The editor of Thorax agrees with a recent review by Peter Gibson and Vanessa McDonald recommending the term ACOS be abandoned, but he goes even further by saying the terms asthma and COPD have also outlived their usefulness.
Like the authors of the original review Andrew Bush from the Royal Brompton Hospital and Imperial College in London and Ian Pavord from the Nuffield Department of Medicine, University of Oxford advocate a personalised management of airway disease.
“The writings of two great men, Richard Asher and Freddy Hargreave, are the bedrock on which thinking about airway disease rests. Richard Asher urged us to describe in plain English what we actually see; and, in the context of airway disease, Freddy Hargreave did just that,” they write in the editorial published in Thorax.
So what, based on his scheme of things can go wrong with a biological tube? they ask.
There may be fixed narrowing, variable narrowing, inflammation and chronic infection. These process(es) may also have systemic effects.
Surely each of these components should be addressed to develop a rational treatment programme, rather than the one size fits all, they say, before going on to highlight an approach to each of these components that would lead to individualised medicine.
“We are at a crossroads; we know that umbrella terms do not even keep off the rain; do we devise ever more ‘overlap’ syndromes, or go the Asher/ Hargreave route?”
“The latter approach has driven the modest progress in new drug discovery we have seen in recent years, and our view is that deconstructing airways disease and challenging deeply held views is an absolute requirement for continued progress,” they conclude.
Related article: Abandon ACOS as a specific phenotype