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...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2019-07-01
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| Series: | European Respiratory Review |
| Online Access: | http://err.ersjournals.com/content/28/152/190010.full |
| _version_ | 1819210954221551616 |
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| author | Thibaut Capron Arnaud Bourdin Thierry Perez Pascal Chanez |
| author_facet | Thibaut Capron Arnaud Bourdin Thierry Perez Pascal Chanez |
| author_sort | Thibaut Capron |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-23T06:19:23Z |
| format | Article |
| id | doaj.art-86dfc789b1074aec9dcb06aa63741aa2 |
| institution | Directory Open Access Journal |
| issn | 0905-9180 1600-0617 |
| language | English |
| last_indexed | 2024-12-23T06:19:23Z |
| publishDate | 2019-07-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | European Respiratory Review |
| spelling | doaj.art-86dfc789b1074aec9dcb06aa63741aa22022-12-21T17:57:14ZengEuropean Respiratory SocietyEuropean Respiratory Review0905-91801600-06172019-07-012815210.1183/16000617.0010-20190010-2019COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedsideThibaut Capron0Arnaud Bourdin1Thierry Perez2Pascal Chanez3 Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France Université de Montpellier, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Dept of Respiratory Diseases, Montpellier, France Dept of Respiratory Diseases, CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019 - CNRS UMR 8204, Université Lille Nord de France, Lille, France Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France 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.http://err.ersjournals.com/content/28/152/190010.full |
| spellingShingle | Thibaut Capron Arnaud Bourdin Thierry Perez Pascal Chanez COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside European Respiratory Review |
| 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 |
| url | http://err.ersjournals.com/content/28/152/190010.full |
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