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Eur Respir Rev. 2019 Jul 8;28(152). pii: 190010. doi: 10.1183/16000617.0010-2019. Print 2019 Jun 30.

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

Author information

1
Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
2
Université de Montpellier, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Dept of Respiratory Diseases, Montpellier, France.
3
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.
4
Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France pascal.chanez@univ-amu.fr.
5
Aix Marseille Université, INSERM, INRA, CV2N, Marseille, France.

Abstract

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.

PMID:
31285287
DOI:
10.1183/16000617.0010-2019
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Conflict of interest statement

Conflict of interest: T. Capron has nothing to disclose. Conflict of interest: A. Bourdin reports personal fees from Novartis, Sanofi, Genentech and Chiesi Farma, and grants and personal fees from GSK, AstraZeneca and Boeringher Ingelheim, outside the submitted work. Conflict of interest: T. Perez reports personal fees from Novartis, Chiesi and Boehringer Ingelheim, and grants from Astra Zeneca, outside the submitted work. Conflict of interest: P. Chanez reports grants and personal fees from ALK, Almirall, Boehringer Ingelheim, GSK, AstraZeneca, Novartis, TEVA and Chiesi, and grants from AMU, outside the submitted work.

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