[Treatment of stable COPD : GOLD 2017 and the associations…]

GOLD 2017 Report highlights the importance of patient symptoms and exacerbation risks in influencing some therapeutic decisions for individualized patient care. Assessment of the severity of airway obstruction is now separated from the " ABCD " groups but remains a key step for the diagnosis, prognostication and nonpharmacological therapies of COPD patients. Inhaled long-acting bronchodilators, alone or in combination, have a central role in the treatment of COPD patients. Their prolonged action allows a significant improvement not only of FEV1, but also of dyspnoea and health status. A clinically important effect was more frequently reached with LABA+LAMA combination than with either medication alone. LAMAs have a greater effect on exacerbation reduction compared to LABAs and LABA+LAMA combination reduces exacerbations compared to monotherapy or LABA+ICS combination. As regular treatment with ICS increases the risk of pneumonia, LABA+ICS combination is not a primary choice excepted in selected cortico-sensitive patients. When appropriate, withdrawal of ICS is achievable without significant harm using LABA+LAMA combination. Studies determining the precise place of LABA+LAMA+ICS combination in the treatment strategy are underway.