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Expert Interview COPD Updated GOLD COPD Recommendations An expert interview with Mario Cazzola Professor of Respiratory Medicine, University of Rome Tor Vergata, Italy Mario Cazzola Mario Cazzola is an Honorary Professor of Respiratory Medicine at the University of Rome Tor Vergata, Italy, and Visiting Professor at the Sackler Institute of Pulmonary Pharmacology, GKT School of Biomedical Sciences, London, UK. He is a fellow of the European Respiratory Society and has received the 2015 European Respiratory Society Lifetime Achievement Assembly Award. Keywords Chronic obstructive pulmonary disease, Global Initiative for Chronic Obstructive Lung Disease recommendations, definition, assessment, treatment, escalating or de-escalating therapy Disclosure: Mario Cazzola has participated as a speaker, and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Lallemand, Mundipharma, Novartis, Pfizer, Verona Pharma, and Zambon, and is or has been a consultant to Chiesi Farmaceutici, Lallemand, Novartis, Verona Pharma, and Zambon. This is an expert interview piece and as such has not undergone the journal’s standard peer review process. No funding was received for the publication of this article. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 25 January 2017 Published Online: 26 July 2017 Citation: European Respiratory & Pulmonary Diseases, 2017;3(1):17–8 Corresponding Author: Mario Cazzola, Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Via Montpellier 1, Rome 00133, Italy. E: mario.cazzola@uniroma2.it C hronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death worldwide. In order to minimize the impact of COPD on public health, there is a need for preventative strategies and appropriate methods of management. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has been developing international guidelines for COPD since 1997. Recently, updated 2017 GOLD guidelines have been released; these include a revised definition of COPD. In an expert interview, Professor Mario Cazzola of the University of Rome Tor Vergata, Italy, discusses the key changes in the new recommendations. Q: The new GOLD recommendations have revised the definition of chronic obstructive pulmonary disease. Could you describe the revised definition and the rationale for the change? I must premise that the GOLD strategy includes recommendations and should not be interpreted as a guideline. Surely we must feel indebted to those who have, over time, developed the GOLD Strategy, but we must also be aware that there are points that are not the unanimous opinion of all experts and clinicians involved in the management of patients with chronic obstructive pulmonary disease (COPD). The latest definition of COPD is ‘a common, preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. The chronic airflow limitation that characterises COPD is caused by a mixture of small airways disease (for example, obstructive bronchiolitis) and parenchymal destruction (emphysema), the relative contributions of which vary from person to person. Chronic inflammation causes structural changes, small airways narrowing and destruction of lung parenchyma. A loss of small airways may contribute to airflow limitation and mucociliary dysfunction, a characteristic feature of the disease. Chronic respiratory symptoms may precede the development of airflow limitation and be associated with acute respiratory events. Chronic respiratory symptoms may exist in individuals with normal spirometry and a significant number of smokers without airflow limitation have structural evidence of lung disease manifested by the presence of emphysema, airway wall thickening and gas trapping.’ 1 If I am correctly interpreting the new definition, I understand that now it is stated that COPD is a disease that can be treated and not that it is potentially treatable. Certainly, the therapeutic approach to COPD has greatly improved in recent years, but I believe that we are still far from being able to say that COPD is a treatable disease. TOU CH MED ICA L MEDIA 17