The number of research articles and publications in general dedicated to chronic obstructive pulmonary disease (COPD) has grown exponentially during the last decade. There have been important advances in the knowledge about the pathogenesis, epidemiology and clinical manifestations – the so-called clinical phenotypes – of the disease. On top of that, new drugs have been launched that have provided a better control of symptoms and improved the prevention of exacerbations. For the practicing physician it is increasingly difficult to be up to date in the most relevant advances in the field of COPD, particularly the aspects closely related to clinical practice. In this context, this supplement to Expert Review of Respiratory Medicine, dedicated to the new questions and answers in COPD, provides an overview of five of the most frequent and relevant questions related to the management of patients with COPD.
Asthma control is clearly defined and clinical trials use the concept of control as an outcome; however, there is not a consensus of what control means in COPD. Jesús Molina París, a primary-care physician dedicated to COPD, has collected all the information generated around the concept of control in COPD and presents his conclusions in an article that will help the readers to understand this concept. Control can be defined both on clinical findings and using standardized tools such as control questionnaires. The combination of both will help physicians adjust the treatment individually in order to improve the quality of life of the patients.
Bronchodilators are the first-line treatment in COPD. It has been extensively demonstrated that bronchodilatation is followed by improvement in all outcomes in this disease, including the reduction in the frequency of exacerbations. Adolfo Baloira covers the issue of identifying the best bronchodilator treatment for COPD patients according to their characteristics and severity.
The use of inhaled corticosteroids (ICS) in COPD is still controversial. Some authors indicate that they have a role in preventing exacerbations, but others believe that bronchodilators can prevent exacerbations to a similar extent without the side effects of ICS. It is clear that not all COPD patients are alike, and there are some patients that share characteristics of asthma and are particularly responsive to the effects of ICS. This new approach of a targeted treatment with ICS is described in detail in the article written by Esther Anton.
Exacerbations are the most important events in the natural history of COPD. Therefore, one of the main objectives of treatment is the prevention of these episodes. However, the definition and classification of severity of exacerbations is still under debate. Juan Antonio Trigueros Carrero presents the new definition of exacerbations and discusses the proposed classifications of these important events.
Finally, José Luis López-Campos introduces the analysis of the existing guidelines in the treatment of COPD. He presents the main recommendations of international documents and the differences that exist with some national guidelines that suggest a more personalized approach to treatment. The future of COPD moves towards more personalized medicine, where patients will be treated according to their clinical and physiological characteristics.
I am sure that clinicians will find answers to the most frequent and important questions in the management of COPD in this supplement to Expert Review of Respiratory Medicine.
Financial & competing interests disclosure
The author has no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Editorial assistance was provided by Content Ed Net and funded by Novartis, Spain.