Editorial

Journal of the Association of Pulmonologists of Tamil Nadu. Vol. 1, Issue 3, January – April 2019

Editorial

Precision Medicine in Respiratory Medicine

Precision medicine aptly applies to Bronchial Asthma. In the early days there were only two obstructive airways diseases. They were asthma and chronic obstructive lung diseases which encompassed smoker’s lung and bronchiectasis. All patients with cough and wheeze used to be grouped under one of this group. The diagnostic labels used to change frequently.

With the advent of Pulmonary Function tests there was a paradigm shift in our attitude towards the diagnostic label. The terms reversible and non reversible obstructive diseases are here to stay. With the availability of lung volume measurements came the concept of hyperinflated lung volumes and with flow volume loops came the concept of intra thoracic and extra thoracic obstructions. The identification of eosinophils and neutrophils in sputum and bronchoalveolar lavage vastly improved our knowledge of cellular biology in asthma. The days of not able to treat effectively these obstructive airways will be thing of the past.

We are able to identify asthma phenotypes like eosinophilic, neutrophilic, paucigranulocytic, obesity and so on. This necessitates the identification and treatment to be individualised. Every allergic patient has different characteristics based on the clinical course, treatment outcomes and disease outcomes. For example an asthmatic with neutrophilic phenotype will be steroid resistant. This variability necessitates the adoption of different strategies in treating these groups.

Let us welcome the era of Precision Medicine.