Chronic obstructive pulmonary disease phenotypes

The future of COPD

Mei Lan K. Han, Alvar Agusti, Peter M. Calverley, Bartolome R. Celli, Gerard Criner, Jeffrey L. Curtis, Leonardo M. Fabbri, Jonathan G. Goldin, Paul W. Jones, William MacNee, Barry J. Make, Klaus F. Rabe, Stephen Israel Rennard, Frank C. Sciurba, Edwin K. Silverman, Jørgen Vestbo, George R. Washko, Emiel F.M. Wouters, Fernando J. Martinez

Research output: Contribution to journalComment/debate

621 Citations (Scopus)

Abstract

Significant heterogeneity of clinical presentation and disease progression exists within chronic obstructive pulmonary disease (COPD). Although FEV 1 inadequately describes this heterogeneity, a clear alternative has not emerged. The goal of phenotyping is to identify patient groups with unique prognostic or therapeutic characteristics, but significant variation and confusion surrounds use of the term "phenotype" in COPD. Phenotype classically refers to any observable characteristic of an organism, and up until now, multiple disease characteristics have been termed COPD phenotypes. We, however, propose the following variation on this definition: "a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes (symptoms, exacerbations, response to therapy, rate of disease progression, or death)." This more focused definition allows for classification of patients into distinct prognostic and therapeutic subgroups for both clinical and research purposes. Ideally, individuals sharing a unique phenotype would also ultimately be determined to have a similar underlying biologic or physiologic mechanism(s) to guide the development of therapy where possible. It follows that any proposed phenotype, whether defined by symptoms, radiography, physiology, or cellular or molecular fingerprint will require an iterative validation process in which "candidate" phenotypes are identified before their relevance to clinical outcome is determined. Although this schema represents an ideal construct, we acknowledge any phenotype may be etiologicaxlly heterogeneous and that any one individual may manifest multiple phenotypes. We have much yet to learn, but establishing a common language for future research will facilitate our understanding and management of the complexity implicit to this disease.

Original languageEnglish (US)
Pages (from-to)598-604
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume182
Issue number5
DOIs
StatePublished - Sep 1 2010

Fingerprint

Chronic Obstructive Pulmonary Disease
Phenotype
Disease Progression
Disease Attributes
Confusion
Dermatoglyphics
Therapeutics
Individuality
Radiography
Language
Research

Keywords

  • Decline
  • Mortality
  • Outcomes
  • Prognosis
  • Therapy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Han, M. L. K., Agusti, A., Calverley, P. M., Celli, B. R., Criner, G., Curtis, J. L., ... Martinez, F. J. (2010). Chronic obstructive pulmonary disease phenotypes: The future of COPD. American Journal of Respiratory and Critical Care Medicine, 182(5), 598-604. https://doi.org/10.1164/rccm.200912-1843CC

Chronic obstructive pulmonary disease phenotypes : The future of COPD. / Han, Mei Lan K.; Agusti, Alvar; Calverley, Peter M.; Celli, Bartolome R.; Criner, Gerard; Curtis, Jeffrey L.; Fabbri, Leonardo M.; Goldin, Jonathan G.; Jones, Paul W.; MacNee, William; Make, Barry J.; Rabe, Klaus F.; Rennard, Stephen Israel; Sciurba, Frank C.; Silverman, Edwin K.; Vestbo, Jørgen; Washko, George R.; Wouters, Emiel F.M.; Martinez, Fernando J.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 182, No. 5, 01.09.2010, p. 598-604.

Research output: Contribution to journalComment/debate

Han, MLK, Agusti, A, Calverley, PM, Celli, BR, Criner, G, Curtis, JL, Fabbri, LM, Goldin, JG, Jones, PW, MacNee, W, Make, BJ, Rabe, KF, Rennard, SI, Sciurba, FC, Silverman, EK, Vestbo, J, Washko, GR, Wouters, EFM & Martinez, FJ 2010, 'Chronic obstructive pulmonary disease phenotypes: The future of COPD', American Journal of Respiratory and Critical Care Medicine, vol. 182, no. 5, pp. 598-604. https://doi.org/10.1164/rccm.200912-1843CC
Han, Mei Lan K. ; Agusti, Alvar ; Calverley, Peter M. ; Celli, Bartolome R. ; Criner, Gerard ; Curtis, Jeffrey L. ; Fabbri, Leonardo M. ; Goldin, Jonathan G. ; Jones, Paul W. ; MacNee, William ; Make, Barry J. ; Rabe, Klaus F. ; Rennard, Stephen Israel ; Sciurba, Frank C. ; Silverman, Edwin K. ; Vestbo, Jørgen ; Washko, George R. ; Wouters, Emiel F.M. ; Martinez, Fernando J. / Chronic obstructive pulmonary disease phenotypes : The future of COPD. In: American Journal of Respiratory and Critical Care Medicine. 2010 ; Vol. 182, No. 5. pp. 598-604.
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