[New clinical parameters in chronic obstructive pulmonary disease].

Almost all clinical practice guidelines have defined chronic obstructive pulmonary disease (COPD) as being characterized by airway obstruction, which is usually progressive. In Spain, COPD is the fifth most common cause of death, behind vascular diseases and cancer. In the last decade, the management of COPD has undergone a marked change, resulting in better disease control by acting on variables other than forced expiratory volume in 1 second, such as exacerbations and symptoms. Clinical experience also indicates favorable effects on functional deterioration and mortality. However, from a scientific point of view, the grade of evidence is still limited. If one of the challenges for the next few years is early diagnosis of COPD, the most upto-date strategies should focus on disease progression and mortality; in the case of the former, to avoid deterioration and reduce the burden of the disease, which is mostly associated with advanced stages, and in the case of the latter, to clarify the role of COPD as a cause of death, since, even in the initial phases, this disease could play an important role in many cases of death associated with cardiovascular disease and lung cancer. The present review aims to put the "classical and new" parameters for the follow-up of COPD into perspective and to evaluate their real importance in the clinical management of these patients today.