Thorax 2013;68:691-694 doi:10.1136/thoraxjnl-2012-202646

• Chest clinic

• Opinion

Multidimensional assessment and tailored interventions for COPD: respiratory utopia or common sense?

1. Vanessa M McDonald1,2,3, 
2. Isabel Higgins1, 
3. Lisa G Wood3,4, 
4. Peter G Gibson2,4,5

+Author Affiliations

1. ¹School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
2. ²School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
3. ³Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
4. ⁴School of Biomedical Science, University of Newcastle, Newcastle, New South Wales, Australia
5. ⁵Woolcock Institute of Medical Research, Sydney, New South Wales, Australia

1. Correspondence toPeter G Gibson, Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Locked Bag #1000, New Lambton, NSW 2305, Australia;peter.gibson@hnehealth.nsw.gov.au

• Received 27 August 2012
• Revised 7 February 2013
• Accepted 11 February 2013
• Published Online First 16 March 2013

Abstract

Introduction The rising disease burden from chronic obstructive pulmonary disease (COPD) requires new approaches.

Method We suggest an approach based around three elements: inflammometry and multidimensional assessment to identify therapeutic targets and case management to design and implement an individualised treatment programme based on these assessments.

Discussion This tailored approach to treatment would maximise efficacy, limit cost and permit a better risk–benefit ratio of treatment. The advantages include the ability to add up the benefits of individual therapies leading to a cumulative therapeutic benefit that is greater than each individual therapy alone. We can now design a multifaceted inflammometry intervention for airway diseases based on targeting eosinophilic inflammation, non-eosinophilic pathways and systemic inflammation. COPD is a complex and challenging disease. The use of inflammometry and multidimensional assessment is necessary to identify relevant treatment targets and maximise the scope of therapy while limiting unnecessary use of drugs. An individualised programme of management can be designed and coordinated by using a case manager. This new approach may provide tangible benefits to people with COPD.

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