The role of personalized medicine in redefining the clinical management of chronic obstructive pulmonary diseases (COPD)

Abstract

Background. For decades COPD has been managed uniformly based on pulmonary function parameters. Personalized medicine takes into account relevant phenotypes, endotypes, biomarkers, advanced imaging and comorbidities into clinical decision-making shifting from a traditional paradigm to a patient-centered approach. Objective(s). To highlight the different clinical patterns requiring personalized approaches, based on clinical phenotypes, endotypes, and biomarkers predictive of a favorable response to corticosteroids. Materials and methods. A retrospective study analyzing acute COPD hospitalizations in Romanian hospitals between 2015 and 2024. Data source: the National DRG database managed by NIHSM, Bucharest. Hospitalization volume, length of stay, discharge status and 30-day readmission rates, costs associated with various clinical conditions were assessed. Results. Over 200,000 acute hospitalization episodes with a primary diagnosis of COPD (ICD-10 = J44) were identified, most coded as acute exacerbations. The average length of stay varied by severity, with a mean of 7.3 days, and the 30-day readmission rate exceeded 15%. The detailed cost analysis revealed significant variations depending on comorbidities, age, and severity score, with the patient's biological and clinical profile being essential for effective management. The need for artificial Intelligence (AI) through clinical decision algorithms was analyzed for risk stratification and optimal treatment selection for COPD. Conclusion(s). Analyzed clinical reality supports the need for more precise patient stratification and differentiated management. Among the challenges were: access to specific laboratory and imaging tests; cost of biologic therapies; need for continuous medical education on personalized medicine.