Table 1.
Subgroups within COPD with potential management considerations prompted by this Special Issue. Table adapted from Turner et al. [5].
| Subgroup | Established Treatment | Future Management Considerations |
|---|---|---|
| Frequent exacerbator | LABA, LAMA, ICS, roflumilast, macrolides | Optimisation of comorbid physical and mental health conditions [27] |
| Chronic bronchitis | Roflumilast, mucolytics | Use of CFTR modulators [13] |
| Emphysema | Lung volume reduction surgery | Correction of miR overexpression [8] |
| Type 1 respiratory failure | Long-term oxygen therapy | Increased vigilance for VTE in acute illness [29] |
| Type 2 respiratory failure | Domiciliary NIV | Consideration of comorbidities such as OSA/ORRF [21] |
| Eosinophilic COPD | Steroids | Identification of distinct microbiome in eosinophil-predominant COPD [15] Investigation of immunomodulatory alternatives to steroids [30] |
| Bronchiectasis | Targeted antibiotics, chest physiotherapy | Identify severity clusters using biomarkers, to stratify follow-up and hospitalisation [33] |
| α-1 antitrypsin deficiency | LABA, LAMA, ICS | α-1 antitrypsin augmentation therapy [17] |
| Subgroups requiring further study | ||
| Biomass and pollutant COPD | Removal of pollutant exposure | Use of predictive machine-learning to target individuals at greatest risk of pollutant-induced emphysema [31] |
| Premalignant COPD | Smoking cessation | Monitoring markers of oxidative stress and miR genotyping for precision-based chemotherapy [10] |
| Iron-deficient COPD | IV iron replacement | Monitoring hepcidin as a marker for non-anaemic iron deficiency [23] |
| Antimicrobial-resistant COPD | Targeted antibiotics based on culture sensitivities | Use of colour charts to determine commencement of antibiotics [14] |
Key-LABA: long-acting β-agonists; LAMA: long-acting muscarinic antagonists; ICS: inhaled corticosteroids; HRQoL: health-related quality of life; CFTR: cystic fibrosis transmembrane receptor; miR: microRNA; VTE: venous thromboembolism; NIV: noninvasive ventilation; OSA/ORRF: obstructive sleep apnoea/obesity-related respiratory failure; COPD: chronic obstructive pulmonary disease; IV: intravenous.