Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
Pulmonology and Cystic Fibrosis Unit, Internal Medicine Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy.
Int J Chron Obstruct Pulmon Dis. 2023 Sep 8;18:1959-1964. doi: 10.2147/COPD.S428391. eCollection 2023.
The complexity of COPD implies the need to identify groups of patients with similar clinical characteristics and prognosis or treatment requirements. This is why much attention has been paid to identifying the different clinical phenotypes by investigating the clinical expression of the disease, and endotypes by studying the biological networks that enable and limit reactions. However, this approach is complicated because one endotype gives rise to one or more clinical characteristics, and clinical phenotypes can be derived from several endotypes. To simplify the approach, a new taxonomic classification of COPD based on the different causes (or etiotypes) has been proposed, but these etiotypes have not yet been validated. A simpler method is the so-called tractable traits approach, which is free from any designation of the disorder to be treated and does not present the criticality of using etiotypes. A large randomised controlled trial on using the treatable traits approach in COPD is still lacking. Nevertheless, this approach is already applied by following the GOLD strategy. However, its application is complicated because several potentially treatable traits have been identified within the pulmonary domain, the extrapulmonary domain, and the behavioural/risk factor domain. In addition, the hierarchy of the dominant treatable traits has not yet been established, and they change over time both spontaneously and because of treatment. This means that the patients being treated according to the tractable traits approach must be constantly followed over time so that the therapy is focused on their temporal needs.
COPD 的复杂性意味着需要识别具有相似临床特征和预后或治疗需求的患者群体。这就是为什么人们非常关注通过研究疾病的临床表现来识别不同的临床表型，以及通过研究能够产生和限制反应的生物学网络来识别内型。然而，这种方法很复杂，因为一个内型会产生一个或多个临床特征，而临床表型可以来自几个内型。为了简化方法，已经提出了一种基于不同病因（或病因型）的 COPD 新分类法，但这些病因型尚未得到验证。一种更简单的方法是所谓的可处理特征方法，它不受任何待治疗疾病的指定的影响，也不具有使用病因型的关键性质。一项关于在 COPD 中使用可处理特征方法的大型随机对照试验仍然缺乏。然而，这种方法已经按照 GOLD 策略得到了应用。然而，其应用很复杂，因为在肺部、肺外和行为/风险因素领域已经确定了几个潜在的可治疗特征。此外，主要可处理特征的层次结构尚未建立，它们会随着时间的推移自发地和由于治疗而发生变化。这意味着根据可处理特征方法进行治疗的患者必须随着时间的推移不断得到随访，以便治疗能够针对他们的时间需求进行。
