Treatable Traits in COPD – A Proposed Approach

Cardoso, João; Ferreira, António Jorge; Guimarães, Miguel; Oliveira, Ana Sofia; Simão, Paula; Sucena, Maria

doi:10.2147/copd.s330817

Cited by 28 publications

(31 citation statements)

References 135 publications

(168 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…Therefore, we recommend further investigation of the interface between inpatient and outpatient sectors to improve intersectoral care of patients with newly diagnosed COPD, for example, by implementing more proactive therapeutic approaches to prevent COPD progression to exacerbation as previously described. 24,25 Some of the untreated patients suffered from a very low FEV 1 , indicating a high probability that immediate treatment with maintenance therapies might have been needed and helpful. However, the majority of these patients already needed regular care, demonstrated by a documented level of need for care according to statutory long-term care insurance, and it is probable that a substantial percentage of these patients live in a nursing home or receive regular domestic care.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis

Buhl¹,

Wilke²,

Picker³

et al. 2022

COPD

View full text Add to dashboard Cite

Purpose This study aimed to describe the real-world treatment of German incident COPD patients, compare that treatment with clinical guidelines, and provide insight into disease development after incident diagnosis. In addition, the economic burden of the disease by assessing COPD-related healthcare costs was described. Patients and Methods Based on a German claims dataset, continuously insured individuals (04/2014-03/2019) aged 40 years or older with at least two incident pulmonologist’s diagnoses or one inpatient diagnosis of COPD (ICD-10-GM code J44.-; no respective diagnosis in a 12-month baseline period) were selected. Treatment patterns after incident diagnosis considering inhaled maintenance therapies identified by ATC codes (outpatient prescriptions) were analyzed. Prescription patterns were compared with recommendations of German COPD treatment guidelines. Severe exacerbations were assessed as hospitalizations with main diagnosis ICD-10-GM code J44.1. COPD-associated costs from the perspective of the health insurance fund AOK PLUS were calculated per patient-year (PY). Results The sample comprised 17,464 incident COPD patients with a mean age of 71.5 years. 58.9% were male and the mean Charlson-Comorbidity-Index was 5.3. During follow-up (median: 2.0 years), 57.1% of the patients received at least one prescription of an inhaled maintenance therapy, whereas 42.9% did not. Among treated patients, 35.2% started their treatment with LABA/LAMA, 25.3% with LAMA monotherapy, 16.2% with LABA/ICS, and 7.8% with LABA/LAMA/ICS therapy. Within four weeks after initial diagnosis, ICS-containing therapies were prescribed in 14.1% of patients. Of all patients with a prescribed triple therapy, 68.9% had no corresponding exacerbation history documented. On average, 0.16 severe exacerbations and 0.19 COPD-related hospitalizations were observed per PY during available follow-up. Direct COPD-related costs were 3,693 €/PY, with COPD-related hospitalizations being responsible for about 79.2% of these costs. Conclusion Long-acting bronchodilators are the mainstay of pharmacological treatment of incident COPD patients in Germany, in line with guideline recommendations. Yet, a considerable proportion of incident COPD patients did not receive any inhaled maintenance therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis

Buhl¹,

Wilke²,

Picker³

et al. 2022

COPD

View full text Add to dashboard Cite

show abstract

“…The concept of treatable traits is a precision medicine approach that has recently been proposed for the management of obstructive airway diseases, including COPD [ 80 , 81 ]. It should be considered as a model of care in which the patient undergoes a multidimensional assessment to identify clinically relevant and treatable problems (traits).…”

Section: Discussionmentioning

confidence: 99%

Blood Eosinophils and Exhaled Nitric Oxide: Surrogate Biomarkers of Airway Eosinophilia in Stable COPD and Exacerbation

