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Thorax 69:72-79 doi:10.1136/thoraxjnl-2013-203602
  • Review

Moving from the Oslerian paradigm to the post-genomic era: are asthma and COPD outdated terms?

  1. Alvar Agusti13
  1. 1Program Development, CIRO+, A Centre of Expertise in Chronic Organ Failure, Horn, The Netherlands
  2. 2Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  4. 4Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Centre Groningen, Groningen, The Netherlands
  5. 5NIHR Biomedical Research Unit, Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, Barts Health NHS Trust, The London Chest Hospital, London, UK
  6. 6Department of Respiratory Medicine, Barts Health NHS Trust, The London Chest Hospital, London, UK
  7. 7Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
  8. 8Department of Respiratory Medicine, University Hospital of Giessen and Marburg, Marburg, Germany
  9. 9Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Foggia, Italy
  10. 10Pulmonary Department, III medical Centre, Mainz University Hospital, Mainz, Germany
  11. 11Department of Respiratory Diseases, University of Modena and Reggio Emilia Modena, Modena, Italy
  12. 12Department of Respiratory Medicine, Allergy and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
  13. 13Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona and FISIB, CIBER Enfermedades Respiratorias (CIBERES), Mallorca, Spain
  1. Correspondence to Dr Lowie Vanfleteren, Program Development, CIRO+, A Centre of Expertise for Chronic Organ Failure, Hornerheide 1, Horn 6085 NM, The Netherlands; lowievanfleteren{at}ciro-horn.nl
  • Received 20 March 2013
  • Revised 3 May 2013
  • Accepted 30 May 2013
  • Published Online First 22 June 2013

Abstract

In the majority of cases, asthma and chronic obstructive pulmonary disease (COPD) are two clearly distinct disease entities. However, in some patients there may be significant overlap between the two conditions. This constitutes an important area of concern because these patients are generally excluded from randomised controlled trials (mostly because of smoking history in the case of asthma or because of significant bronchodilator reversibility in the case of COPD). As a result, their pathobiology, prognosis and response to therapy are largely unknown. This may lead to suboptimal management and can limit the development of more personalised therapeutic options. Emerging genetic and molecular information coupled with new bioinformatics capabilities provide novel information that can pave the way towards a new taxonomy of airway diseases. In this paper we question the current value of the terms ‘asthma’ and ‘COPD’ as still useful diagnostic labels; discuss the scientific and clinical progress made over the past few years towards unravelling the complexity of airway diseases, from the definition of clinical phenotypes and endotypes to a better understanding of cellular and molecular networks as key pathogenic elements of human diseases (so-called systems medicine); and summarise a number of ongoing studies with the potential to move the field towards a new taxonomy of airways diseases and, hopefully, a more personalised approach to medicine, in which the focus will shift from the current goal of treating diseases as best as possible to the so-called P4 medicine, a new type of medicine that is predictive, preventive, personalised and participatory.