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In Italy, the gap between estimated and diagnosed prevalence highlights the need for improved early detection and proactive management. This expert opinion, developed by a multidisciplinary panel, translates current evidence into practical recommendations tailored to the Italian healthcare context. Patient characterization has moved from a spirometry-centered approach to a proactive, multidimensional model integrating symptom burden, exacerbation history, and cardiopulmonary risk. Early diagnosis should be driven by structured case-finding in primary care and internal medicine, using spirometry for confirmation. Early identification of uncontrolled patients relies on standardized tools, including symptom quantification (CAAT score) and indirect markers like recurrent antibiotic or oral corticosteroid use. Exacerbations are critical events that accelerate both pulmonary and cardiovascular deterioration, identifying a high-risk phase requiring prompt reassessment and optimization. In this context, single-inhaler triple therapy (SITT) is the only pharmacological strategy consistently associated with reduced exacerbations and all-cause mortality in high-risk populations. Timely SITT use may also reduce cardiopulmonary risk. Furthermore, preventing exacerbations limits antibiotic and systemic corticosteroid use, promoting antimicrobial stewardship and mitigating resistance. This expert opinion emphasizes the need for integrated care pathways, standardized clinical tools, and multidisciplinary coordination to overcome therapeutic inertia. A shift toward early identification, timely intervention, and prevention-oriented strategies is essential to improve outcomes and reduce the systemic burden of COPD.<\/jats:p>","DOI":"10.1007\/s11739-026-04479-8","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T17:20:07Z","timestamp":1787332807000},"page":"1945-1953","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Strategies for therapeutic optimization and proactive care in chronic obstructive pulmonary disease (COPD): an Italian expert opinion"],"prefix":"10.1007","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-5040","authenticated-orcid":false,"given":"Paola","family":"Rogliani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Andreoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Dentali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Micheletto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Montagnani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Montano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Papi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierachille","family":"Santus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"4479_CR1","unstructured":"IQVIA Solutions Italy (2023) Management of COPD in Italy: impact of the pandemic and of note 99 on therapeutic care [in Italian]. 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D.F. reported grants and personal fees for lectures and consultancy from Alfa Wassermann, Alfasigma, AstraZeneca, Bayer, Boehringer, BMS-Pfizer, Daiichi Sankyo, IL, GSK, Menarini, Novartis, Sandoz, Sanofi, and Tillots Pharma AG. P.R. reported grants\/research support to her institution from Arcede Pharma, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Sanofi, and Verona Pharma and honoraria or consultation fees from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Pfizer, Recipharm, Regeneron, Roche, and Sanofi. A.P. declared payments to his institution from Chiesi, AstraZeneca, GlaxoSmithKline, and Sanofi; consultancy fees from AstraZeneca, Avillion, Chiesi, GlaxoSmithKline, Moderna, Regeneron, Roche, Sanofi, Zambon, and Zentiva; and payment or honoraria for lectures, presentations, and speakers\u2019 bureaus, from AstraZeneca, Avillion, Chiesi, GlaxoSmithKline, Moderna, Regeneron, Roche, Sanofi, and Zambon. P.S. received honoraria for lectures from AstraZeneca, Berlin-Chemie, GlaxoSmithKline, Gilead Sciences, and Sanofi; grants or contracts from AstraZeneca, Edmond Pharma, and GlaxoSmithKline; and consultancy fees from AstraZeneca, Berlin-Chemie, Domp\u00e9 Farmaceutici, Edmond Pharma, GlaxoSmithKline, Neopharmed Gentili, Sanofi, Roche, and Armstrong Lab. M.A. reported payment or honoraria for lectures, presentations, manuscript writing, or educational events from Gilead Sciences, AbbVie, ViiV Healthcare, and Pfizer; support for attending meetings and\/or travel from AstraZeneca and Gilead Sciences; participation on a Data Safety Monitoring Board or Advisory Board for Moderna and Gilead Sciences. A.R. declared personal fees for participation on advisory boards and consultancy from GSK, AstraZeneca, Seqirus, and MSD.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This manuscript does not report research involving human participants and does not include identifiable patient data.","order":2,"name":"Ethics","label":"Human and animal rights","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Therefore, ethics committee approval and informed consent were not required.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}