Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
NOVA Medical School, Nova University Lisbon, Lisboa, Portugal.
Int J Chron Obstruct Pulmon Dis. 2021 Nov 18;16:3167-3182. doi: 10.2147/COPD.S330817. eCollection 2021.
The well-recognized individual heterogeneity within COPD patients has led to a growing interest in greater personalization in the approach of these patients. Thus, the treatable traits strategy has been proposed as a further step towards precision medicine in the management of chronic airway disease, both in stable phase and acute exacerbations. The aim of this paper is to perform a critical review on the treatable traits strategy and propose a guide to approach COPD patients in the light of this new concept. An innovative stepwise approach is proposed - a multidisciplinary model based on two distinct phases, with the potential to be implemented in both primary care and hospital settings. The first phase is the initial and focused assessment of a selected subset of treatable traits, which should be addressed in all COPD patients in both settings (primary care and hospital). As some patients may present with advanced disease at diagnosis or may progress despite this initial treatment requiring a more specialized assessment, they should progress to a second phase, in which a broader approach is recommended. Beyond stable COPD, we explore how the treatable traits strategy may be applied to reduce the risk of future exacerbations and improve the management of COPD exacerbations. Since many treatable traits have already been related to exacerbation risk, the strategy proposed here represents an opportunity to be proactive. Although it still lacks prospective validation, we believe this is the way forward for the future of the COPD approach.
慢性阻塞性肺疾病（COPD）患者的个体异质性是众所周知的，这导致人们对这些患者的治疗方法更加个体化产生了浓厚的兴趣。因此，可治疗特征策略被提议作为慢性气道疾病管理中精准医学的进一步步骤，无论是在稳定期还是急性加重期。本文的目的是对可治疗特征策略进行批判性评价，并根据这一新概念提出一种针对 COPD 患者的处理方法指南。本文提出了一种创新的分步方法——一种基于两个不同阶段的多学科模型，有可能在初级保健和医院环境中实施。第一阶段是对一组选定的可治疗特征进行初始和集中评估，这应该在初级保健和医院环境中的所有 COPD 患者中进行（初级保健和医院）。由于一些患者在诊断时可能已经处于疾病晚期，或者尽管进行了初始治疗，但仍会进展，需要更专门的评估，因此他们应该进入第二阶段，建议采用更广泛的方法。除了稳定期 COPD 之外，我们还探讨了可治疗特征策略如何应用于降低未来加重的风险并改善 COPD 加重的管理。由于许多可治疗特征已经与加重风险相关，因此这里提出的策略代表了一种积极主动的机会。尽管它仍缺乏前瞻性验证，但我们相信这是 COPD 治疗未来的发展方向。