Antus

Barta

2022

Biomedicines

View full text Add to dashboard Cite

In recent years, tremendous efforts have been devoted to characterizing the inflammatory processes in chronic obstructive pulmonary disease (COPD) in order to provide more personalized treatment for COPD patients. While it has proved difficult to identify COPD-specific inflammatory pathways, the distinction between eosinophilic and non-eosinophilic airway inflammation has gained clinical relevance. Evidence has shown that sputum eosinophil counts are increased in a subset of COPD patients and that these patients are more responsive to oral or inhaled corticosteroid therapy. Due to feasibility issues associated with sputum cell profiling in daily clinical practice, peripheral blood eosinophil counts and fractional exhaled nitric oxide levels have been evaluated as surrogate biomarkers for assessing the extent of airway eosinophilia in COPD patients, both in stable disease and acute exacerbations. The diagnostic value of these markers is not equivalent and depends heavily on the patient’s condition at the time of sample collection. Additionally, the sensitivity and specificity of these tests may be influenced by the patient’s maintenance treatment. Overall, eosinophilic COPD may represent a distinct disease phenotype that needs to be further investigated in terms of prognosis and treatment outcomes.

show abstract

“…34 Therefore, the purpose of the present study was to address the complexity of chronic obstructive airway diseases physiologically, selecting specific target parameter values expressed in z-scores, [35][36][37][38] with proven discriminatory statistical power, and hence to present a multidimensional perception of a treatable trait strategy 39 within a new concept of precision. 39,40…”

Section: Introductionmentioning

confidence: 99%

Functional Predictors Discriminating Asthma–COPD Overlap (ACO) from Chronic Obstructive Pulmonary Disease (COPD)

Kraemer¹,

Gardin²,

Smith³

et al. 2022

COPD

View full text Add to dashboard Cite

Background A significant proportion of patients with obstructive lung disease have clinical and functional features of both asthma and chronic obstructive pulmonary disease (COPD), referred to as the asthma–COPD overlap (ACO). The distinction of these phenotypes, however, is not yet well-established due to the lack of defining clinical and/or functional criteria. The aim of our investigations was to assess the discriminating power of various lung function parameters on the assessment of ACO. Methods From databases of 4 pulmonary centers, a total of 540 patients (231 males, 309 females), including 372 patients with asthma, 77 patients with ACO and 91 patients with COPD, were retrospectively collected, and gradients among combinations of explanatory variables of spirometric (FEV 1 , FEV 1 /FVC, FEF 25-75 ), plethysmographic (sR eff , sG eff , the aerodynamic work of breathing at rest; sWOB), static lung volumes, including trapped gases and measurements of the carbon monoxide transfer (DL CO , K CO ) were explored using multiple factor analysis (MFA). The discriminating power of lung function parameters with respect to ACO was assessed using linear discriminant analysis (LDA). Results LDA revealed that parameters of airway dynamics (sWOB, sR eff , sG eff ) combined with parameters of static lung volumes such as functional residual capacity (FRC pleth ) and trapped gas at FRC (V TG FRC ) are valuable and potentially important tools discriminating between asthma, ACO and COPD. Moreover, sWOB significantly contributes to the diagnosis of obstructive airway diseases, independent from the state of pulmonary hyperinflation, whilst the diffusion capacity for carbon monoxide (DL CO ) significantly differentiates between the 3 diagnostic classes. Conclusion The complexity of COPD with its components of interaction and their heterogeneity, especially in discrimination from ACO, may well be differentiated if patients are explored by a whole set of target parameters evaluating, interactionally, flow limitation, airway dynamics, pulmonary hyperinflation, small airways dysfunction and gas exchange disturbances assessing specific functional deficits.

show abstract

Treatable Traits in COPD – A Proposed Approach

Cited by 28 publications

References 135 publications

Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis

Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis

Blood Eosinophils and Exhaled Nitric Oxide: Surrogate Biomarkers of Airway Eosinophilia in Stable COPD and Exacerbation

Functional Predictors Discriminating Asthma–COPD Overlap (ACO) from Chronic Obstructive Pulmonary Disease (COPD)

Contact Info

Product

Resources

About