In summary, we have demonstrated that the
COPD population is heterogeneous with regard
to the symptoms, value of FEV1, and susceptibility
to exacerbations. Over half of the patients
were in category D, which is characterised by
frequent exacerbations, and over 51% of them
were current smokers. The identification of this
group of patients is very important from a clinical
point of view because COPD exacerbations can be
prevented by numerous methods, thus reducing
acute events. First, intensive smoking cessation
strategies must be adopted in these patients. Moreover,
influenza and pneumococcal vaccination
should be offered to all COPD patients together
with treatment with long-acting inhaled bronchodilators
andor long acting anticholinergic
agents, with or without inhaled corticosteroids
and a phosphodiesterase inhibitor. Triple inhaled
therapy is also recommended