Medical Research Institute of New Zealand.
Capital and Coast District Health Board.
Curr Opin Pulm Med. 2018 Jan;24(1):24-31. doi: 10.1097/MCP.0000000000000445.
To describe the rationale on which the treatable traits approach to the management of airways disease is based and the issues that need to be considered for its implementation in clinical practice.
In clinical practice, treatable traits can be classified according to both endotypes and phenotypes, broadly grouped within pulmonary, extrapulmonary, environmental and behavioural factors. Specific investigations and treatments are undertaken for each of the traits rather than a 'one size fits all' stepwise approach to pharmacological treatment which currently represents the core of asthma and chronic obstructive pulmonary disease (COPD) guidelines. Although there is strong evidence of the benefit of the treatable traits approach to specific traits in asthma and/or COPD, there is uncertainty regarding the preferred method of implementation, efficacy and cost-effectiveness of multidimensional intervention programmes in clinical practice. It is likely that 'master protocols' for randomized controlled trials will be required to evaluate such multiple interventions in broad populations of patients with airways disease.
Current evidence suggests that the precision medicine approach based on the identification and treatment of treatable traits is preferable to a 'one-size-fits-all' stepwise approach to the treatment of airways disease, although high-quality evidence to guide the practical application of this multidimensional management strategy is now required. VIDEO ABSTRACT.
描述可治疗特征方法在气道疾病管理中的基本原理，以及在临床实践中实施该方法需要考虑的问题。
在临床实践中，可治疗特征可根据表型和内型进行分类，大致分为肺内、肺外、环境和行为因素。针对每个特征进行特定的检查和治疗，而不是采用目前哮喘和慢性阻塞性肺疾病（COPD）指南核心的“一刀切”逐步式药物治疗方法。尽管有强有力的证据表明，针对哮喘和/或 COPD 的特定特征采用可治疗特征方法具有益处，但对于多维干预方案在临床实践中的首选实施方法、疗效和成本效益仍存在不确定性。可能需要针对随机对照试验的“主方案”来评估气道疾病患者广泛人群中的此类多种干预措施。
目前的证据表明，基于可治疗特征的识别和治疗的精准医疗方法优于针对气道疾病的“一刀切”逐步式治疗方法，尽管现在需要高质量的证据来指导这种多维管理策略的实际应用。视频摘要。
