Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
Universitat de Barcelona, Biomedicine Department. Immunology Unit, Barcelona, Spain.
Respirology. 2024 Jul;29(7):551-562. doi: 10.1111/resp.14760. Epub 2024 Jun 11.
To date, the treatable traits (TTs) approach has been applied in the context of managing diagnosed diseases. TTs are clinical characteristics and risk factors that can be identified clinically and/or biologically, and that merit treatment if present. There has been an exponential increase in the uptake of this approach by both researchers and clinicians. Realizing the potential of the TTs approach to pre-clinical disease, this expert review proposes that it is timely to consider acting on TTs present before a clinical diagnosis is made, which might help to prevent development of the full disease. Such an approach is ideal for diseases where there is a long pre-clinical phase, such as in chronic obstructive pulmonary disease (COPD). The term 'pre-COPD' has been recently proposed to identify patients with respiratory symptoms and/or structural or functional abnormalities without airflow limitation. They may eventually develop airflow limitation with time but patients with pre-COPD are likely to have traits that are already treatable. This review first outlines the contribution of recently generated knowledge into lifetime lung function trajectories and the conceptual framework of 'GETomics' to the field of pre-COPD. GETomics is a dynamic and cumulative model of interactions between genes and the environment throughout the lifetime that integrates information from multi-omics to understand aetiology and mechanisms of diseases. This review then discusses the current evidence on potential TTs in pre-COPD patients and makes recommendations for practice and future research. At a broader level, this review proposes that introducing the TTs in pre-COPD may help reenergize the preventive approaches to health and diseases.
迄今为止，可治疗特征 (Trait, TT) 方法已被应用于诊断疾病的管理中。TT 是可以通过临床和/或生物学方法识别的临床特征和风险因素，如果存在这些特征和因素，就值得进行治疗。研究人员和临床医生都在大量采用这种方法。鉴于 TT 方法在临床前疾病方面的潜力，本专家评论建议，现在就应该考虑对临床诊断前出现的 TT 进行治疗，这可能有助于预防疾病的全面发展。对于存在较长临床前阶段的疾病，如慢性阻塞性肺疾病 (COPD)，这种方法是理想的。最近提出了“前 COPD”一词，用于识别有呼吸道症状和/或结构或功能异常但无气流受限的患者。随着时间的推移，他们可能会发展为气流受限，但前 COPD 患者可能已经存在可治疗的特征。本综述首先概述了最近在整个生命周期内的肺功能轨迹和“GETomics”概念框架方面的知识对前 COPD 领域的贡献。GETomics 是一个动态的、累积的基因与环境相互作用模型，贯穿整个生命周期，它整合来自多组学的信息，以了解疾病的病因和发病机制。然后，本综述讨论了前 COPD 患者中潜在 TT 的现有证据，并为实践和未来研究提出了建议。从更广泛的角度来看，本综述建议在前 COPD 中引入 TT 可能有助于重新激发预防健康和疾病的方法。
