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Targeted therapy for chronic respiratory disease: a new paradigm

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Targeted therapy represents a new treatment paradigm that shows great promise in treating serious chronic respiratory diseases for which we presently have limited treatment options.1 Pharmacotherapy in the 20th century was best characterised by the use of antibiotics for infectious diseases. An antimicrobial drug targets a specific pathogen which is the cause of an infectious disease, leading to cure. This approach has its basis in Paul Ehrlich’s magic bullet (zauberkugel) theory and his success with a series of specific antimicrobials for syphilis.2 Although highly effective for acute infectious diseases, this approach cannot be usefully applied to non-communicable chronic diseases (NCCDs) because a single aetiological agent cannot be identified.

Step therapy has emerged as the dominant treatment paradigm for NCCDs such as cardiovascular disease (hypertension, congestive cardiac failure), type 2 diabetes mellitus, cancer and chronic airway disease (asthma, chronic obstructive pulmonary disease). In step therapy, drugs are added (step up) or withdrawn (step down) based on the level of responsiveness to treatment. This has led to improved outcomes but is limited. A key limitation is that individual variability in treatment response is ignored in this one-size-fits-all paradigm.

A new concept is to take individual variability into account when making management…