Integrating Comorbidities and Phenotype-Based Medicine in Patient-Centered Medicine in COPD
Abstract
:1. Introduction
2. The First Dilemma: Does the Patient Have COPD
2.1. What Is ACO
2.2. How to Identify an ACO
2.3. How to Treat ACO
3. The Second Dilemma: How Do I Start Therapy
4. The Third Dilemma: What If the Patient Does not Respond to Initial Therapy
5. The Fourth Dilemma: How Do I Organize Follow-Up
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Asthma | COPD |
---|---|
Clinical presentation (for suspicion) | |
Symptoms:
| Symptoms:
|
Distribution of symptoms:
| Distribution of symptoms:
|
Complementary tests (for confirmation) | |
Documented excessive variability in lung function with documented expiratory airflow limitation, with any of the following:
| Spirometry is required to make the diagnosis in this clinical context; the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD in patients with appropriate symptoms and significant exposures to noxious stimuli. |
Comorbidities | Complementary Test |
---|---|
Respiratory conditions | |
Bronchial asthma | Re-evaluation of asthma diagnostic criteria |
Bronchiectasis | High-resolution CT scan |
Chronic bronchial infection | Sputum culture |
Lung hyperinflation | Lung volumes and diffusing capacity High-resolution CT scan |
Alpha1-antitripsyn deficiency | Serum alpha1-antitrypsin, if not yet done |
Lung cancer | Chest radiography/CT scan |
Pleural effusion | Chest radiography |
Sleep apnea | Sleep study |
Interstitial lung disease (emphysema-fibrosis) | High-resolution CT scan |
Non-respiratory conditions | |
Cardiovascular disease | Electrocardiogram + echocardiography Cardiopulmonary exercise testing |
Muscle deconditioning | Exercise testing |
Malnutrition | Evaluation of nutritional status |
Mood disorders | Mood disorder screening |
Anemia/polyglobulia | Blood cell count |
Hypothyroidism | Thyroid function |
Liver insufficiency | Liver function |
Kidney insufficiency | Kidney function |
Gastro-esophageal reflux | Endoscopy 24 h esophageal pH test |
Vitamin D deficiency | Vitamin D measurement |
Primary or secondary immune deficiencies | Immune function analyses |
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Lopez-Campos, J.L.; Ruiz-Duque, B.; Carrasco-Hernandez, L.; Caballero-Eraso, C. Integrating Comorbidities and Phenotype-Based Medicine in Patient-Centered Medicine in COPD. J. Clin. Med. 2020, 9, 2745. https://doi.org/10.3390/jcm9092745
Lopez-Campos JL, Ruiz-Duque B, Carrasco-Hernandez L, Caballero-Eraso C. Integrating Comorbidities and Phenotype-Based Medicine in Patient-Centered Medicine in COPD. Journal of Clinical Medicine. 2020; 9(9):2745. https://doi.org/10.3390/jcm9092745
Chicago/Turabian StyleLopez-Campos, José Luis, Borja Ruiz-Duque, Laura Carrasco-Hernandez, and Candelaria Caballero-Eraso. 2020. "Integrating Comorbidities and Phenotype-Based Medicine in Patient-Centered Medicine in COPD" Journal of Clinical Medicine 9, no. 9: 2745. https://doi.org/10.3390/jcm9092745