Addressing treatable traits important part of precision medicine in COPD

Breakthroughs in COPD care are not always dramatic innovations but often consist of quieter, meaningful advances that improve patient outcomes, says prof. Nicholas Roche. Individualised and precision-based treatment built on treatable traits needs to be paired with evidence-supported interventions, such as rehabilitation, bronchoscopy procedures and structured non-pharmacological care models, as highlighted in this session. Overall, Roche underscored that understanding phenotypes, endotypes, and patient preferences is key to tailoring effective COPD management.

Don’t underestimate the impact of subtle improvements

The session challenged one of the most fundamental dogmas in respiratory medicine: that sPharmacological progress shows promise for selected patient subgroups, though not at the transformative scale seen in asthma. Treatment of acute exacerbations is also evolving, with growing evidence supporting inflammation‑guided therapy rather than routine corticosteroid use.

In his talk, Nicolas Roche started to define a breakthrough by specifying that a breakthrough does not mean spectacular. The concept of «breakthrough» extends beyond new groundbreaking pharmaceuticals associated with dramatic progress, as seen in asthma care. Instead, breakthroughs can also be found in more subtle improvements that help redefine patient care and outcomes.

"There are many interventions and initiatives that are developed and does not make a lot of noise but mean a lot for the patients"

- Prof N. Roche

Personalised medicine: Treat what can be treated

The general principle for modern COPD-care should be individualised treatment. Main guiding principle should be a precision medicine approach based on treatable traits – clinical traits we can target with treatment. In the last decade, the concept of treatable traits has become central in COPD management. This involves identifying phenotypes and endotypes to categorise patients into subgroups that can be targeted with individualised care strategies.¹

Goal: Symptom relief and less disease progression

The goal of the treatment should be structured around two main objectives, relieve symptoms and prevent disease progression.² There is extensive evidence that shows benefit of pulmonary rehabilitation when it comes to relieving of symptoms. However, the implementation of such programs remains a challenge.³ The key advancement is that there are emerging several type of programs so healthcare professionals are able to tailor rehabilitation programs to suit each patient’s preferences.

For patients with advanced emphysema and severe lung destruction, options such as surgical lung volume reduction and interventional bronchoscopy are available. Current guidelines from leading respiratory societies indicate that both surgical and endoscopic interventions are effective.² While these may not be sensational breakthroughs, they provide valuable options, allowing treatment to be tailored through shared decision-making that considers anatomy, side effects, and costs.

Promising pharmacological treatments

Biologics is treament breakthrough for COPD. There are currently a couple of antibodies targeting different inflammatory pathways, showing promising results. These therapies are in early stages and more data is needed to guide treatment in this directions.² Professor Roche states that there is great promise for biologics in COPD, but believes that it will not be revolutionise treatment of COPD.

Non-pharmacological interventions

Procedures such as targeted lung denervation via bronchoscopy have shown promise, though recent studies reveal the importance of patient selection.⁴

Vaccination still is essential and new data support its central role in reducing hospitalisations among COPD patients.⁵ Integrated care models, such as self-management, home monitoring and e-health, can reduce mortality when properly implemented, though effectiveness depends on the specific components included.²

Treatment for acute exacerbations

The treatment of acute exacerbations is also evolving. Inflammatory profiles may be a way to individualise therapy, as highlighted in recent studies. For example, patients with low eosinophil counts had fewer treatment failures when receiving placebo in one study, compared to when those receiving oral corticosteroid.⁶ Professor Roche advised against treating low eosinophilic patients acutely with oral corticosteroids. Treatment of acute exacerbations with biologics shows varying, but promising results, depending on the drug used.

Conclusion: the sum of improvements offer new hope in COPD

Better understanding of patient phenotypes, endotypes, and treatable traits is needed, concluded Prof Roche. This approach enables health care professionals to tailor treatment decisions to individual patients. There has been significant progress in new non-pharmacological therapies, including digital health, telerehabilitation, and bronchoscopy. Additionally, several breakthroughs have occurred in pharmacological treatments, such as the application of biologics to specific patient subgroups.

Although not all advances are dramatic, they collectively offer new hope for patients.