Personalized medicine for patients with COPD: where are we?

Abstract

Chronic airflow limitation is the common denominator of patients with chronic obstructive pulmonary disease (COPD). However, it is not possible to predict morbidity and mortality of individual patients based on the degree of lung function impairment, nor does the degree of airflow limitation allow guidance regarding therapies. Over the last decades, understanding of the factors contributing to the heterogeneity of disease trajectories, clinical presentation, and response to existing therapies has greatly advanced. Indeed, diagnostic assessment and treatment algorithms for COPD have become more personalized. In addition to the pulmonary abnormalities and inhaler therapies, extra-pulmonary features and comorbidities have been studied and are considered essential components of comprehensive disease management, including lifestyle interventions. Despite these advances, predicting and/or modifying the course of the disease remains currently impossible, and selection of patients with a beneficial response to specific interventions is unsatisfactory. Consequently, non-response to pharmacologic and non-pharmacologic treatments is common, and many patients have refractory symptoms. Thus, there is an ongoing urgency for a more targeted and holistic management of the disease, incorporating the basic principles of P4 medicine (predictive, preventive, personalized, and participatory). This review describes the current status and unmet needs regarding personalized medicine for patients with COPD. Also, it proposes a systems medicine approach, integrating genetic, environmental, (micro)biological, and clinical factors in experimental and computational models in order to decipher the multilevel complexity of COPD. Ultimately, the acquired insights will enable the development of clinical decision support systems and advance personalized medicine for patients with COPD.

Keywords:

• chronic obstructive pulmonary disease
• personalized medicine
• systems medicine
• review

Acknowledgments

We would like to apologize to all colleagues whose excellent contributions to the field of personalized COPD medicine could not be included in this text due to space constraints. Part of this work has been funded by German Ministry for Education and Research (BMBF) (ERACoSysMed2 SysMed-COPD-FKZ 031L0140, JPIAMR Pneumo-AMR-Protect-FKZ 01KI1702, e:Med CAPSYS-FKZ 01X1304E/01ZX1304F) to BS and by a Kootstra Talent Fellowship from the Center for Research Innovation, Support and Policy (CRISP) of Maastricht University Medical Center + to BJB. ZonMW (ERACoSysMed 90030355) funded the Dutch consortium partners to FMEF and EFMW. Austrian Science Fund FWF (ERACoSysMed I 3736-B30) funded the Austrian consortium partner SI. NB and FKR were funded by the Norwegian Research Council grant number 284045.

Disclosure

FMEF received personal fees for lectures and consultancies from AstraZeneca, Boehringer Ingelheim, Chiesi, TEVA, GlaxoSmithKline, and Novartis, outside of this work. He also received research grants from Novartis and MedImmune. BS received research funding from GlaxoSmithKline. SI reports grants from Austrian Science Fund FWF, during the conduct of the study. DM reports grants from Austrian Science Fund FWF, during the conduct of the study. MM reports grants from German Ministry for Education and Research (BMBF), during the conduct of the study. CFV reports grants and personal fees from AstraZeneca Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Grifols, Menarini, Mundipharma, Novartis, TEVA, Cipla, Bayer Schering, MSD, and Pfizer, outside the submitted work. BS reports grants from BMBF and GlaxoSmithKline, during the conduct of the study. The authors report no other conflicts of interest in this work.