Chronic Obstructive Pulmonary Disease Endotypes in Low- and Middle-Income Country Settings: Precision Medicine for All

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Am J Respir Crit Care Med

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease marked by largely irreversible airflow obstruction due to small airway obstruction and emphysema that results from complex gene–environment interactions over the lifespan of an individual. Although the clinical definition of COPD has existed for more than 50 years, there have been limited advances in therapeutic modalities as a result of heterogeneity in disease expression and natural history. COPD has historically been subcategorized into phenotypes based on pathology (macroscopic emphysema) and clinical presentation (chronic bronchitis, frequent exacerbator, rapid decliner, and asthma–COPD overlap) with an aim of improving treatment outcomes. Endotyping has been proposed to identify subgroups of COPD based on shared biologic underpinnings of pathology with the aim of identifying precision therapies. Furthermore, the classification of COPD and therapeutics to treat and manage this disease have been studied almost exclusively in high-income settings. Over 90% of COPD-related morbidity and mortality occurs in low- and middle-income countries (LMICs) where a significant proportion of those with COPD are never-smokers (2). We propose two potential COPD endotypes based on distinct exposures and related histopathology in LMICs: biomass- and tuberculosis (TB)-associated COPD.

Siddharthan T, Gupte A, Barnes PJ. COPD Endotypes in Low- and Middle-income Country Settings: Precision Medicine for All. Am J Respir Crit Care Med. 2020 May 12. doi: 10.1164/rccm.202001-0165ED. Online ahead of print. PMID: 32396738.