| Chronic Obstructive Pulmonary Disease (COPD) is characterized by a chronic airflow limitation and a range of pathophysiological changes in the lung, some extrapulmonary effects, and important comorbidities which may contribute to the severity of the disease in individual patients. Thus COPD should be regarded as a pulmonary disease, but these significant comorbidities must be taken into consideration to determine the appropriate treatment.
GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines define COPD as a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients, its pulmonary component is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
As seen also for asthma, no therapeutic agents can definitely cure the disease: in fact, none of the currently existing medications has been demonstrated to modify the long-term decline in lung-function in COPD patients. Therefore, COPD pharmacotherapy leads only to the decrease of symptoms and/or complications.
The choice of the most appropriate pharmacological treatment should be planned on the basis of a stepwise approach, as suggested by GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines3: with this regard, compared to asthma, there is an important difference, since a step-down phase of treatment, recommended for asthmatic patients once achieved the control of the disease, cannot be applied in COPD because of its continuous progression, that requires a corresponding medications increase.
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