Treatment of COPD: the simplicity is a resolved complexity

Abstract

The introduction of simple and reproducible functional parameters as Forced Expiratory Volume in 1 s (FEV1) and Forced Vital Capacity (FVC) has been fundamental to diagnose, classify and measure the progression of Chronic Obstructive Pulmonary Disease (COPD). However, it has been recently emphasized that these parameters do not allow an overview of the complexity and heterogeneity of COPD. In fact, the disease can show several intrapulmonary and extrapulmonary components with non-linear dynamic interactions of which not all these components are present in all patients nor in individual patients, at all time points [1]. These differences have justified the recognition of different phenotypes among patients with COPD. The objective of this review is to overhaul the evidences recently published in order to define COPD characteristics able to suggest a therapeutic algorithm.