The heterogeneous nature of chronic obstructive pulmonary disease (COPD) was recognised long before the term was popularised by Briscoe and Nash,1 and the original classifications of chronic bronchitis and emphysema remain more recognisable to the general public than the term COPD.

The challenge in recent years has been to better characterise the different phenotypes that make up the syndrome of COPD and so develop a new classification and terminology for COPD. This is not an esoteric pursuit but a worthwhile endeavour which has the potential to shed light on the underlying pathophysiology, risk factors, natural history and treatment responses of the specific phenotypes. Ultimately, this has the potential to enable tailoring of treatment regimes to individual patients.

Currently this is not possible as the treatment guidelines for COPD do not differ according to phenotype, other than by severity. Furthermore, the randomised controlled trials on which the guidelines...

Authors : Fingleton, J., Weatherall, M., Beasley, R.
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