COPD exacerbation phenotypes: The next frontier

Moran, Angela; Pavord, Ian D.

doi:10.1111/resp.13693

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…61,[68][69][70] Assessment of blood eosinophil count in combination with exacerbation history can be used to predict responsiveness to ICS, and further markers such as fractional exhaled nitric oxide (FeNO) can indicate that ICS might be beneficial. 68 Physicians should also consider allergic (atopic) asthma as an alternative diagnosis by testing for immunoglobulin E. 71 The JRS guidelines recommend measurement of this type 2 inflammation biomarker to confirm asthma-like features in patients with COPD. 11 In combination with an exacerbation history, a high blood eosinophil count is a predictive biomarker that helps to identify patients who would benefit from ICS treatment.…”

Section: Phenotype 2: Patients Still Exacerbating Despite Laba/lama A...mentioning

confidence: 99%

Stepwise management of COPD: What is next after bronchodilation?

Miravitlles,

Matsunaga,

Dreher

2023

Ther Adv Respir Dis

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Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination is currently the mainstay of treatment for chronic obstructive pulmonary disease (COPD). Treatment guidelines recommend the addition of inhaled corticosteroids (ICS) to LABA/LAMA only in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma. Despite this, real-world data suggest that clinicians are not adhering to this guidance and that ICS are frequently overused. This is possibly due to the incorrect assumption that when LABA/LAMA therapy is not sufficient, adding an ICS to the treatment regimen is the logical next step. In this narrative review, we describe global and country-specific guideline recommendations from Germany, Spain, and Japan and compare these with real-world data on LABA/LAMA and ICS use in clinical practice. We also provide a clinical guide to the use of add-on therapies with LABA/LAMA for different patient phenotypes, including (1) patients still symptomatic (but not exacerbating) despite LABA/LAMA treatment; (2) patients still exacerbating despite LABA/LAMA treatment who have high blood eosinophil counts; and (3) patients still exacerbating despite LABA/LAMA treatment who do not have high blood eosinophils or concomitant asthma.

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Section: Phenotype 2: Patients Still Exacerbating Despite Laba/lama A...mentioning

confidence: 99%

Stepwise management of COPD: What is next after bronchodilation?

Miravitlles,

Matsunaga,

Dreher

2023

Ther Adv Respir Dis

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“…In recent years, ECOPD has been identified as a clinically important phenotype of COPD with distinct clinical features and prognosis. 4 As one of the major phenotypes of COPD, it is associated with the progression of emphysema and irreversible airflow limitation. 5 Moreover, it is the leading cause of COPD-related hospitalisation that results in increased overall morbidity.…”

Section: Introductionmentioning

confidence: 99%

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

Wang,

He,

Dong

et al. 2023

BMJ Open Resp Res

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BackgroundExacerbation of chronic obstructive pulmonary disease (ECOPD) is a complex phenomenon, with marked heterogeneity in the aetiology, pathophysiology and clinical manifestations. This study aimed to evaluate the clinical characteristics and long-term outcomes of patients with 30-day exacerbation among those hospitalised with ECOPD in China.MethodsData from the Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry were used in this study. The patients were divided into re-event and non-event groups based on the incidence of re-exacerbation within 30 days of discharge. Exacerbation, severe exacerbation and all-cause readmissions in the following 12 months were the outcomes of interest. The cumulative incidence rates and incidence densities were calculated. Multivariate hazard function models were used to determine the association between 30-day re-exacerbation and the long-term outcomes after accounting for the competing risk of death.ResultsRe-exacerbation within 30 days of discharge was observed in 4.9% (n=242) of the patients (n=4963). The cumulative incidence rates and incidence densities of exacerbation, severe exacerbation and all-cause readmissions in the event group were significantly higher than those in the non-event group. After adjustment, re-exacerbation within 30 days of discharge was associated with increased risks of exacerbation, severe exacerbation and all-cause readmissions in the following 12 months (adjusted HR: 3.85 (95% CI: 3.09 to 4.80), 3.46 (2.66 to 4.50) and 3.28 (2.52 to 4.25) accordingly).ConclusionRe-exacerbation of COPD within 30 days of discharge is a significant predictor of long-term prognosis. In clinical practice, short-term re-exacerbation is a significant clinical phenotype of ECOPD that requires careful management at the earliest.

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The Current Molecular and Cellular Landscape of Chronic Obstructive Pulmonary Disease (COPD): A Review of Therapies and Efforts towards Personalized Treatment

Farrell,

O’Rourke,

Padula

et al. 2024

Proteomes

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Chronic obstructive pulmonary disease (COPD) ranks as the third leading cause of global illness and mortality. It is commonly triggered by exposure to respiratory irritants like cigarette smoke or biofuel pollutants. This multifaceted condition manifests through an array of symptoms and lung irregularities, characterized by chronic inflammation and reduced lung function. Present therapies primarily rely on maintenance medications to alleviate symptoms, but fall short in impeding disease advancement. COPD’s diverse nature, influenced by various phenotypes, complicates diagnosis, necessitating precise molecular characterization. Omics-driven methodologies, including biomarker identification and therapeutic target exploration, offer a promising avenue for addressing COPD’s complexity. This analysis underscores the critical necessity of improving molecular profiling to deepen our comprehension of COPD and identify potential therapeutic targets. Moreover, it advocates for tailoring treatment strategies to individual phenotypes. Through comprehensive exploration-based molecular characterization and the adoption of personalized methodologies, innovative treatments may emerge that are capable of altering the trajectory of COPD, instilling optimism for efficacious disease-modifying interventions.

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COPD exacerbation phenotypes: The next frontier

Abstract: See related https://onlinelibrary.wiley.com/doi/10.1111/resp.13660

Cited by 3 publications

References 14 publications

Stepwise management of COPD: What is next after bronchodilation?

Stepwise management of COPD: What is next after bronchodilation?

Re-exacerbation within 30 days of discharge is associated with poor prognosis in the following year among patients hospitalised with exacerbation of chronic obstructive pulmonary disease: a clinical cohort study

The Current Molecular and Cellular Landscape of Chronic Obstructive Pulmonary Disease (COPD): A Review of Therapies and Efforts towards Personalized Treatment

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