COPD management in the modern era

Chronic obstructive pulmonary disease (COPD) is a heterogeneous pathology that impacts more than 380 million people globally, being the third leading cause of death worldwide. Since its recognition in the 1960s, the understanding and management of COPD have significantly evolved, thanks to advances in knowledge about its etiopathogenesis and treatment. The guidelines from the Global Initiative for COPD (GOLD COPD) represent an effort to standardize diagnosis and treatment, with its review in 2023 updating the disease's definition. Proper management of COPD includes accurate diagnosis, pharmacological and non-pharmacological therapies, and prevention strategies focused especially on smoking cessation, the main cause of the disease. Diagnosis is based on the history of exposure to noxious particles or gases, with spirometry as a key exam to confirm not completely reversible bronchial obstruction. The treatment strategy has improved with the development of new drugs and administration devices, focusing on reducing symptoms and the risk of exacerbations. Pharmacological therapy is adapted according to the GOLD classification of the patient, with options ranging from bronchodilator therapies to combinations of multiple drugs for more severe cases. The importance of detecting and treating comorbidities is critical, given their high prevalence in patients with COPD and their impact on mortality. Non-pharmacological strategies include smoking cessation, long-term oxygen therapy, physical activity, and pulmonary rehabilitation, as well as ensuring adequate immunization. The management of exacerbations must be appropriate and early, as they are associated with an increase in morbidity and mortality. This review seeks to provide an evidence based integral approach to the management of COPD.