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1、Toward precision medicine of chronic airway diseases DisclosuresResearch grants/clinical trials:AstraZeneca,GSK,Menarini,MSD Lector for:AstraZeneca,Boheringer-Ingelheim,Chiesi,Menarini,Teva,Novartis,GSK,KyorinMember of scientific(advisory)board:AstraZeneca,Boheringer-Ingelheim,Chiesi,GSK,NovartisCon
2、sultant:NoneEmployer(including part-time):NoneTobacco Industry relationship:NoneOutline Personalized vs.Precision medicine Precision medicine in COPD How are we doing?Are we missing something?How do we implement it in practice?Outline Personalized vs.Precision medicine Precision medicine in COPD How
3、 are we doing?Are we missing something?How do we implement it in practice?Medical practice has ALWAYS been personalized!Population riskIndividual riskWe define precision medicine as treatments targeted to the needs of individual patients on the basis of genetic,biomarker,phenotypic,or psychosocial c
4、haracteristics that distinguish a given patient from other patients with similar clinical presentations.doi:10.1056/NEJMsb1503104Outline Personalized vs.Precision medicine Precision medicine in COPD How are we doing?Are we missing something?How do we implement it in practice?20062011Risk(Exacerbatio
5、n history)2 or 1 hosp.10mMRC 0-1CAT 2CAT 10 CCQ1SymptomsRisk(GOLD Classification of Airflow Limitation)ABCDOutline Personalized vs.Precision medicine Precision medicine in COPD How are we doing?Are we missing something?How do we implement it in practice?Missings Inflammation Pulmonary Systemic Lung
6、cancer DLCO Microbiome Disease activity FEV1 decline Biomarkers Imaging Emphysema Bronchiectasis Molecular imagingProspective clinical trials are required and the mechanism for an apparently increased effect of ICS in COPD patients with higher Blood Eos.count remain unclearMissings Inflammation Pulm
7、onary Systemic Lung cancer Emphysema,DLCO Microbiome Disease activity FEV1 decline Biomarkers Imaging Emphysema Bronchiectasis Molecular imagingDLCO 80%refMissings Inflammation Pulmonary Systemic Lung cancer Emphysema,DLCO Microbiome Disease activity FEV1 decline Biomarkers Imaging Emphysema Bronchi
8、ectasis Molecular imagingMissings Inflammation Pulmonary Systemic Lung cancer Emphysema,DLCO Microbiome Disease activity FEV1 decline Biomarkers Imaging Emphysema Bronchiectasis Molecular imagingVestbo J et al.NEJM365(13):1184-1192,2011Faner R,Agust.Annals ATS 2016;13:S466-S70.Missings Inflammation
9、Pulmonary Systemic Lung cancer Emphysema,DLCO Microbiome Disease activity FEV1 decline Biomarkers Imaging Emphysema Bronchiectasis Molecular imagingMartinez-Garcia MA et al.AJRCCM,2013 Prognostic Value of Bronchiectasisin Moderate-to-Severe COPD0 20 40 60 80 100 Follow-up(months)Cumulative survival1
10、.00.90.80.70.60.50.4Outline Personalized vs.Precision medicine Precision medicine in COPD How are we doing?Are we missing something?How do we implement it in practice?COPDAgusti A.Thorax 69(9):857-864,2014PhenotypesCOPDAgusti A.Thorax 69(9):857-864,2014COPDTreatable TraitsAgusti A.Thorax 69(9):857-8
11、64,2014Eur.Resp.J.2016;47;410We propose here a precision medicine strategy for the management of patients with airway disease that is“label-free”and based on the identification of“treatable traits”in each patient.These traits can be“treatable”based on“phenotypic”recognition or on deep understanding
12、of the critical causal pathways(“endotypes”).Treatable traits can coexist in the same patient and change with time(spontaneously or as a result of treatment)There are pulmonary and extra-pulmonary treatable traits as well as behavioral/social risk factors that merit individual attention and potential treatmentThorax 68:687-690,2013SEVERITYIC/TLCFEV1PaO26MWDComorbid.FEV1 declineSmokingExacerb.WeightBiomarkersACTIVITYIMPACTDaily activityCAT scoremMRCThe COPD control panelOMICSProteomicsMetabolomicsGenomicsAgusti A,MacNee W.Thorax 68:687-690,2013Thank you for your attentionAAGUSTIclinic.cat
医学交流课件：Toward precision medicine of chronic airway diseases
