Do asthma and COPD truly exist?

[gerald]

This looks quite promising.  They started out with everything being COPD. Then Emphysema and Bronchitis. The added Pulmonary Fibrosis etc etc. 

This going back to square one and actually dealing with the patient and their issues/symptoms rather than painting all with the same brush will help.    We have been fighting with medications that were applied to all COPD when they are really only effective to a specific subset!  This hopefully will change that!



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Do asthma and COPD truly exist?
European Lung Foundation


Defining a patient's symptoms using the historical diagnostic labels of asthma and chronic obstructive pulmonary disease (COPD) is an outdated approach to understanding an individual's condition, according to experts writing in the European Respiratory Journal today (Feb. 1, 2016).

In a perspective article, Professor Alvar Agusti and colleagues call for a new approach to patient management, which moves away from categorising patients using the broad disease terms of asthma and COPD and towards a more personalised approach to management that identifies 'treatable traits' in each patient.

Hospitalisation rates for COPD are continuing to increase and a majority of asthma patients live with significant symptoms, impairing their quality of life. While the labels of asthma and COPD are valuable for patients who display stereotypical symptoms, there are a growing number of patients who do not fit this category, including patients with adult-onset asthma, smoking asthmatics, or patients with the so-called asthma-COPD overlap syndrome.

In the past 30 years, new technologies have developed, providing clinicians with a range of tools to allow them to observe a patient and define that patient's condition. Previously, understanding a patient's condition relied on analysis of symptoms and signs, such as lung function measurements and airway hyper-responsiveness, but now clinicians can access information about a range of other underlying complex biological traits, including cellular and molecular traits. This could include measures such as CT scanning, cellular and molecular markers taken from blood samples, sputum and exhaled air and microbiome anaylsis.

Professor Agusti commented: "We propose a label-free precision medicine approach based on treatable traits that categorise the clinical and biological complexity of airway disease. The approach we are suggesting would radicalise healthcare and have significant implications for the organisation of a healthcare system. By recognising the clinical and biological complexity of a disease, we can use causal mechanistic disease pathways to adopt a more precise approach, which is hopefully more effective at managing patients with these conditions."

In an accompanying editorial, Professor Peter Sterk, from the University of Amsterdam, supports the call for a move away from diagnostic labels. Professor Sterk commented: "We are living in an era where we have new biological knowledge and new targets for therapy but we largely continue to guide patient management with diagnostic labels. It is the right time for healthcare professionals to take bold steps and move aware from historical diagnoses that are impeding modern medicine."

www.eurekalert.org/pub_releases/2016-01/elf-daa012916.php

[Deborah]

Hmm. Not sure about this - one of the things about labels is that it helps situate the medical problems within a spectrum that is easily understood by family, friends, and the public. Also, to dismiss ACOS as "so-called" when it was just announced by the world health organizations as a recognizable and diagnosable syndrome seems a bit...peevish or something.

Obviously we are all individuals and hopefully our treatment recognizes our individual needs. Like Jackie used to say, you need to be your own best advocate.

[gerald]

This is what appears to be a new article but is in fact a recut of the one that started this thread. It appears that this is now just an attempt to hype the diagnostic tests with scans, test etc. No real objective towards new treatments or success goals

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COPD: Precision Medicine Breaks Old Rules
Feb 09, 2016 | Carolyn Colwell
Tailoring treatment of patients with breathing problems to rigid protocols for treating chronic obstructive pulmonary disease or asthma is an outmoded approach, an international group of researchers conclude in an essay in the European Respiratory Journal.

Instead, precision medicine and new technology offer a more individualized approach. That change is based on evaluation of the underlying traits and causal, mechanistic pathways of each person’s lung impairment. Newer tools -- CT scanning, identifying cellular and molecular markers and microbiome analysis and others -- allow more pinpointed treatment than the use of just symptomatic assessments, such as lung function measurements and airway hyper-responsiveness, they said.

“The limitations of the umbrella terms asthma and COPD, and the assumptions that are made when these terms are applied, are increasingly apparent,” wrote lead author Alvar Agusti MD, “Here, we proposed a precision-medicine strategy for chronic airway diseases in general, and asthma and COPD in particular, that is based on the presence of what we call ‘treatable traits.”
Agusti works at the Respiratory Institute, Hospital Clinic, IDIBAPS at the University of Barcelona in Spain.

As examples of “treatable traits”, the authors listed airway smooth muscle contraction, lost of elastic recoil, and airway mucosal edema among others. A focus on reliable biomarkers for a trait such eosinophilic fairway inflammation, for example, could “provide a better perspective on risk and the likely response to treatment with corticosteroids,” Agusti and his team wrote.
Additional benefits of paying attention to biomarkers include more effective and economical use of current treatments and the possible development of new drugs for lung diseases, they suggested.

“Progress in new drug discovery has been slower in airway disease than other specialty areas,” the paper said. “Although several explanations are possible, the most important factors are outmoded disease concepts and poor targeting of treatment.”

This precision medicine approach also is needed because of the lack of progress in treating asthma and COPD, the authors said.

For example, they noted an increased hospitalization rate for patients with COPD and the continuation of significant symptoms and life impairment for the majority of treated asthma patients.

The study also argued that when traditional diagnostic categories drive treatment they do not take into account new genetic, molecular or imaging information. Also, they do not work as well for non-stereotypic cases of asthma and COPD. These non-sterotypical cases include adult-onset asthma, asthma-COPD overlap syndrome, smoking asthmatics, or asthmatics with fixed airflow limitations

www.hcplive.com/medical-news/copd-precision-medicine-breaks-old-rules

[mary57]

Interesting, more food for thought, and the more they 'think' the more bits of the puzzle will be found.

[susan]

So, researchers are now thinking "outside the box".  This is cutting edge research when they start looking at "designer" treatments such as "cellular and molecular markers ... and exhaled air and microbiome analysis".  Treatments tailored specifically to your body rather than a one size fits all approach.