Treatment of COPD and the TOnado trial: a tempest in a teapot?

The treatment of COPD follows a stepwise approach in practically all clinical practice guidelines and also current strategy documents [1]. Lung function impairment or low forced expiratory volume in 1 s (FEV1), once considered the single most important treatment parameter, now represents one of the target parameters for risk reduction in patients with chronic obstructive pulmonary disease (COPD), alongside exacerbations and respiratory symptoms, dyspnoea in particular. Furthermore, more holistic COPD approaches increasingly recognise the importance of physical activity and multimorbidity for disease outcome, mortality in particular [2].