title: Treatment options for moderate-to-very severe chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The appropriate drug management of COPD is still based on the use of bronchodilators, possibly associated with an anti-inflammatory agent. However, there are still fundamental questions that require clarification to optimise their use and major unmet clinical needs that must be addressed.
  
  
  METHODS
  The advances obtained with the pharmacological options currently consolidated and the different approaches that are often used in an attempt to respond to unmet therapeutic needs are reviewed Expert opinion: In view of the unsatisfactory status of current treatments for COPD, there is an urgent need for alternative and more effective therapeutic approaches that will help to relieve patient symptoms and affect the natural course of COPD, inhibiting chronic inflammation and reversing the disease process or preventing its progression. However, new pharmacologic options have proved difficult to develop. Therefore, it is mandatory to optimize the use of the treatment options at our disposal. However, there are still fundamental questions regarding their use, including the step-up and step-down pharmacological approach, that require clarification to optimise the use of these drugs. It is likely that phenotyping COPD patients would help in identifying the right treatment for each COPD patient and improve the effectiveness of therapies.
authors.affiliation: a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cazzola
authors.affiliation: a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Rogliani
authors.affiliation: a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.
authors.forename: Josuel
authors.initials: J
authors.lastname: Ora
authors.affiliation: b Department of Experimental Medicine , Second University of Naples , Naples , Italy.
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Matera
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007249:Inflammation / Q000188:drug therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D007155:Immunologic Factors
keywords: COPD phenotypes; Chronic obstructive pulmonary disease; therapeutic options; treatment guidelines; unmet needs