UBC Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada.
Dept of Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada.
Eur Respir J. 2019 Apr 11;53(4). doi: 10.1183/13993003.02460-2018. Print 2019 Apr.
Although there has been tremendous growth in our understanding of chronic obstructive pulmonary disease (COPD) and its pathophysiology over the past few decades, the pace of therapeutic innovation has been extremely slow. COPD is now widely accepted as a heterogeneous condition with multiple phenotypes and endotypes. Thus, there is a pressing need for COPD care to move from the current "one-size-fits-all" approach to a precision medicine approach that takes into account individual patient variability in genes, environment and lifestyle. Precision medicine is enabled by biomarkers that can: 1) accurately identify subgroups of patients who are most likely to benefit from therapeutics and those who will only experience harm (predictive biomarkers); 2) predict therapeutic responses to drugs at an individual level (response biomarkers); and 3) segregate patients who are at risk of poor outcomes from those who have relatively stable disease (prognostic biomarkers). In this essay, we will discuss the current concept of precision medicine and its relevance for COPD and explore ways to implement precision medicine for millions of patients across the world with COPD.
尽管在过去几十年中，我们对慢性阻塞性肺疾病（COPD）及其病理生理学的理解有了巨大的增长，但治疗创新的步伐却非常缓慢。COPD 现在被广泛认为是一种具有多种表型和内型的异质疾病。因此，迫切需要将 COPD 的治疗从当前的“一刀切”方法转变为一种考虑个体患者基因、环境和生活方式差异的精准医学方法。生物标志物可以实现精准医学：1）准确识别最有可能从治疗中受益和只会受到伤害的患者亚组（预测性生物标志物）；2）预测个体对药物的治疗反应（反应性生物标志物）；3）将预后不良风险的患者与疾病相对稳定的患者区分开来（预后生物标志物）。在这篇文章中，我们将讨论精准医学的当前概念及其与 COPD 的相关性，并探讨如何为全球数百万 COPD 患者实施精准医学。
