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Exacerbation implies a substantial impairment of patient respiratory ability and quality of life and can even lead to death. It has been demonstrated that only smoking cessation can produce a relative slowdown in the chronic course of the disease while pharmaceutical therapies aim to improve patient's quality find more of life by reducing exacerbation frequency and severity.[1] The Global Initiative for Chronic Lung Disease (GOLD) was established in 1997. Its goals are to increase awareness of COPD and decrease mortality and morbidity from the disease. The GOLD guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible, it is usually progressive and is associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases.[2,3] Global Initiative for Chronic Obstructive Lung Disease estimates suggests Selumetinib that COPD will raise from the fourth to the third most common cause of death world wide by 2020. The GOLD 2004 guideline classifies disease severity in four stages based on chronic symptoms, forced expiratory volume in 1 s (FEV1), and forced vital capacity (FVC).[4,5] This pragmatic staging approach aims to simplify practical patient management and offer some general indications for pharmacotherapeutic choice. At the stage I, bronchodilators are generally prescribed on an as-needed basis for relief of persistent, or worsening, symptoms. The most commonly used bronchodilator drugs include ��2-agonists, anticholinergics, and methylxanthines. At stage II, GOLD guidelines recommend the addition of pulmonary rehabilitation and regular treatment Thymidine kinase with one or more long-acting bronchodilators. Pulmonary rehabilitation aims at resolving a range of nonpulmonary problems including social isolation altered mood states (especially depression), muscle wasting and weight loss. The addition of regular treatment with inhaled glucocorticosteroids is appropriate for symptomatic COPD patients with an FEV1