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Eur Respir Rev. 2017 Jan 3;26(143). pii: 160010. doi: 10.1183/16000617.0010-2016. Print 2017 Jan.

Personalised medicine in asthma: from curative to preventive medicine.

Author information

1
Dept of Pulmonary Medicine, Reunion Island University Hospital/South Reunion Island Hospital Group, Saint-Pierre, France laurent.guilleminault@chu-reunion.fr.
2
INSERM, UMR 1188 Diabetes-Atherothrombosis Therapies Reunion Island Indian Ocean (DéTROI), Reunion Island Indian Ocean Cyclotron (CYROI) Platform, Sainte-Clotilde, France.
3
University of Reunion Island, UMR 1188, Sainte-Clotilde, France.
4
Dept of Pulmonary Medicine, Angers University Hospital, Angers, France.
5
Dept of Pulmonary Medicine, Rennes University Hospital, Rennes, France.
6
Pulmonary Medicine Practice, St Grégoire Private Hospital, Saint-Grégoire, France.
7
Nantes University Hospital, Nantes-Roscoff National Cystic Fibrosis Reference Centre, Nantes, France.
8
Novartis Pharma, Scientific Operations, Rueil-Malmaison, France.
9
European University of Brittany, University of Brest, EA3878, IFR148, Dept of Internal and Respiratory Medicine, La Cavale Blanche Hospital, Brest, France.
10
UMR_S 1087 CNRS UMR_6291, L'Institut du Thorax, University of Nantes, Nantes, France.

Abstract

The concept of asthma has changed substantially in recent years. Asthma is now recognised as a heterogeneous entity that is complex to treat. The subdivision of asthma, provided by "cluster" analyses, has revealed various groups of asthma patients who share phenotypic features. These phenotypes underlie the need for personalised asthma therapy because, in contrast to the previous approach, treatment must be tailored to the individual patient. Determination of the patient's asthma phenotype is therefore essential but sometimes challenging, particularly in elderly patients with a multitude of comorbidities and a complex exposure history. This review first describes the various asthma phenotypes, some of which were defined empirically and others through cluster analysis, and then discusses personalisation of the patient's diagnosis and therapy, addressing in particular biological therapies and patient education. This personalised approach to curative medicine should make way in the coming years for personalised preventive and predictive medicine, focused on subjects at risk who are not yet ill, with the aim of preventing asthma before it occurs. The concept of personalised preventive medicine may seem a long way off, but is it really?

PMID:
28049124
DOI:
10.1183/16000617.0010-2016
[Indexed for MEDLINE]
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