| Earlier in this chapter, COPD has already been described as a chronic and
progressive pathology: this makes a stepwise increase in the treatment necessary to
manage the disease, whereas no step-down approach is applicable. The following
table reports the recommended treatment for every stage of COPD (Table 8).
Table 8: GOLD, 2006 Update
The scheme clearly correlates the stage of the disease with the suggested
therapeutic approach. Although, as already explained, specific treatments
should be tailored-made for every patient, it can be generally established that:
Stage I - MILD COPD: Patient should just take short-acting bronchodilators, in
order to control dyspnoea and coughing spasm, when necessary.
Stage II – MODERATE COPD: When symptoms are not controlled with an as-needed
treatment with short-acting bronchodilators, a therapy with a long-acting inhaled
bronchodilator is recommended, either as monotherapy or combination therapy.
Stage III – SEVERE COPD / Stage IV – VERY SEVERE COPD: Adding a regular
treatment with inhaled corticosteroids to an ordinary bronchodilator therapy
would reduce the frequency of exacerbations and improve the health status of
the patient. Additional mechanic interventions (long-term oxygen) may be
necessary for patients in stage IV.
The following table reports all the drug formulations commonly used in COPD,
combinations included (Table 9).
Table 9: GOLD, 2006 Update
Therefore, it is evident how currently COPD management mainly relies on the
use of bronchodilators, whereas glucocorticoids are used in late stages of the
disease as additional medications: this approach results to be somehow
"opposite" to that adopted for the therapy of asthma, that establishes first to
treat the patient with steroids and then to add a bronchodilator. This depends
on the different features of the inflammatory processes that underlie the two
diseases.
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