a Department of Systems Medicine , Chair of Respiratory Medicine, University of Rome "Tor Vergata" , Rome , Italy.
b Division of Respiratory Medicine, Department of Internal Medicine , University Hospital "Tor Vergata" , Rome , Italy.
Expert Rev Respir Med. 2018 Jan;12(1):43-54. doi: 10.1080/17476348.2018.1398086. Epub 2017 Nov 3.
Treatment recommendations are based on randomized controlled trials (RCTs). However, only about 1 in 20 people meet the inclusion criteria for RCTs forming consensus guidelines in chronic obstructive pulmonary disease (COPD). Consequently, the one-size-fits-all approach focused merely on traditional symptoms and risk of exacerbations is inadequate to treat COPD. COPD needs a personalized medicine strategy because of the relevance of COPD heterogeneity for subject-based health risk assessment and stratification in the clinical arena. Areas covered: Since the therapeutic approach proposed by the 2017 GOLD report takes no account of COPD heterogeneity, the advances with the current pharmacological options and the different approaches focused on phenotypes of COPD that can be used in an attempt to respond to unmet therapeutic needs are reviewed. Expert commentary: The one-size-fits-all approach that focuses solely on traditional symptoms and risk of exacerbations is inadequate to treat COPD. COPD needs a personalized medicine strategy because of the relevance of COPD heterogeneity. Phenotyping provides potential for a more personalized approach than the former model of care because it allows clustering patients defined by clinical characteristics and sharing common clinical outcomes. However, it is still too much of a simplistic method that, in any case, must be validated in future clinical studies.
治疗建议基于随机对照试验 (RCT)。然而，只有大约 1/20 的人符合慢性阻塞性肺疾病 (COPD) 形成共识指南的 RCT 纳入标准。因此，仅仅关注传统症状和恶化风险的一刀切方法不足以治疗 COPD。由于 COPD 异质性与基于个体的健康风险评估和临床领域的分层相关，因此 COPD 需要个性化的医学策略。
由于 2017 年 GOLD 报告提出的治疗方法没有考虑 COPD 异质性，因此对当前药理学选择的进展以及针对 COPD 表型的不同方法进行了回顾，这些方法可以用于尝试满足未满足的治疗需求。
仅仅关注传统症状和恶化风险的一刀切方法不足以治疗 COPD。由于 COPD 异质性的相关性，因此需要 COPD 的个性化医学策略。表型提供了比以前的护理模式更个性化的方法的潜力，因为它允许根据临床特征对患者进行聚类，并共享共同的临床结果。然而，它仍然是一种过于简单的方法，无论如何，都必须在未来的临床研究中得到验证。
