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2030年慢性阻塞性肺疾病领域将会发生什么?

What will Happen in the World of COPD 2030?

作者信息

Russell Richard E K, Bafadhel Mona

机构信息

Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.

Lymington New Forest Hospital, Lymington, Hampshire, United Kingdom.

出版信息

Turk Thorac J. 2019 Jul 30;20(4):253-257. doi: 10.5152/TurkThoracJ.2019.190307. Print 2019 Oct.

Abstract

2030 may seem to be a long way into the future, but it's not. We live in a world of relentless rapid change in modern medicine and our approach to our patients with chronic diseases such as chronic obstructive pulmonary disease (COPD) will need to evolve at speed. This review looks at what may occur in society and medicine that will influence the way we manage COPD. The article is the opinion of the authors and is based upon current research at the cutting edge of management with a degree of gazing into a dimly lit crystal ball. COPD is a current epidemic, and this is likely to continue. Legislative efforts to reduce smoking will continue and hopefully accelerate, but this will not be globally accepted or successful. Technological advances will occur that will lead to miniaturization and the rise of near patient testing. This itself will enable a personalised approach to management with the ability to measure rapidly biomarkers which will direct therapy. The blood eosinophil is the most promising of these and is available now. New developments in the identification of disease clusters and phenotypes will also enhance a more personalised approach. Through both these epidemiological studies and also new developments in the understanding of basic mechanisms it is hoped that in the future patients will be given treatments that may fundamentally change the prognosis of COPD. Small molecule and antibody directed therapies may, if given early enough, stop and even possibly reverse the effects of COPD on cells and organs. Of course, the most important step which is achievable now is to ban all tobacco-based products from the world.

摘要

2030年看似还有很长一段时间才会到来,但其实并非如此。我们生活在一个现代医学不断快速变化的世界里,我们对待慢性阻塞性肺疾病(COPD)等慢性病患者的方式需要迅速演变。这篇综述探讨了社会和医学领域可能发生的事情,这些事情将影响我们管理慢性阻塞性肺疾病的方式。本文是作者的观点,基于管理前沿的当前研究,并带有一定程度对未知情况的展望。慢性阻塞性肺疾病目前是一种流行病,而且这种情况可能会持续下去。减少吸烟的立法努力将继续,并且有望加速,但这不会在全球范围内被接受或取得成功。技术进步将会出现,这将导致设备小型化以及床边检测的兴起。这本身将使个性化管理成为可能,能够快速测量生物标志物以指导治疗。血液嗜酸性粒细胞是其中最有前景的,并且现在已经可以检测。疾病集群和表型识别方面的新进展也将增强个性化治疗方法。通过这些流行病学研究以及对基本机制理解的新进展,希望未来患者能够得到可能从根本上改变慢性阻塞性肺疾病预后的治疗。小分子和抗体导向疗法如果给予足够早,可能会阻止甚至逆转慢性阻塞性肺疾病对细胞和器官的影响。当然,现在可以实现的最重要一步是在全球范围内禁止所有烟草制品。

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