Expertentreffen COPD: Personalisierte Therapie der COPD – Wunsch oder Wirklichkeit?^[*]

Zusammenfassung

Die chronische obstruktive Lungenerkrankung (COPD) wird als komplexe und heterogene Erkrankung betrachtet, die aus mehreren Komponenten besteht. Ihre klinische Erscheinungsform, die Art der Funktionsstörung, der Verlauf und die Pathologie variiert erheblich zwischen individuellen Patienten trotz der Gemeinsamkeit einer unvollständig reversiblen Einschränkung des Atemflusses. Es gilt daher als akzeptiert, dass die COPD sich durch verschiedenartige Phänotypen auszeichnet, die prognostisch relevante Endpunkte wie Symptome, Exazerbationen, Funktionsverlust und Tod beeinflussen. Solche COPD-Phänotypen erfordern wahrscheinlich gezielte Behandlungsstrategien im Sinne der personalisierten Therapie.

In dieser Übersicht, die als Resultat der Präsentation von Referaten im Rahmen einer Expertentagung erscheint, wird die Bedeutung genetischer, morphologischer und entzündlicher Phänotypen und wichtiger Komorbiditäten für den klinischen Verlauf und die Therapie diskutiert.

Abstract

Chronic obstructive pulmonary disease (COPD) is considered to be a complex and heterogeneous disease comprising multiple components. Its clinical presentation, pattern of functional disturbance, disease presentation and pathology varies tremendously between individuals despite the common feature of incompletely reversible airflow obstruction. It is therefore widely accepted that COPD is characterized by discriminable phenotypes that represent specific patterns of these disease features. COPD phenotypes are believed to correlate with outcome parameters such as severity of symptoms, exacerbations, functional loss or death and to require different treatment algorithms.

This survey is the result of presentations that were given during an expert conference. It highlights the significance of major comorbidities, genetic, morphologic and inflammatory COPD-phenotypes and their impact on disease progression and treatment modalities.

Fazit

Bei COPD-Patienten wurden fünf wesentliche Veränderungen der Skelettmuskulatur nachgewiesen: eine Muskelatrophie, veränderte Anteile von Muskelfasern Typ I und Typ II, eine verringerte oxidative Kapazität, eine Dysfunktion der Mitochondrien und eine geringere Muskelkraft im Oberschenkel [60]. Abbauprozesse in der Muskulatur können heutzutage gut quantifiziert werden. Ärzte sollten ihre Patienten früher als bisher dazu motivieren, dem Fortschreiten dieser Veränderungen durch geeignete Programme zur Steigerung der körperlichen Aktivität entgegenzutreten.

^* Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG

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