Conflict of interest and financial support: disclosure forms provided by the authors are available along with the full text of this article at www.ntvg.nl, search for A5399; click on ‘Belangenverstrengeling’ (‘Conflict of interest’).
The classification of COPD based only on the presence of airway obstruction fails to provide insight into the burden of the disease, quality of life and prognosis. The severity of symptoms, degree of exercise intolerance and presence of comorbidity are also determinants for classifying the severity of the disease.
COPD starts with abnormalities in the bronchiolar compartment which cause obstruction in the airways. This results in incomplete expiration; first during exercise and later, also at rest. This is called dynamic hyperinflation or air trapping.
Such changes in the mechanics of breathing occur early in course of the disease, even in mild COPD (the GOLD I stage), and contribute to physical inactivity and deconditioning.
Maximal bronchodilation – more precisely: bronchiolodilation – reduces the mechanism of dynamic hyperinflation inasmuch as the condition allows. This has a positive effect on the symptoms of dyspnoea during exercise and thus on exercise capacity and trainability, even early on in the disease.
Medicinal therapy has a positive effect on the progression of COPD, also in the early stages of disease.