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 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.