Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Nov 5, 2020; 10(2): 11-16
Published online Nov 5, 2020. doi: 10.5320/wjr.v10.i2.11
Personalising exacerbation prediction strategies in chronic obstructive pulmonary disease
Paul R Ellis, Alice M Turner
Paul R Ellis, Alice M Turner, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
Author contributions: Ellis PR wrote the initial draft manuscript; Turner AM and Ellis PR both contributed to the review and editing of the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Paul R Ellis, MBChB, Research Fellow, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom. p.ellis@bham.ac.uk
Received: April 30, 2020
Peer-review started: April 30, 2020
First decision: July 4, 2020
Revised: August 22, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: November 5, 2020

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide. One of the most important features of this disease is exacerbations where a patient’s respiratory symptoms episodically worsen. Exacerbations accounted for over 140000 hospital admissions in 2012 in the United Kingdom with considerably more exacerbations being treated in primary care. Despite significant research in this area in recent years, treatment of acute exacerbations in the community remains limited to oral glucocorticoids, antibiotics and bronchodilators. One of the issues with unpicking the complexity of exacerbations is trying to find out the exact underlying cause and mechanism that leads to symptoms and lung destruction. Currently symptoms are initially guided by symptoms alone though multiple causes of exacerbations have common presentations. This includes viral and bacterial infections and episodes relating to environmental triggers such as pollen and pollution. There is also evidence that cardiovascular factors can contribute to symptoms of breathlessness that can mimic COPD exacerbations. In this editorial we discuss recent advances in the use of precision medicine to more accurately treat exacerbations of COPD. This includes identification of phenotypes that could help rationalise treatment and more importantly identify novel drug targets. We also consider the future role of precision medicine in preventing exacerbations and identifying COPD patients that are at increased risk of developing them.

Keywords: Chronic obstructive pulmonary disease, Exacerbations, Phenotypes, Endotypes, Precision medicine, Clinical

Core Tip: Chronic obstructive pulmonary disease (COPD) patients and the exacerbations they suffer are complex and heterogenous in nature. They should all be treated on an individual basis with detailed clinical history and initial work up to better understand the impact it is having on their life. Careful consideration of the benefits of treatment should be weighed up against the risks of their side effects to ensure the maximum benefit of treatment. Precision medicine is starting to appear in management of COPD, both for acute exacerbations and their prevention.