Journal of Pulmonary & Respiratory Medicine
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Chronic obstructive pulmonary disease causes signifi cant morbidity and mortality worldwide. Most patients can be treated in
primary care. However, even in patients with relatively mild airfl ow obstruction referral to a specialist may lead to important
fi ndings, both related to the COPD and to comorbidities. Several classifi cations and grading have been proposed throughout the years
that help in categorizing patients, yet not all have direct consequences for the management, that typically includes lifestyle changes
of which smoking cessation and increased physical activity or even rehabilitation are paramount and pharmacotherapy. Inhaled
medication is aimed at improving expiratory fl ow, reducing hyperinfl ation and infl ammation to slow down disease progression and
improve quality of life and prognosis. Long acting bronchodilators have clinically signifi cant eff ects and are widely used, also in
mild to moderate disease. In recent years the Asthma COPD Overlap Syndrome has been proposed, which is a misnomer and
oft en an excuse to skip an adequate diagnostic process and prescribe triple-therapy in patients who would do well with only one or
two diff erent drugs. Unfortunately, the majority of COPD patients are on inhaled steroids but eff ects are small, oft en not clinically
relevant and side eff ects such as an increased risk of pneumonia should warrant clinicians to be more prudent in prescribing those.
Self management is considered an important component of management strategies, even if eff ects on various outcomes are limited.
Repeated lung function measurements are oft en performed both in primary care and in the hospital with limited if any eff ects on
management. Taken together, appropriate COPD management is not only about what we should do but certainly also about what we
Geertjan Wesseling has studied Biology and Medicine at the Free University of Amsterdam, Netherlands. He has completed his Training in Respiratory Medicine in 1991 and obtained his PhD in 1993. He is a Professor of Respiratory Medicine in Maastricht and coordinates the international Master in Medicine of Maastricht University, Netherlands. He is a Former President of the Dutch Pulmonology Society.