Treatable Traits in COPD – A Proposed Approach

Abstract

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.

Keywords:

• COPD
• precision medicine
• treatable traits strategy
• phased approach
• future

Acknowledgments

Medical writing support for this article was provided by Paula Pinto, PhD, of PMA – Pharmaceutical Medicine Academy and was funded by Bial. All authors contributed equally to this work and should be considered co-first authors for this study.

Disclosure

Prof. Dr. João Cardoso reports personal fees from Astra Zeneca, GSK, Bial, Boehringer Ingelheim, Mylan and Novartis, outside the submitted work. Prof. Dr. António Jorge Ferreira reports personal fees from TEVA Pharma, Bial, GSK, Boehringer Ingelheim and Mylan; and personal fees and non-financial support from Menarini, outside the submitted work. Dr. Miguel Guimarães reports personal fees from GSK, Novartis, Menarini, Bial and Boehringer Ingelheim, outside the submitted work. Dr. Ana Sofia Oliveira reports personal fees from Medinfar, GSK, Bial, Novartis and Menarini, outside the submitted work. Dr. Paula Simão reports personal fees from Bial, GSK, Novartis and Boehringer Ingelheim, outside the submitted work. Dr. Maria Sucena reports personal fees and non-financial support from Bial, CSL Behring and Grifols, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This article was funded by Bial. Bial provided all necessary scientific bibliography and funded medical writing support and publishing charges. The authors did not receive direct funding for the writing of this article.