COPD: To be or not to be, that is the question

As our knowledge on the natural history of COPD progresses, a conceptual model simply based on an accelerated decline of lung function in adult life in response to smoking has become inadequate to capture the complexity of this disease and increasing attention is being given to possible contributions from events and/or alterations of developmental processes that take place earlier in life. In addition, a remarkable heterogeneity has emerged among the pathobiological mechanisms that are involved in different phenotypes of COPD, suggesting that an effective disease management will require individualised treatment approaches largely based on the underlying biological mechanisms (endotypes).