Proper diagnosis of chronic obstructive pulmonary disease and personalised treatment

In the treatment of chronic diseases, the principle of reaching the goal or “treat to target” is assumed. It is possible if the diagnosis of the disease is appropriate, based on contemporary criteria. The second condition in the effective implementation of the goal is to have appropriate drugs that can reach the most peripheral airways. The inflammatory process in the course of chronic obstructive pulmonary disease (COPD) takes place in small bronchi, which not all inhaled drugs can reach. In addition, the diagnosis of COPD – eosinophilic or neutrophilic endotype – is important in the choice of treatment. In the eosinophilic endotype, patients with COPD respond well to inhaled glucocorticoids, while in the neutrophilic endotype there is a better response to administered preparations of long-acting muscarinic agonists (LAMA). Treatment with benralizumab and mepolizumab in patients with COPD with high eosinophilia significantly reduced the number of exacerbations. New therapeutic options require a precise diagnosis of the disease in order to personalise the treatment according to the endotype and phenotype.