The assessment tool, which is used to classify patients into 4 groups (A to D), has been refined to use only respiratory symptoms and history of exacerbations.
The pharmacological management of ongoing COPD has been completely revised, with strategies for escalation and de-escalation of treatment.
Inhaled corticosteroids are now only recommended if patients with ongoing COPD experience further exacerbations while on long-acting bronchodilators, or in those with likely asthma-COPD overlap.
Progressive disease state characterised by airflow limitation that is not fully reversible.
Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease.
Presents with progressive shortness of breath, wheeze, cough, and sputum production, including haemoptysis.
Diagnostic tests include PFTs, CXR, chest CT scan, oximetry, and ABG analysis.
Patients should be encouraged to stop smoking or occupational exposure and be vaccinated against viral influenza and Streptococcus pneumoniae .
Treatment options include bronchodilators, inhaled corticosteroids, and systemic corticosteroids.
Long-term oxygen therapy improves survival in severe COPD.
COPD is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible. It encompasses both emphysema and chronic bronchitis. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases. It is primarily caused by cigarette smoking. Although COPD affects the lungs, it also has significant systemic consequences. Exacerbations and comorbidities are important contributors to the overall condition and prognosis in individual patients. 
Fountain Valley Regional Medical Center
MAS declares that he has no competing interests.
Dr Manoochehr Abadian Sharifabad would like to gratefully acknowledge Dr Jonathan P. Parsons and Dr Michael Ezzie, the previous contributors to this monograph. JPP has contributed at speakers' bureaus for GlaxoSmithKline, Inc., Schering-Plough, Inc., and AstraZeneca, Inc. ME declares that he has no competing interests.
Hackensack University Medical Center
HA declares that he has no competing interests.
Assistant Professor of Medicine
National Jewish Medical and Research Center
University of Colorado Health Sciences Center
WJ declares that he has no competing interests.
Director of Respiratory Medicine
Eastern Health & Monash University
FT declares that he has no competing interests.
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