Targeting disease activity to predict and prevent damage in obstructive airway diseases.

The discovery of clinically accessible biomarkers that identify patients with obstructive airway disease who are at risk of adverse outcomes along with the availability of highly effective targeted treatments has increased interest in earlier target intervention and disease modification. In this review I argue that the time is ripe to move the focus from diseases entities that require disease related damage ('too late disease') to a new framework where the focus is on identification of high disease activity ('high risk disease'). I review the evidence in favour of this approach and identify gaps in this evidence. Finally, I discuss opportunities to operationalise this new approach.