An overview of the current management of chronic obstructive pulmonary disease: can we go beyond the GOLD recommendations?

ABSTRACT

Introduction: Treatment recommendations are based on randomized controlled trials (RCTs). However, only about 1 in 20 people meet the inclusion criteria for RCTs forming consensus guidelines in chronic obstructive pulmonary disease (COPD). Consequently, the one-size-fits-all approach focused merely on traditional symptoms and risk of exacerbations is inadequate to treat COPD. COPD needs a personalized medicine strategy because of the relevance of COPD heterogeneity for subject-based health risk assessment and stratification in the clinical arena.

Areas covered: Since the therapeutic approach proposed by the 2017 GOLD report takes no account of COPD heterogeneity, the advances with the current pharmacological options and the different approaches focused on phenotypes of COPD that can be used in an attempt to respond to unmet therapeutic needs are reviewed.

Expert commentary: The one-size-fits-all approach that focuses solely on traditional symptoms and risk of exacerbations is inadequate to treat COPD. COPD needs a personalized medicine strategy because of the relevance of COPD heterogeneity. Phenotyping provides potential for a more personalized approach than the former model of care because it allows clustering patients defined by clinical characteristics and sharing common clinical outcomes. However, it is still too much of a simplistic method that, in any case, must be validated in future clinical studies.

KEYWORDS:

• COPD
• phenotypes
• precision medicine
• bronchodilators
• anti-inflammatory agents
• mucolytics
• augmentation therapy
• treatment of comorbidities

Declaration of interest

M Cazzola has participated as a speaker and advisor in scientific meetings and course under the sponsorship of Almirall, AstraZeneca, Biofuturam Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Menarini Group, Lallemand, Mundipharma, Novartis, Pfizer, Recipharm, and Zambon. He is or has been a consultant to ABC Farmaceutici, Chiesi, Lallemand, Novartis, Verona Pharma, and Zambon. P Rogliani has participated as a speaker and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Menarini Group, Mundipharma, and Novartis. J Ora has participated as a speaker in scientific meetings and courses under the sponsorship of Boehringer Ingelheim, and Zambon. MG Matera has participated as a lecturer, speaker and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, and Zambon. She is or has been a consultant to ABC Farmaceutici, and Chiesi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This manuscript has not received any funding.