CHEST Guidelines-Rebuttal-From-Dr-Pavord_2018

Rebuttal-From-Dr-Pavord_2018_chest

Pdf Summary

Dr. Ian D. Pavord's rebuttal in the <em>CHEST</em> journal discusses emerging consensus on inhaled corticosteroids (ICS) for treating Chronic Obstructive Pulmonary Disease (COPD). He agrees with Professor Chalmers on the focused application of ICS in COPD management, emphasizing that treatments should be guided by a biologic pathway rather than an arbitrary label. Blood eosinophil count is highlighted as a robust biomarker for identifying patients who would benefit from corticosteroid treatment, primarily to reduce acute exacerbations. The rebuttal deliberates on the criteria for ICS therapy: whether it should be continued at a threshold of 150 cells/mm³ blood eosinophil count and how it retains predictive value, even in ICS-treated patients.

Dr. Pavord questions the necessity of triple therapy involving ICS, long-acting β2-agonists (LABA), and long-acting muscarinic antagonists (LAMA) in all patients, suggesting that ICS/LABA may suffice for certain profiles. He emphasizes the need for a comprehensive patient history and suggests that physicians must discern patients with reduced exacerbation frequency due to successfully targeted ICS therapy from those inherently at low risk. There is also an emphasis on moving away from generalized treatment approaches to more biomarker-directed treatments in primary care.

Dr. Pavord discusses his financial disclosures and affiliations with various pharmaceutical companies and research organizations, indicating transparency within his research context. He also acknowledges the need to tailor COPD medication treatments, drawing parallels with biomarker-directed cardiovascular risk management in primary care settings. The article advocates for precision in COPD treatment leveraging biomarker data for targeted therapeutic strategies.

Keywords

inhaled corticosteroids

Chronic Obstructive Pulmonary Disease

blood eosinophil count

biologic pathway

COPD management

triple therapy

biomarker-directed treatment

precision medicine

acute exacerbations

ICS therapy criteria