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      Treatment of severe stable COPD: the multidimensional approach of treatable traits

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          Abstract

          Now that additional treatment options for severe chronic obstructive pulmonary disease (COPD) have emerged in recent years, patients with severe COPD should not be left in the rather hopeless situation of “there is nothing to improve” any more. Inertia or fatalism is a disservice to our patients. Ranging from advanced care planning to quite intense and demanding therapies such as multidisciplinary pulmonary rehabilitation, (endoscopic) lung volume reduction, chronic noninvasive ventilation and lung transplantation, caregivers should try to provide a personalised treatment for every severe COPD patient. In this review, we aim to describe the multidimensional approach to these patients at our centre along the lines of treatable traits leading to specific additional treatment modalities on top of standard care.

          Abstract

          Severe COPD is not hopeless; in light of treatment options such as pulmonary rehabilitation, bronchoscopic lung volume reduction, chronic noninvasive ventilation and lung transplantation, every patient deserves a personalised assessment of treatable traits https://bit.ly/2TO7jxB

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          Most cited references120

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          Pulmonary rehabilitation for chronic obstructive pulmonary disease.

          Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006.
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            Pulmonary hypertension in chronic lung disease and hypoxia

            Pulmonary hypertension (PH) frequently complicates the course of patients with various forms of chronic lung disease (CLD). CLD-associated PH (CLD-PH) is invariably associated with reduced functional ability, impaired quality of life, greater oxygen requirements and an increased risk of mortality. The aetiology of CLD-PH is complex and multifactorial, with differences in the pathogenic sequelae between the diverse forms of CLD. Haemodynamic evaluation of PH severity should be contextualised within the extent of the underlying lung disease, which is best gauged through a combination of physiological and imaging assessment. Who, when, if and how to screen for PH will be addressed in this article, as will the current state of knowledge with regard to the role of treatment with pulmonary vasoactive agents. Although such therapy cannot be endorsed given the current state of findings, future studies in this area are strongly encouraged.
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              The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth Adult Heart Transplantation Report — 2019; Focus Theme: Donor and Recipient Size Match

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                Author and article information

                Journal
                ERJ Open Res
                ERJ Open Res
                ERJOR
                erjor
                ERJ Open Research
                European Respiratory Society
                2312-0541
                July 2020
                21 September 2020
                : 6
                : 3
                : 00322-2019
                Affiliations
                [1 ]Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
                [2 ]Groningen Research Institute of Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
                [3 ]Centre of Rehabilitation Beatrixoord, Haren, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
                Author notes
                Marlies van Dijk, Dept of Pulmonary Diseases, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands. E-mail: m.van.dijk05@ 123456umcg.nl
                Author information
                https://orcid.org/0000-0002-2043-1276
                https://orcid.org/0000-0001-9555-3422
                https://orcid.org/0000-0001-7705-7927
                https://orcid.org/0000-0002-8818-9447
                Article
                00322-2019
                10.1183/23120541.00322-2019
                7502698
                32984420
                f4915549-d619-4605-a936-41c224b0b2a4
                Copyright ©ERS 2020

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 20 November 2019
                : 26 May 2020
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