Funding: National Heart, Lung, And Blood Institute, 2016-2021 (1 K23 HL 128936 01 A1)
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the country, affecting nearly 24 million Americans. Further, COPD is a heterogeneous disease, making it difficult to personalize treatment decisions. Existing treatment recommendations, heavily influenced by severity of airflow obstruction, do not account for individuals who will benefit more or less from certain therapies than the average outcome reported from randomized trials (RCTs). Elderly COPD patients frequently have impairments in vision, hearing, memory, incontinence, falls, and sarcopenia, and are at risk for dependency for activities of daily living (all hereafter termed geriatric conditions). These factors change the baseline risk and are probable contributors to heterogeneity of treatment response - but have been, so far, overlooked. This project re-analyzes RCTs of COPD treatments to identify heterogeneity of treatment effects and test the hypothesis that adding data on geriatric conditions will yield more robust and personalized risk models.