Singh Dave, Han MeiLan K, Bhatt Surya P, Miravitlles Marc, Compton Chris, Kolterer Stefanie, Mohan Tharishini, Sreedharan Suneal K, Tombs Lee, Halpin David M G
Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
University of Michigan, Ann Arbor, Michigan.
Am J Respir Crit Care Med. 2025 Mar;211(3):452-463. doi: 10.1164/rccm.202406-1254CI.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by progressive airflow obstruction. Despite advancements in diagnosis and treatment, the disease burden remains high; although clinical trials have shown improvements in outcomes such as exacerbations, quality of life, and lung function, improvement may not be attainable for many patients. For patients who do experience improvement, it is challenging to set management goals given the progressive nature of COPD. We therefore propose disease stability as an appropriate and attainable treatment goal. Other disease areas have developed definitions of no disease activity or remission, which provide relevant information for defining and achieving stability for patients with COPD. Disease stability builds on related concepts already defined in COPD, such as clinical control and clinically important deterioration. Current components that could form part of a disease stability definition include exacerbations, health status (including quality of life and symptoms), and lung function. Considerations should be given to intervals over which stability is defined and assessed, appropriate thresholds, and defining a composite. Ensuring a holistic approach, objective measurements, and harmonious, clear communication between patients and physicians can further support establishing disease stability. Here we propose a preliminary definition of disease stability, informed by existing research in COPD. Further research will be needed to validate the framework for use in clinical and research settings. Exploring disease stability as a goal, however, is an opportunity to develop and validate an attainable treatment target to advance the standard of care for patients with COPD.
慢性阻塞性肺疾病（COPD）是一种以进行性气流受限为特征的异质性肺部疾病。尽管在诊断和治疗方面取得了进展，但疾病负担仍然很高；尽管临床试验表明在诸如急性加重、生活质量和肺功能等结局方面有所改善，但许多患者可能无法实现这种改善。对于确实有所改善的患者，鉴于COPD的进展性，设定管理目标具有挑战性。因此，我们提出疾病稳定作为一个合适且可实现的治疗目标。其他疾病领域已经制定了无疾病活动或缓解的定义，这为定义和实现COPD患者的疾病稳定提供了相关信息。疾病稳定建立在COPD中已定义的相关概念之上，如临床控制和具有临床意义的恶化。目前可构成疾病稳定定义一部分的要素包括急性加重、健康状况（包括生活质量和症状）以及肺功能。应考虑定义和评估稳定状态的时间间隔、合适的阈值以及定义一个综合指标。确保采用整体方法、进行客观测量以及患者与医生之间进行和谐、清晰的沟通，可进一步支持确立疾病稳定状态。在此，我们根据COPD的现有研究提出疾病稳定的初步定义。需要进一步研究以验证该框架在临床和研究环境中的应用。然而，将疾病稳定作为一个目标进行探索，是一个开发和验证可实现的治疗靶点以提高COPD患者护理标准的机会。
