Table Of ContentSang-Do Lee
Editor
COPD
Heterogeneity and
Personalized Treatment
123
COPD
Sang-Do Lee
Editor
COPD
Heterogeneity and Personalized
Treatment
Editor
Sang-Do Lee
Department of Pulmonary and Critical Care Medicine
Asan Medical Center University
of Ulsan College of Medicine
Seoul
South Korea
ISBN 978-3-662-47177-7 ISBN 978-3-662-47178-4 (eBook)
DOI 10.1007/978-3-662-47178-4
Library of Congress Control Number: 2017947875
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Preface
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity
and mortality worldwide. Over the last few decades, the study of COPD has
become one of the most rapidly developing fields in medicine. The recent years
have provided clinicians and researchers with major advances in the under-
standing of underlying mechanisms in COPD. In the past decades, COPD was
classified solely on the basis of the degree of airflow limitation. Nowadays,
COPD is regarded as a heterogeneous disease, with multiple etiological factors,
clinical phenotypes, and comorbidities. One of the main reasons for poor
understanding and poor treatment is the heterogeneity of COPD. The strategy
for the management of COPD is moving toward a more personalized approach
compared with the historical approach. Dissecting the heterogeneity would
lead to a better understanding and effective personalized treatment of COPD.
Airway Vista, also known as Chronic Obstructive Airway Diseases
Symposium, has been hosted by the Obstructive Lung Disease Research
Foundation in South Korea since 2008. This academic event is designed to offer
respiratory health professionals new horizons in their understanding of COPD
and asthma. The scientific program of the symposium includes the most signifi-
cant advances in the researches of chronic airway diseases, COPD, asthma, and
pulmonary functional imaging. We have held Airway Vista successfully every
year, featuring more than 50 world-renowned speakers respectively. This year
(2017) has marked the 10th anniversary of Airway Vista. To celebrate the
achievements of this 10-year-old symposium, we decided to publish a textbook
by gathering the contents of previous symposium programs. We have tried to
provide readers with an overview of COPD, the current understanding of its
pathobiology, and a contemporary approach to diagnosis and treatment. With
this goal in mind, a group of experts took the task of developing this publica-
tion, focusing on essential issues that all providers should be aware of.
The first chapter of this book covers overviews of COPD which include
the current definition, epidemiology, risk factors, and pathogenesis of COPD.
The second chapter is comprised of diagnosis and assessment given to COPD
patients. In Chap. 3, COPD heterogeneity was described in a clinical pheno-
type as well as radiological and genetic aspects. Various pharmacological and
nonpharmacological management strategies are reviewed based on evidence
in the fourth chapter. The final chapter outlines a future perspective on COPD.
This book presents state-of-the-art knowledge on issues related to heteroge-
neity, such as phenotypes (clinical, physiological, radiological, etc.), geno-
types, tools to be used for dissecting heterogeneity (CT/MRI/Scan, Biomarkers
v
vi Preface
etc.), and tailored treatment strategies in each subgroup of patients. Especially,
radiologic imaging is a new promising tool for this issue and will be presented
in detail with numerous figures. A further key feature is presentation about the
current and future treatment strategies for tailored medicine including broncho-
scopic lung volume reduction, pulmonary hypertension, and comorbidity man-
agement. This textbook will become a great asset in clinical practice and
research to all who are involved or interested in COPD.
I would like to acknowledge the work done by the members of the Korean
Obstructive Lung Disease (KOLD) Cohort Study who contributed to the
preparation of this book. We are especially grateful to all contributing authors
from abroad: Norbert Voelkel, Edwin Silverman, Meilan Han, Paul Jones,
Rubin Tuder, and Nurdan Kokturk. Finally we wish to thank our families for
their patience and consistent support during our academic lives.
I hope that all readers will find these chapters as helpful and insightful as
we have.
