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Bioclinical phenotyping may benefit diagnosis of chronic airway disease

Bioclinical phenotyping of asthma and chronic obstructive pulmonary disease may be the future of diagnosing these chronic diseases, according to a recent analysis.

Peter J. Sterk, MD, of the department of respiratory medicine at University of Amsterdam, said that bioclinical phenotyping is the next step after following gold standard protocols for pattern-recognition diagnosis outlined by the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD).

“This concept of adequately phenotyping patients with airway disease was originally launched by De Vries et al in 1968, who at that time promoted the usage of various inhalation challenge tests to obtain an individual phenotype of a patient with chronic airway disease,” he wrote. “Now, we can sample biology and (ultra) structure, which eventually provides phenotypes that more precisely represent the status of the organism. This is not only suitable for more adequately selecting patients for existing or newly available therapies (treatable traits), but also for adequately describing comorbidities and for as-yet nontreatable traits that require the development of novel treatment modalities.”

However, Sterk recommends that with this ability to phenotype patients should come a re-evaluation of asthma and COPD that incorporates a more complex biology, including “cellular, molecular and morphometric parameters.”

“For chronic airway diseases like asthma and COPD, Agusti et al not only propose pulmonary function and airway hyperresponsiveness to be included for capturing the traits, but also computed tomography, and cellular and molecular markers in blood, sputum and exhaled air, together with sensitive microbial analysis,” he wrote. “These measures are meant to capture phenotypes of chronic airway disease that can be linked to evidence-based therapeutic choices.”

Although Agusti and colleagues describe treatable traits for chronic airway diseases, Sterk recommends that researchers ultimately adopt this new way forward, rather than relying on the precision medicine strategy as an adjunct to the historical diagnosis gold standard. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.