Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Peer reviewer login
  • Journal club
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Peer reviewer login
  • Journal club
  • Alerts
  • Subscriptions

Targeted therapy in respiratory disease

Brian D. Kent
Breathe 2021 17: 210170; DOI: 10.1183/20734735.0170-2021
Brian D. Kent
1Dept of Respiratory Medicine, St James’ Hospital, Dublin, Ireland
2School of Medicine, Trinity College Dublin, Dublin, Ireland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: briankent@physicians.ie
  • Article
  • Info & Metrics
  • PDF
Loading

Abstract

Advances in understanding of respiratory diseases have allowed the development of targeted therapies tailored to the individual patient https://bit.ly/3CEhokk

Until recently, the management of respiratory disease often relied upon relatively broad and untargeted therapeutic approaches. Patients with severe asthma were by necessity plied with oral corticosteroids (OCS), controlling their airways disease but at the cost of significant medication-related morbidity. COPD management was heavily based on lung function measures ahead of other clinical considerations. People with both cystic fibrosis (CF) and non-CF bronchiectasis were given similar combinations of airway clearance techniques and antibiotics. Clinicians managing interstitial lung disease (ILD) clinics had little evidence to guide care of their patients, particularly those with an ILD other than idiopathic pulmonary fibrosis. Things have changed though, and changed dramatically.

The past 20 years have seen parallel revolutions in our understanding of these diseases, in the underlying pathobiological processes driving them, and in the development of treatment approaches tailored to the individual patient and their illness. In this issue of Breathe we explore how patient care has evolved in the management of severe asthma, of CF, of COPD, of non-CF bronchiectasis, and of connective tissue disease (CTD)-related ILD, allowing personalised and targeted treatment to replace the broader brush strokes of the past.

Severe asthma is perhaps the exemplar disease here. The characterisation of the inflammatory pathways underlying asthmatic airways disease has facilitated the development of a growing family of biologic agents with proven ability to improve disease control and to reduce both exacerbation frequency and OCS exposure. Clinicians managing the care of patients with severe asthma now face the pleasant dilemma of having to decide which one of these drugs would best suit each individual. Kavanagh et al. [1] discuss these therapies and their evidence base, and discuss a framework for choosing the right drug for the right patient. Strides have also been made in personalising COPD care, where it has become clear that a uniform therapeutic approach based on lung function or other severity classifications may not always yield the best outcomes. Duszyk et al. [2] describe how using treatable traits, such as markers of airway inflammation, can be used to guide appropriate treatment in COPD.

Meanwhile, the outlook for people diagnosed with CF has been transformed by the use of cystic fibrosis transmembrane conductance regulator (CFTR)-potentiating medications, designed on the back of advances in understanding of CFTR pathobiology. The use and selection of these agents, and their impact on outcomes, is discussed in depth by Tewkesbury et al. [3]. Non-CF bronchiectasis has for many years been a Cinderella disease in respiratory medicine, with little high-quality laboratory or clinical data available to guide an empirical understanding of patient care. Pembridge and Chalmers [4] show how our understanding of bronchiectasis has progressed to the point where genuine individualised care for these often frail patients is now possible. Finally, Wu and Molyneaux [5] describe how emerging clinical trial data help them select appropriate therapy for their patients with CTD-related ILD.

As a whole, the contents of this issue of Breathe stand as testimony to the contribution of thousands of patients, scientists and clinicians in characterising these diseases, in developing new therapies, and in identifying which new treatments actually work. Huge strides have been made, but the need for further advances is demonstrated in a Patient Voice article describing the successes and frustration associated with receiving biologic therapy for severe asthma [6]. The new treatments we have at our disposal can be transformative for some patients, but are not a universal panacea.

This is my first issue as Chief Editor of Breathe. I'd like to start my 3-year tenure/reign of terror by paying tribute to my immediate predecessor, Prof. Claudia Dobler. Claudia continued the work of previous Breathe editors in making the journal synonymous with high-quality clinical education, and introduced innovative multidisciplinary educational content, such as the popular Lung Function Corner series. At a personal level, she was a great source of advice and guidance, always open to suggestions that could help strengthen the journal. I'd also like to thank the departing members of the Editorial Board for all their work over the past 3 years.

I am delighted to welcome Dr Jayesh Bhatt as Deputy Chief Editor. A veteran Breathe Associate Editor, Jayesh's appointment will allow us to further develop our educational content in paediatric respiratory medicine. Welcome also to our new Associate Editors and ERS Assembly Secretaries, all of whom join the incoming Breathe Editorial Board. I greatly look forward to working with you all to ensure that Breathe remains a benchmark for respiratory clinical education.

Finally, many of you will have read of the recent death of Kai-Håkon Carlsen. Prof. Carlsen held several pivotal roles with the ERS over his long and distinguished career, but also played a key part in the development of an ERS educational journal, which eventually became Breathe. The thoughts of the Breathe editorial team are with his family.

Footnotes

  • Conflict of interest: B.D. Kent has participated in advisory boards and/or received speaker fees from Astra Zeneca, Chiesi, GSK, Novartis, and Teva; has received educational travel bursaries from Boehringer Ingelheim, Chiesi, and Napp; and has received research funding from Itamar Medical.

  • Received November 18, 2021.
  • Accepted November 19, 2021.
  • Copyright ©ERS 2021
http://creativecommons.org/licenses/by-nc/4.0/

Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

References

    1. Kavanagh JE,
    2. Hearn AP,
    3. Jackson DJ
    . A pragmatic guide to choosing biologic therapies in severe asthma. Breathe 2021; in press [https://doi.org/10.1183/20734735.0144-2021].
    1. Duszyk K,
    2. McLoughlin RF,
    3. Gibson PG, et al.
    The use of treatable traits to address COPD complexity and heterogeneity and to inform the care. Breathe 2021; in press [https://doi.org/​10.1183/20734735.0118-2021].
    1. Tewkesbury DH,
    2. Robey RC,
    3. Barry PJ
    . Progress in precision medicine in cystic fibrosis: a focus on CFTR modulator therapy. Breathe 2021; in press [https://doi.org/​10.1183/​20734735.0112-2021].
    1. Pembridge T,
    2. Chalmers JD
    . Precision medicine in bronchiectasis. Breathe 2021; 17: 210119. Doi: 10.1183/20734735.0119-2021
    OpenUrlAbstract/FREE Full Text
    1. Wu Z,
    2. Molyneaux PL
    . Choosing pharmacotherapy for ILD in patients with connective tissue disease. Breathe 2021; 17: 210114. Doi: 10.1183/20734735.0114-2021
    OpenUrlFREE Full Text
    1. Denning J,
    2. Negus J,
    3. Cullen N
    . Patient experience of biologic treatment for severe asthma: the good, the outstanding and the deeply frustrating. Breathe 2021; in press [https://doi.org/​10.1183/20734735.0145-2021].
PreviousNext
Back to top
Vol 17 Issue 4 Table of Contents
Breathe: 17 (4)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Targeted therapy in respiratory disease
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Targeted therapy in respiratory disease
Brian D. Kent
Breathe Dec 2021, 17 (4) 210170; DOI: 10.1183/20734735.0170-2021

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Targeted therapy in respiratory disease
Brian D. Kent
Breathe Dec 2021, 17 (4) 210170; DOI: 10.1183/20734735.0170-2021
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Footnotes
    • References
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

  • Infectious disease in respiratory medicine
  • The COVID-19 Surge in Indonesia
Show more Editorials

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About Breathe

  • Journal information
  • Editorial board
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Intructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN: 1810-6838
Online ISSN: 2073-4735

Copyright © 2022 by the European Respiratory Society