Seoul, South Korea Sang-Do Lee
Contents
Part I Overview
1 Definition and Epidemiology of COPD . . . . . . . . . . . . . . . . . . . . . . 3
Young Sam Kim
2 Risk Factors: Factors That Influence Disease
Development and Progression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Ji Ye Jung
3 Pathology of Chronic Obstructive Pulmonary Diseases . . . . . . . 17
Rubin M. Tuder
4 Pathogenesis of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Ji-Hyun Lee
Part II Assessment
5 Pathophysiology of COPD � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 57
Eun Kyung Kim
6 Diagnosis and Assessment of COPD . . . . . . . . . . . . . . . . . . . . . . . 65
Yong Bum Park
7 Symptomatic Assessment of COPD . . . . . . . . . . . . . . . . . . . . . . . . 75
Paul W. Jones
8 Imaging of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Sang Min Lee, Sang Min Lee, Song Soo Kim, Hye Jeon Hwang,
and Joon Beom Seo
9 Biomarkers of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Ho Il Yoon
Part III Heterogeneity
10 Phenotypes of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Jamie Sheth and MeiLan Han
11 Genetics of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Woo Jin Kim
vii
viii Contents
12 Imaging Heterogeneity of COPD . . . . . . . . . . . . . . . . . . . . . . . . . 179
Sang Min Lee and Joon Beom Seo
13 Asthma-COPD Overlap Syndrome . . . . . . . . . . . . . . . . . . . . . . . 189
Chin Kook Rhee
14 The Spectrum of Pulmonary Disease in COPD . . . . . . . . . . . . . 195
Norbert F. Voelkel, Shiro Mizuno,
and Carlyne D. Cool
Part IV Management
15 Prevention of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
HyoungKyu Yoon
16 Pharmacologic Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Seong Yong Lim
17 Non-pharmacologic Management: LVR,
Rehabilitation, and Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Sei Won Lee and Eun Mi Kim
18 Exacerbation of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Jin Hwa Lee
19 Comorbidities: Assessment and Treatment . . . . . . . . . . . . . . . . 267
Nurdan Kokturk, Ayse Baha, and Nese Dursunoglu
20 Personalized Treatment in COPD . . . . . . . . . . . . . . . . . . . . . . . . 299
Jae Seung Lee and Sang-Do Lee
Part V Prospectives
21 Cohort Study in COPD: Introduction to COPD
Cohorts (The KOLD and COPDGene Study)
and Collaborative Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Deog Kyeom Kim
22 Big Data and Network Medicine in COPD . . . . . . . . . . . . . . . . . 321
Edwin K. Silverman
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Part I
Overview
1
Definition and Epidemiology
of COPD
Young Sam Kim
Definition of COPD lung function impairment and prognosis [2].
Traditionally, COPD has been classified as
Chronic Obstructive Pulmonary Disease (COPD) chronic bronchitis (CB) and emphysema. CB is
is a common disease and prevalence is increasing defined as the presence of a chronic productive
worldwide. It is characterized by persistent air- cough for 3 months in each of two consecutive
way obstruction that is partially reversible but it years. Emphysema is defined as the destruction
is considered preventable and treatable disease of alveolar walls and permanent enlargement of
now. Airflow limitation is associated with chronic the airspaces distal to the terminal bronchioles.
and abnormal inflammatory response in the air- Current GOLD guidelines do not include the use
ways and the lung to noxious stimuli [1]. Airway of these terms in the definition of COPD. Asthma
obstruction is defined by a reduction of expira- and COPD represent different disease entity with
tory airflow. Generally, forced expiratory volume different pathogeneses and risk factors.
in 1 s/forced volume capacity (FEV/FVC) ratio Sometimes clinical manifestations of both dis-
1
of less than 70% after bronchodilator has been eases may overlap in a patient with airway
used to identify COPD patient. The use of lower obstruction and cannot be classified as COPD or
limit of normal (LLN) values has been proposed asthma only. Large population studies show that
to define airflow limitation by spirometry, but some of the patients with airway obstruction are
current Global initiative for chronic Obstructive classified with more than one diagnosis.
Lung Disease (GOLD) and American Thoracic Therefore, overlapping diagnoses of asthma and
Society/European Respiratory Society guidelines COPD has been proposed and it is called COPD
continue to recommend the fixed ratio criteria and Asthma Overlap Syndrome (ACOS) [1].
instead of an LLN for the diagnosis of COPD [1].
Patients with COPD have shown a great deal of
heterogeneity and can be classified according to Epidemiology of COPD
their clinical and radiologic parameters, biomarkers,
COPD is a leading cause of morbidity and
mortality worldwide. The prevalence and bur-
den of COPD is increasing now. It is due to
continued exposure of risk factors especially
Y.S. Kim smoking and aging population. Estimate of
Division of Pulmonology, Department of Internal
prevalence and incidence of COPD is different
Medicine, Severance Hospital, Yonsei University
according to the study population and diagnos-
College of Medicine, Seoul, South Korea
e-mail: [email protected] tic criteria [2, 3].
© Springer-Verlag Berlin Heidelberg 2017 3
S.-D. Lee (ed.), COPD, DOI 10.1007/978-3-662-47178-4_1
