Author Contributions

All authors contributed equally to the preparation and review of this work. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

P. Emmanouil, N. Koulouris, S. Tryfon, and F. Perlikos have nothing to disclose. P. Bakakos has received fees for advisory boards from AstraZeneca, GSK, Menarini, and ELPEN and honoraria from GSK, Astra Zeneca, Chiesi, Elpen, Novartis, and Boheringer Ingelheim. A. Boutou has received a research grant from the Hellenic Thoracic Society, honoraria from Menarini Hellas, Elpen, and Chiesi Hellas, and support for attending meetings from Chiesi Hellas, Menarini Hellas, Elpen, Actelion Hellas, and Boehringer Ingelheim. K. Dimakou has received consulting fees and honoraria from Chiesi, AstraZeneca, Boerhinger Ingelheim, GSK, Pfizer, Menarini, and Novartis. G. Hillas has received consulting fees from AstraZeneca, Novartis, Boehringer Ingelheim, GSK, Chiesi, Menarini, ELPEN, Pharmathen, Specialty Therapeutics and Sanofi, honoraria from AstraZeneca, Boehringer Ingelheim, CHIESI, CSL Behring, ELPEN, Innovis, GSK, Menarini, Novartis, Pharmathen, Sanofi, Specialty Therapeutics, and UCB, and support for attending meetings from AstraZeneca, Novartis, Boehringer Ingelheim, Chiesi, GSK, Menarini, Innovis, and Elpen. P. Katasounou has received financial support for travelling and congress from Chiesi, Boehringer Ingelheim, AstraZeneca, Novartis, and Pfizer. E. Kosmas has received grants, consulting fees, honoraria, and support for attending meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, Elpen, GSK, Menarini, Novartis, and Vianex. S. Loukides has received honoraria from Elpen, AstraZeneca, GSK, Chiesi, Sanofi, Boehringer Ingelheim, and Menarini. A. Papaioannou has received consulting fees from AstraZeneca, Novartis, Boehringer Ingelheim, and Chiesi, honoraria for presentations from AstraZeneca Novartis, Boehringer Ingelheim, Chiesi, Menarini, and Elpen, and support for attending meetings from AstraZeneca Novartis, Boehringer Ingelheim, Chiesi, Menarini, and ELPEN. N. Rovina has received honoraria from Astra Zeneca, Chiesi, and Menarini and support for attending meetings from Chiesi and Menarini. P. Steiropoulos has received consulting fees, honoraria, and support for attending meetings from AstraZeneca, Boehringer Ingelheim, Elpen, GSK, Menarini, and Novartis. G. Stratakos has received honoraria from AstraZeneca and Behring, support for attending meetings from Chiesi and Behring, and participation in advisory boards for AstraZeneca and Behring. N. Tzanakis has received consulting fees and honoraria from GSK, Novartis, AstraZeneca, Elpen, Pharmathen, Chiesi, Takeda, Pfizer, Bayer, UCB, Nycomed, Vianex, Help, Takeda, and Boehringer Ingelheim and support for attending meetings from GSK, Boehringer Ingelheim, Novartis, AstraZeneca, Elpen, Pharmaten, Chiesi, Takeda, and UCB. E. Zervas has received honoraria from AstraZeneca, Novartis, Menarini, Chiesi, and Elpen, support for attending meetings from AstraZeneca, Boehringer Ingelheim, Novartis, Menarini, Chiesi, and Elpen, and participation in advisory boards from AstraZeneca, GSK, Menarini, Chiesi, and Elpen.

Figure 1. Steps in the treatment of COPD. Abbreviation: COPD, chronic obstructive pulmonary disease. 1 Evaluate comorbidities carefully. 2 Use the Lower Limit of Norma, (LLN) in borderline values especially in patients bellow 45 and over 80 years of age.

Figure 1. Steps in the treatment of COPD. Abbreviation: COPD, chronic obstructive pulmonary disease. 1 Evaluate comorbidities carefully. 2 Use the Lower Limit of Norma, (LLN) in borderline values especially in patients bellow 45 and over 80 years of age.

Figure 2. (a) Classification of prognostic risk. Footnote: 1 Carefully evaluate comorbidities. 2 Use LLNs in patients with borderline values, especially in patients <45 and >80 years of age. Abbreviation: LLN, lower limit of normal. (b) Treatment algorithm for stable COPD. Abbreviation: COPD, chronic pulmonary disease.

Figure 2. (a) Classification of prognostic risk. Footnote: 1 Carefully evaluate comorbidities. 2 Use LLNs in patients with borderline values, especially in patients <45 and >80 years of age. Abbreviation: LLN, lower limit of normal. (b) Treatment algorithm for stable COPD. Abbreviation: COPD, chronic pulmonary disease.

Figure 3. Home management of a COPD exacerbation. Abbreviation: COPD, chronic pulmonary disease.

Figure 3. Home management of a COPD exacerbation. Abbreviation: COPD, chronic pulmonary disease.

Table 1. Differential diagnosis of COPD.

Table 1. Differential diagnosis of COPD.

DiagnosisMain CharacteristicsCOPD

Onset always in adulthood

History of exposure to risk factors (smoking)

Symptoms for several years with little fluctuation over time, gradually deteriorating

Asthma

Onset usually in childhood

There is often concomitant atopy, rhinitis, or eczema, family history

Symptom severity varies over time; symptoms are worse at night or in the morning

BronchiectasisChronic heart
failure

History, clinical signs of heart disease

Cardiomegaly on chest X-ray

Spirometry indicative of a restrictive, rather than an obstructive, syndrome

Bronchiolitis (infectious or autoimmune)Tuberculosis

Table 2. COPD stages and association with symptoms, exacerbations, and comorbidities.

Table 2. COPD stages and association with symptoms, exacerbations, and comorbidities.

Stages of Severity
(FEV1 % Pred.)SymptomsExacerbationsComorbiditiesStage 1 (>80) Dyspnea with moderate physical exertion, little/no effect on physical activity, cough and/or sputum productionFrequency and severity increase per stageObserved at all stagesStage 2 (79–50)Increased dyspnea, e.g., after walking 100 m on level ground, decreased physical activity, cough and sputum production, recurrent respiratory tract infectionsStage 3 (49–30)Dyspnea with little physical exertion, daily cough and sputum production, a significant decrease in daily activity, and symptoms of frequent infections; Stage 4 patients usually have severe hypoxemia and/or respiratory failureStage 4 (<30)