Chronic obstructive pulmonary disease (COPD) is a heterogeneous and complex condition. Individual patient needs vary, requiring precision medicine approaches to help develop appropriate and targeted treatment plans.

The concept of personalized treatment incorporates selecting the right therapy for the right patient at the right time. For patients suffering from COPD, personalized care includes numerous considerations, including maximizing symptomatic benefit and functional status, as well as reducing exacerbations. To achieve this, a clinician must select appropriate inhaled pharmacotherapy, choose the device, and tailor treatment to a patient’s predominant symptom, with a goal of optimizing patient adherence. A clinician should carefully consider the following question: What am I trying to achieve for this individual patient?

For symptomatic patients, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 report recommends treatment strategies that include longitudinal pharmacotherapy using combination agents. A key component is to personalize treatment with long-acting bronchodilators, alone or in combination, to tailor therapy to the key patient requirement. For example, if a patient’s main concern is breathlessness, a long-acting bronchodilator may be an appropriate choice to maximize symptomatic benefit.

Similarly, exacerbation reduction is an important therapeutic paradigm. A key advance in the GOLD 2026 recommendations is advocacy for the concept that “1 exacerbation is too many,” such that 1 exacerbation should trigger an aggressive therapeutic approach. As such, for a patient with COPD who is at risk for future exacerbations, which is now defined as having experienced at least 1 moderate or severe exacerbation in the previous year, the GOLD strategy recommends dual bronchodilation. Moreover, if a patient has an elevated blood eosinophil count, it recommends the addition of an ICS. This comprehensive approach to the personalization of inhaled maintenance therapy can mitigate the risk of recurrent exacerbations.

Adherence is an equally important consideration in treatment selection for patients with COPD. The GOLD strategy recommendations are most relevant if the patient uses the medication and uses it correctly. As such, it is vital that the clinician consider whether the patient can access the medication. Alas, the availability or cost of medications may be a practical challenge. This then raises the following important questions: Is the medication available to the patient, and is there an associated cost?

Another consideration relates to the device for inhalational therapy and whether the patient with COPD will be able to deliver the medication. For example, a patient with severe airflow obstruction may experience difficulty generating an adequate inspiratory flow rate to trigger some devices, such as dry-powder delivery. Similarly, a patient with cognitive dysfunction may lack the coordination needed to use a metered-dose inhaler. Fortunately, clinicians have a breadth of devices to choose from, leading to the next question to further personalize care: Can this patient use the device? Closely related to this concept is the vital importance of sufficient patient education on how to use inhalation devices.