Siafakas Nikolaos, Corlateanu Alexandru, Fouka Evangelia
a Medical School , Unvieristy of Crete , Heraklion , Crete , Greece.
b Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu" , Chisinau , Moldova , Republic of Moldova.
COPD. 2017 Jun;14(3):367-374. doi: 10.1080/15412555.2017.1303041. Epub 2017 Apr 7.
Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous and complex disease with great morbidity and mortality. Despite the new developments in the managements of COPD, it was recognized that not all patients benefit from the available medications. Therefore, efforts to identify subgroups or phenotypes had been made in order to predict who will respond to a class of drugs for COPD. This review will discuss phenotypes, endotypes, and subgroups such as the frequent exacerbator, the one with systemic inflammation, the fast decliner, ACOS, and the one with co-morbidities and their impact on therapy. It became apparent, that the "inflammatory" phenotypes: frequent exacerbator, chronic bronchitic, and those with a number of co-morbidities need inhaled corticosteroids; in contrast, the emphysematous type with dyspnea and lung hyperinflation, the fast decliner, need dual bronchodilation (deflators). However, larger, well designed studies clustering COPD patients are needed, in order to identify the important subgroups and thus, to lead to personalize management in COPD.
慢性阻塞性肺疾病（COPD）是一种具有高发病率和高死亡率的异质性复杂疾病。尽管COPD管理方面有新进展，但人们认识到并非所有患者都能从现有药物中获益。因此，已努力识别亚组或表型，以预测哪些患者会对一类COPD药物产生反应。本综述将讨论表型、内型和亚组，如频繁急性加重者、存在全身炎症者、快速肺功能下降者、哮喘 - 慢性阻塞性肺疾病重叠综合征（ACOS）以及合并症患者，以及它们对治疗的影响。显然，“炎症性”表型，即频繁急性加重者、慢性支气管炎患者以及患有多种合并症的患者需要吸入糖皮质激素；相比之下，出现呼吸困难和肺过度充气的肺气肿型患者、快速肺功能下降者需要双重支气管扩张剂。然而，需要开展更大规模、设计良好的研究对COPD患者进行聚类分析，以识别重要亚组，从而实现COPD的个体化管理。
