COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups.

Clinic for Pulmonary Diseases Clinical Centre of Serbia Faculty of Medicine University of Belgrade Belgrade Serbia

Clinic of Infectious Chest Diseases Dermatovenereology and Allergology Vilnius University Centre of Pulmonology and Allergology Vilnius University Hospital Vilnius Lithuania

Clinic of Pulmonary Diseases Military Medical Academy Sofia Bulgaria

Department of Pneumology University Hospital Hradec Králové Czech Republic

Department of Pulmonary Medicine University of Tartu

Department of Pulmonology Russian National Research Medical University Moscow Russia

Department of Pulmonology University of Szeged Deszk Hungary

Department of Respiratory and Critical Care Medicine Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology Vienna Austria

Department of Respiratory Medicine and Tuberculosis Faculty of Medicine PJ Safarik University Košice Slovakia

Emek Medical Center Clalit Healthcare Services Afula Israel

Institute of Pulmonary Medicine Hadassah Medical Center Jerusalem Israel

Lung Clinic Tartu University Hospital Tartu Estonia

Lung Pathophysiology Department National TB and Lung Diseases Research Institute Warsaw Poland

Marius Nasta Institute of Pneumology Bucharest Romania

Medical Faculty of Latvian University Riga East University Hospital Riga Latvia

School of Medicine Dubrava University Hospital Zagreb Croatia

University Clinic of Respiratory and Allergic Diseases Golnik Slovenia

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