• Mirjam Osthoff, Christine Jenkins, and Jörg D Leuppi.
• Clinic of Internal Medicine, University Hospital Basel, Switzerland; miosthoff@uhbs.ch.
• Swiss Med Wkly. 2013 Jan 1;143:w13777.

AbstractChronic obstructive pulmonary disease (COPD) is a global health challenge and a leading cause of death worldwide. Several risk factors have been identified, with cigarette smoking being the most important. Diagnostic assessment is based on symptoms, risk of exacerbations and results of lung function testing. A fixed post-bronchodilator ratio for forced expiratory volume in one second to forced expiratory volume (FEV1/FVC) of <0.7 is required to make the diagnosis, and the severity of airflow obstruction defines the grade according to GOLD (Global Strategy for the Diagnosis, Management, and Prevention of COPD). The GOLD strategy makes therapeutic recommendations taking into account the grade, symptomatic assessment and future risk of exacerbations. This review focuses on the therapeutic options for COPD, in accordance with the GOLD strategy. Smoking cessation is the most effective treatment option in all COPD stages. Bronchodilators, namely long-acting antimuscarinic drugs and long-acting beta-agonists, form the mainstay of treatment in COPD. Patients with frequent exacerbations also benefited from the addition of inhaled corticosteroids. Roflumilast is an add-on option for patients with severe COPD. Several controversies are the subject of discussion: (1.) whether pharmacotherapy can modify the natural history of COPD; (2.) whether pharmacotherapy should be started in the early stages of COPD; (3.) the impact of therapy on comorbidities; (4.) whether patients benefit from a combination therapy with a long-acting beta-agonist, a long-acting antimuscarinic drug and an inhaled corticosteroid; (5.) step-down therapy. This overview also reviews the evidence for recommended vaccines in COPD, as well as nonpharmacological therapies. Rehabilitation is an essential part of COPD treatment. Oxygen therapy, noninvasive nocturnal ventilation and surgical treatment options only apply to a highly selected group of patients. Disease management programmes and guideline adherence are briefly discussed. In conclusion, although there is debate as to the extent with which pharmacological therapies influence mortality, adherence to the GOLD strategy is recommended.

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