Precision medicine in airway diseases: moving to clinical practice

Abstract

On February 21, 2017, a European Respiratory Society research seminar held in Barcelona discussed how to best apply precision medicine to chronic airway diseases such as asthma and chronic obstructive pulmonary disease. It is now clear that both are complex and heterogeneous diseases, that often overlap and that both require individualised assessment and treatment. This paper summarises the presentations and discussions that took place during the seminar. Specifically, we discussed the need for a new taxonomy of human diseases, the role of different players in this scenario (exposome, genes, endotypes, phenotypes, biomarkers and treatable traits) and a number of unanswered key questions in the field. We also addressed how to deploy airway precision medicine in clinical practice today, both in primary and specialised care. Finally, we debated the type of research needed to move the field forward.

Treatable traits can be identified in a severe asthma registry and predict future exacerbations

“…A 2017 Lancet commission proposed that the current concept of airway diseases fails to recognize the complexity of disease and does little to promote individualized management . To address this issue, a new approach has been proposed that characterizes individuals with airway diseases by the presence of potentially modifiable elements that impact symptoms and prognosis, called treatable traits . Management is subsequently individually tailored to directly target these identified traits.…”

RESPIRE: breathing new life into bronchiectasis

“…Taken together, the RESPIRE trials while promising provide a clear warning that we need better methods to stratify, classify and endophenotype bronchiectasis. To avoid making mistakes of the past, we need novel approaches to ensure we identify the right group of patients, at the right time and use the right therapeutic [12]. This is only achievable with clearer precision medicine approaches for the disease which in turn is reliant on a better mechanistic understanding of its pathology and progression.…”

New perspectives of childhood asthma treatment with biologics

“…Biomarkers can constitute either therapeutic targets or prognostic factors. Targeted therapy is part of personalized medicine which aims to better define each patient's phenotype and endotype to prescribe the most suitable treatment at an individual level . The pathophysiology of severe pediatric asthma involves the Th2 inflammatory pathway of both the adaptive and innate immune systems: adaptive immunity associated with cytokines IL‐4 or IL‐13 linked to IgE production and with IL‐5 linked to activation and survival of eosinophils, and innate immunity associated with the type 2 innate lymphoid cells activated by the epithelial alarmins TSLP, IL‐33, or IL‐25 (Figure ) .…”