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COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside

Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classi...

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Detalles Bibliográficos
Autores principales: Capron, Thibaut, Bourdin, Arnaud, Perez, Thierry, Chanez, Pascal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488991/
https://www.ncbi.nlm.nih.gov/pubmed/31285287
http://dx.doi.org/10.1183/16000617.0010-2019
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author Capron, Thibaut
Bourdin, Arnaud
Perez, Thierry
Chanez, Pascal
author_facet Capron, Thibaut
Bourdin, Arnaud
Perez, Thierry
Chanez, Pascal
author_sort Capron, Thibaut
collection PubMed
description Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction. Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.
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spelling pubmed-94889912022-11-14 COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside Capron, Thibaut Bourdin, Arnaud Perez, Thierry Chanez, Pascal Eur Respir Rev Review Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction. Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability. European Respiratory Society 2019-07-08 /pmc/articles/PMC9488991/ /pubmed/31285287 http://dx.doi.org/10.1183/16000617.0010-2019 Text en Copyright ©ERS 2019. https://creativecommons.org/licenses/by-nc/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.
spellingShingle Review
Capron, Thibaut
Bourdin, Arnaud
Perez, Thierry
Chanez, Pascal
COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
title COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
title_full COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
title_fullStr COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
title_full_unstemmed COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
title_short COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
title_sort copd beyond proximal bronchial obstruction: phenotyping and related tools at the bedside
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9488991/
https://www.ncbi.nlm.nih.gov/pubmed/31285287
http://dx.doi.org/10.1183/16000617.0010-2019
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