University of Manchester, Manchester, UK
Hospital Clínic, Universitat de Barcelona, CIBERES, Barcelona, Spain.
Eur Respir J. 2019 May 18;53(5). doi: 10.1183/13993003.00164-2019. Print 2019 May.
Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.
精准医学是一种针对患者个体的方法，它整合了所有相关的临床、遗传和生物学信息，以优化治疗效果，同时降低个体发生副作用的可能性。最近的临床试验表明，慢性阻塞性肺疾病（COPD）患者的血液嗜酸性粒细胞计数较高与吸入性皮质类固醇（ICSs）的疗效更高相关。血液嗜酸性粒细胞计数是一种具有潜在临床应用价值的生物标志物，可用于帮助 COPD 患者更精准地靶向 ICS 治疗，这些患者尽管接受了适当的支气管扩张剂治疗，但仍有加重史。基于 ABCD 评估的 2017 年全球慢性阻塞性肺疾病倡议（GOLD）药理学治疗算法相对容易应用于初始就诊时的治疗初治个体。然而，在已经接受维持治疗的患者随访期间，其使用更加成问题。需要一种不同的系统来指导 COPD 维持治疗期间的药理学管理。最近的大型随机对照试验提供了关于 ICS 和长效支气管扩张剂对加重影响的治疗效果的重要新信息。关于血液嗜酸性粒细胞和吸入治疗的新证据，以及区分初始和随访药理学管理的必要性，导致 GOLD 药理学治疗建议发生了变化。本文解释了 GOLD 2019 年药理学治疗建议的证据和基本原理。
