Trattamento personalizzato dei pazienti con BPCO in fase stabile

In clinical practice there are no more justifications for the therapeutic nihilism because nowadays the personalised pharmacologic and non-pharmacologic treatment of the patients with stable chronic obstructive pulmonary disease (COPD), according to current Global initiative for chronic Obstructive Lung Disease (GOLD) guidelines is effective in decreasing respiratory symptoms, in increasing exercise tolerance and capacity, improving quality of life, preventing many COPD exacerbations (even the most severe) and decrease the mortality. However, smoking cessation and long-term oxygen therapy (in patients with advanced COPD and severe chronic hypoxemia refractory to maximal treatment with bronchodilator and anti-inflammatory drugs) are the only two interventions that have unequivocally shown to reduce COPD mortality. At the opposite the current pharmacologic personalised treatment of stable COPD is mainly symptomatic and modify only partially the natural history of the disease. This conclusion should reinforce the necessity of further human translational medicine research in order to promote a better understanding of the pathogenesis of COPD and also we need more long term controlled clinical studies of new drugs using as primary measures of clinical efficacy their effects on the lung function decline and the mortality. To accelerate research in this field, substantial investments are required at all levels, including the public and private sectors, with the ambitious aim of making in the near future COPD a preventable and fully treatable disease.