Kombination mit ausgeatmeten Biomarkern [36, 37] berücksichtigt werden, wodurch die Spezifität steigen und die Akzeptanz in Zukunft zunehmen dürfte.…”

Section: Das Erste Dilemma: Hat Der Patient Eine Copd?unclassified

Einbeziehung von Komorbiditäten und phänotypbasierter Medizin beim patientenzentrierten COPD-Management

et al. 2021

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Trotz der jüngsten bedeutenden Innovationen in der Behandlung der chronisch-obstruktiven Lungenerkrankung (chronic obstructive pulmonary disease, COPD) wurden in der patientenzentrierten Medizin keine wesentlichen Fortschritte erzielt. Die Empfehlungen der aktuellen Leitlinien basieren auf den Durchschnittsergebnissen klinischer Studien, was zur Folge hat, dass die medizinische Praxis als «mittelwertbasiert» bezeichnet werden kann. Auf der Patientenebene ist das therapeutische Ansprechen jedoch variabel. Zudem führt die Variabilität des klinischen Bildes im Wechselspiel mit den Komorbiditäten dazu, dass ein komplexes klinisches Szenario entsteht, mit dem die Ärzte umgehen müssen. Aus diesem Grund gibt es bislang keinen Konsens über einen praktischen Ansatz bei der Kombination von Komorbiditäten und Markern des klinischen Bildes im Therapie-Algorithmus. Diesbezüglich steht der Arzt ab dem ersten Patientenbesuch vor vier wichtigen Dilemmata: 1. Stellung der korrekten Diagnose «COPD» in Abgrenzung zu anderen Atemwegserkrankungen wie etwa Bronchialasthma; 2. Festlegung des initialen Therapieansatzes auf Grundlage der klinischen Merkmale des jeweiligen Falles; 3. Festlegung der diagnostischen Strategie für Patienten, die nicht auf die Therapie ansprechen; 4. Festlegung einer Strategie für die Verlaufskontrolle mit zwei genau definierten Zeiträumen, je nachdem, ob eine engmaschige oder eine langfristige Verlaufskontrolle erforderlich ist. Die vorliegende Arbeit geht auf die Hauptdilemmata bei der Suche nach einem patientenzentrierten Ansatz für das COPD-Management ein und liefert Vorschläge, wie diese alle in einer einzigen, einfach anwendbaren Strategie kombiniert werden können.

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“…Despite the fact that this is widely used clinically, there is ongoing controversy as to whether adjusting treatment on the basis of its values improves asthma control, and neither is there a well-established cut-off point separating what is normal from pathological; consequently, a recent review in the Cochrane database advises against this indication (except, perhaps, in patients with frequent exacerbations). 69 In COPD, something similar happens: its persistent high levels seem to be associated to a greater risk of exacerbation of COPD, 70 , 71 but a therapeutic strategy based on this biomarker has not yet been demonstrated to have an impact on clinical results, and neither has the best cut-off points been established as yet.…”

Section: Therapeutic Goals and Treatable Traits In Cadmentioning

confidence: 99%

<p>A Proposed Approach to Chronic Airway Disease (CAD) Using Therapeutic Goals and Treatable Traits: A Look to the Future</p>

Llano¹,

Miravitlles²,

Golpe³

et al. 2020

COPD

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Chronic airflow obstruction affects a wide range of airway diseases, the most frequent of which are asthma, COPD, and bronchiectasis; they are clearly identifiable in their extremes, but quite frequently overlap in some of their pathophysiological and clinical characteristics. This has generated the description of new mixed or overlapping disease phenotypes with no clear biological grounds. In this special article, a group of experts provides their perspective and proposes approaching the treatment of chronic airway disease (CAD) through the identification of a series of therapeutic goals (TG) linked to treatable traits (TT)-understood as clinical, physiological, or biological characteristics that are quantifiable using biomarkers. This therapeutic approach needs validating in a clinical trial with the strategy of identification of TG and treatment according to TT for each patient independently of their prior diagnosis.

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Alveolar and Bronchial Nitric Oxide in Chronic Obstructive Pulmonary Disease and Asthma–COPD Overlap

Cited by 10 publications

References 33 publications

Ten Research Questions for Improving COPD Care in the Next Decade

Ten Research Questions for Improving COPD Care in the Next Decade

Einbeziehung von Komorbiditäten und phänotypbasierter Medizin beim patientenzentrierten COPD-Management

<p>A Proposed Approach to Chronic Airway Disease (CAD) Using Therapeutic Goals and Treatable Traits: A Look to the Future</p>

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