Pharmacological treatment of COPD: the devil is always in the detail

Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition with considerable pathophysiological and clinical variability across patients [1]. For this reason, the current Global Initiative for the Management of Chronic Obstructive Lung Disease (GOLD) report recommends an individualised treatment approach for patients with a diagnosis of COPD that has been established by appropriate clinical and spirometric criteria [2]. This approach is based on symptom severity and exacerbation history (which predicts future exacerbation risk) [2], and categorises patients into four "phenotypic" groups (A, B, C or D) [2, 3]. Each group has distinct pharmacological treatment algorithms where the clinical response to treatment (improvement, no change or deterioration) is used to escalate, de-escalate or switch treatment. It is straightforward in treatment-naïve individuals seen at initial presentation by healthcare workers but it may become more complex and cumbersome during follow-up . GOLD ABCD should be used for initial assessment and treatment, but follow-up treatment should focus on treatable traits <http://ow.ly/Vm5l30iXYYU> While the authors are members of the GOLD science committee, this article is not part of the GOLD report. The views expressed here are the personal opinions of the authors.