Treatment of severe stable COPD: the multidimensional approach of treatable traits

Abstract

Now that additional treatment options for severe chronic obstructive pulmonary disease (COPD) have emerged in recent years, patients with severe COPD should not be left in the rather hopeless situation of “there is nothing to improve” any more. Inertia or fatalism is a disservice to our patients. Ranging from advanced care planning to quite intense and demanding therapies such as multidisciplinary pulmonary rehabilitation, (endoscopic) lung volume reduction, chronic noninvasive ventilation and lung transplantation, caregivers should try to provide a personalised treatment for every severe COPD patient. In this review, we aim to describe the multidimensional approach to these patients at our centre along the lines of treatable traits leading to specific additional treatment modalities on top of standard care.

Endobronchial Valves for the Treatment of Advanced Emphysema

“…Smoking cessation, receiving guideline pharmacologic therapy, completed pulmonary rehabilitation, and/or are participating in a structured physical therapy program, nutrition support, long-term oxygen therapy, and noninvasive ventilation should all have been evaluated and optimized as appropriate. 13,21 Step 3: Airflow Obstruction…”

“…Basic elements for a successful program are dedication, COPD expert knowledge, access to interventional pulmonology, access to multimodality treatments for COPD (other bronchoscopic and surgical LVR techniques, 47 pulmonary rehabilitation, noninvasive ventilation, and lung transplantation), 21 , 48 well-organized in-house logistics and facilities (radiology, pulmonary function testing, anesthesia, thoracic surgery), and a solid referral network. Participation in scientific efforts can be important for advancing the BLVR field and getting the exposure needed for patient referrals.…”

“…Only by doing this can you ensure the best possible treatment is offered to each individual patient with COPD. 21 , 42 , 48 As an expert center, we offer other hospitals the chance to discuss potential cases using a weekly scheduled videoconferencing meeting. By organizing this, we educate referral and other treatment hospitals to prevent them from the pitfalls we previously encountered, thereby ensuring high quality standards.…”

Investigation of the Clinical, Radiological and Biological Factors Associated with Disease Progression, Phenotypes and Endotypes of COPD in China (COMPASS): study design, protocol and rationale

“…[5] This indicates the need for personalized management, for example using a treatable traits approach to assessment, classification, and management of COPD. [6,7] Three large observational studies, Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) [8], Genetic Epidemiology of COPD (COPDGene) Study [9], Subpopulations and Intermediate Outcomes in COPD Study (SPIROMICS) [10] were designed to address the complexity and heterogeneity of COPD, but they were all conducted in North America and Europe. A fourth study in individuals with obstructive lung disease (NOVELTY) is ongoing and includes patients in Asia.…”

Lung volume reduction in real clinical practice

“…Careful patient selection for the different treatment options is very important for treatment success and including different disciplines in the multidisciplinary team emphysema expert meeting is key to ideal treatment allocation. This meeting could even be expanded when including more disciplines and treatment options like in a recently described multidimensional respiratory failure meeting [ 12 ]. Consequently, this indicates that it is important to have specialised emphysema treatment centres who have experience with the disease and have access to the different treatment options, which will lead to the potential most ideal treatment option for the patient.…”