The current approach to defining a patient’s symptoms using the diagnostic labels of asthma and COPD is outdated and fails to provide optimal care in a significant number of patients, experts claim.
Writing in a perspective article in the European Respiratory Journal the international team including Professor Peter Gibson from the John Hunter Hospital in Newcastle and GOLD committee member Professor Alvar Agusti say the current management of airway diseases is based on “Oslerian diagnostic labels” that do not consider novel genetic, molecular or imaging information.
While this approach may be valid for “stereotypical” patients, it may be of much less clear value in patients with adult-onset asthma, smoking asthmatics, or patients with the so-called asthma-COPD overlap syndrome.
Failure to recognise the complexity of airway diseases is clinically relevant for a number of reasons, they say.
For instance it can lead to sub-optimal management because diseases with different endotypes may require different therapeutic strategies.
Instead they call for a new approach to patient management, which moves away from categorising patients using the broad disease terms towards a more personalised approach that identifies ‘treatable traits’ in each patient.
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“By recognising the clinical and biological complexity of a disease, we can use causal mechanistic disease pathways to adopt a more precise approach, which is hopefully more effective at managing patients with these conditions,” they said.
The approach would likely have significant implications for healthcare systems but may facilitate the development of new drugs by the pharmaceutical industry, they wrote.
In an accompanying editorial, Professor Peter Sterk, from the University of Amsterdam, supports the call for a move away from diagnostic labels.
“We are living in an era where we have new biological knowledge and new targets for therapy but we largely continue to guide patient management with diagnostic labels,” he wrote.
“It is the right time for healthcare professionals to take bold steps and move aware from historical diagnoses that are impeding modern medicine.”
5 things wrong with the current approach to airway diseases:
1) Fails to provide optimal care in a significant number of patients because it does not consider the biological complexity of airway diseases and does not consider the distinct endotypes present in each patient.
2) Does not appreciate common patterns of disease (e.g. chronic cough);
3) Can increase clinical practice variability and enhance inappropriate prescription of some drugs (e.g. inhaled corticosteroids) in some patients;
4) Can contribute to treatment failure and high rates of hospital readmissions; and,
5) Inhibits research progress.
There’s a podcast
You can listen to a podcast of Marc Humbert, Chief editor of the European Respiratory Journal, discussing the perspective article with Professor Agusti here