**4. Conclusions**

Although it is generally considered that COPD has heterogeneity, COPD is currently diagnosed based on physiologic criteria using spirometry. Hence, individual patients with COPD should be classified by distinct phenotypes (stratified medicine). Research for characterization of different subtypes COPD has been conducted on according to multivariable approaches to address disease using multiple dimensions including clinical, physiologic, imaging, and endotyping [1, 9] (**Figure 1**). However, possible distinct phenotypes have been not yet established up to today. Recently,

#### **Figure 4.**

*A direction to aim for the management of COPD. Precision medicine of personalized medicine is suitable for a heterogeneous disease. Illustrated based on refs. [1, 3, 5].*

precision medicine due to treatable trait has been proposed as aimed treatment for COPD in near future [3–5] (**Figure 4**). It is defined as treatments targeted to the needs of individual patients based on genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations (personalized medicine) [116–119].
