Inhaled therapy, cardiovascular risk and benefit–risk considerations in COPD: innocent until proven guilty, or vice versa?

Extract

COPD management mainly aims at relieving symptoms, and improving exercise tolerance and quality of life, as well as preventing exacerbations, disease progression and mortality, while providing adequate management of comorbidities. There is strong evidence showing that inhaled maintenance therapy has the capacity to target symptoms, exacerbations and quality of life; some evidence is now also available regarding mortality [1]. As always in the current era of personalised medicine, the choice of therapy needs to be based on a thorough benefit–risk assessment accounting for the characteristics of each individual patient [2]. This assessment can be somehow complexified by the fact that COPD is most often a component of a chronic complex multimorbid condition, rather than an isolated disease [3]. It can coexist with various comorbidities (or be a comorbidity for various diseases) including cardiovascular diseases, anxiety and depression, sarcopenia and peripheral muscle dysfunction, osteopenia and osteoporosis, lung cancer, anaemia or polycythaemia [4].