Author:
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Agustí García-Navarro, Àlvar; Compte, Albert; Faner, Rosa; García Aymerich, Judith; Noell, Guillaume; Cosío, Borja G.; Rodriguez-Roisin, Robert; Celli, Bartolome R.; Anto, Josep Maria
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Abstract:
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The natural history of chronic obstructive pulmonary disease
(COPD) is still not well understood. Traditionally believed to
be a self-inflicted disease by smoking, now we know that not all
smokers develop COPD, that other inhaled pollutants different
from cigarette smoke can also cause it, and that abnormal lung
development can also lead to COPD in adulthood. Likewise, the
inflammatory response that characterizes COPD varies
significantly between patients, and not all of them perceive
symptoms (mostly breathlessness) similarly. To investigate the
variability and determinants of different "individual natural
histories" of COPD, we developed a theoretical, multi-stage,
computational model of COPD (EASI) that integrates dynamically
and represents graphically the relationships between exposure
(E) to inhaled particles and gases (smoking), the biological
activity (inflammatory response) of the disease (A), the
severity (S) of airflow limitation (FEV1) and the impact (I) of
the disease (breathlessness) in different clinical scenarios.
EASI shows that the relationships between E, A, S and I vary
markedly within individuals (through life) and between
individuals (at the same age). It also helps to delineate some
potentially relevant, but often overlooked concepts, such as
disease progression, susceptibility to COPD and issues related
to symptom perception. In conclusion, EASI is an initial
conceptual model to interpret the longitudinal and
cross-sectional relationships between E, A, S and I in different
clinical scenarios. Currently, it does not have any direct
clinical application, thus it requires experimental validation
and further mathematical development. However, it has the
potential to open novel research and teaching alternatives. |