Clinical phenotyping is currently used to guide pharmacological treatment decisions in
chronic obstructive pulmonary disease (
COPD), a personalized approach to care.
Precision medicine integrates biological (endotype) and clinical (phenotype) information for a more individualized approach to
pharmacotherapy, to maximize the benefit versus risk ratio.
Biomarkers can be used to identify endotypes. To evolve toward
precision medicine in
COPD, the most appropriate
biomarkers and clinical characteristics that reliably predict treatment responses need to be identified. FEV1 is a marker of
COPD severity and has historically been used to guide
pharmacotherapy choices. However, we now understand that the trajectory of FEV1 change, as an
indicator of disease activity, is more important than a single FEV1 measurement. There is a need to develop
biomarkers of disease activity to enable a more targeted and individualized approach to
pharmacotherapy. Recent clinical trials testing commonly used
COPD treatments have provided new information that is likely to influence pharmacological treatment decisions both at initial presentation and at follow up. In this Perspective, we consider the impact of recent clinical trials on current
COPD treatment recommendations. We also focus on the movement toward
precision medicine and propose how this field needs to evolve in terms of using clinical characteristics and
biomarkers to identify the most appropriate patients for a given pharmacological treatment.