Fig. 11:  To summarize, hypersecretory states with abundant secretions denote a further burden to patients with COPD.  What do the GOLD guidelines^[9] recommend in their updated strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease?  Almost nothing.  Mucous hypersecretion is mentioned only three times in the total report, telling us (1) that not all patients with COPD suffer from hypersecretion, (2) that activation from EGF may play a role in the pathogenesis of the disease, the definition of chronic bronchitis not shown here, and (3) that inhaled tiotropium does not retard mucous clearance from the lungs.  Thus, it is not really an adequate report with respect to secretions.  Geiseler J. Chest 2016;00. 

Reference:

9. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (Updated 2016). 2016. http://goldcopd.org/global-strategy-diagnosis-management-prevention-copd-2016/ Accessed May 11, 2016.