New article from ERJ Open Research by Celli and Agusti is dedicated to hot topic in COPD: new classification with absolutely fresh approach!
Due to well-conducted epidemiological studies and advances in genetics,
molecular biology, translational research, the advent of computed
tomography of the lungs and bioinformatics, the diagnosis of chronic
obstructive pulmonary disease (COPD) as a single entity caused by
susceptibility to cigarette smoke is no longer tenable. Furthermore, the
once-accepted concept that COPD results from a rapid and progressive
loss of lung function over time is not true for a sizeable proportion of
adults with the disease. Now we know that some genetic predisposition
and/or different environmental interactions (nutritional, infectious,
pollution and immunological) may negatively modulate post-natal lung
development and lead to poorly reversible airflow limitation later in
life, consistent with COPD.
We believe it is time to rethink the
taxonomy of this disease based on the evidence at hand. To do so, we
have followed the principles outlined in the 1980s by J.D. Scadding who
proposed that diseases can be defined by four key characteristics: 1)
clinical description (syndrome), 2) disorder of structure (morbid
anatomy), 3) disorder of function (pathophysiology) and 4) causation
(aetiology).
Here, we propose a pragmatic approach to the taxonomy of
COPD based on different processes that result in a similar syndromic
presentation. It can accommodate changes over time, as the pathobiology
that may lead to COPD expands. We hope that stakeholders in the field
may find it useful to better define the patients now boxed into one
single entity, so that specific studies can be designed and conducted
for each type of COPDs.
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