Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2022.0029    [Accepted]
Published online July 13, 2022.
Phenotype of Chronic Obstructive Pulmonary Disease Based on Computed Tomography-Defined Underlying Pathology
Won-Dong Kim, M.D.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Correspondence:  Won-Dong Kim, Tel: 82-10-8880-4491, Fax: 82-2-6083-4087, 
Email: wdkim2@naver.com
Received: 13 March 2022   • Revised: 6 May 2022   • Accepted: 6 July 2022
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease and not all patients respond to available drugs. Identifying respondents to therapy is critical to delivering the most appropriate treatment and avoiding unnecessary medication. Recognition of an individual patient’s dominant characteristics by phenotype is a useful tool to better understand their disease and tailor treatment accordingly. To look for a suitable phenotype, it is important to understand what makes COPD complex and heterogeneous.
The pathology of COPD includes small airway disease and/or emphysema, so COPD is not a single disease entity. In addition, there are two types of panlobular and centrilobular emphysema in COPD. It is therefore conceivable that the coexistence of different pathological subtypes could be the reason for the complexity and heterogeneity of COPD. Then it is necessary to look for the phenotype based on the difference in the underlying pathology. Review of the literature has shown that there is a difference in the clinical manifestation and the therapeutic response to pharmacological therapy depending on the presence of computed tomography (CT)-defined airway wall thickening in COPD patients.
Defining the phenotype of COPD based on the underlying pathology is encouraging as most clinical manifestations can be distinguished by the presence of increased airway wall thickness. Pharmacological therapy has shown significant effects in COPD with airway wall thickening, but limited use in COPD without airway disease. The Phenotype of COPD based on the underlying pathology can be a useful tool to better understand the disease and adjust treatment accordingly.
Key Words: Chronic Obstructive Pulmonary Disease, Phenotype, Small Airway Disease, Emphysema, Panlobular Emphysema, Centrilobular Emphysema


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