**3. Confronting COPD within different contexts**

The age of nihilism should also give way to a future of hope. Historical phenomena such as the stigmatization of smokers who develop COPD and denial of treatment options for those with the severe disease remain significant only as they are related to the responsibility of the present and the promises of the future. An appreciation of different contexts in the clinical presentation of COPD calls for earlier means of diagnosing COPD in an individual patient's lifetime, or at least the ability to predict which individuals are susceptible to COPD. From the newer theoretical understanding of the development of COPD also emanates anticipation of better preventive strategies in the future [4, 5].

In treating COPD, contextualization is crucial. Global guidelines formulated using evidence derived from restricted clinical trial formats are unlikely to be fully relevant to every clinical context in the real world. Clinicians in low-resource countries may be quite adept at managing COPD without the standard spirometry and other tests to rule out differential diagnoses as recommended by global practice guidelines. Recent developments in genomics, phenotyping, endotyping, and identifying treatable traits for the *telos* of personalized medicine may be impracticable in certain settings. Here again is where the universality of COPD, in that it is such a prevalent disease, must be balanced with the particularity of managing COPD within different contexts. Precision medicine does not always entail the use of proteomics and biomarkers, important as they are for the understanding and treatment of the disease, to guide therapeutic decisions. Neither does personalizing medicine mean forsaking the norm or whatever works for the whole, in favor of the quixotic or specific. More empirically, individualizing treatment requires reasoning and adaptation. When confronting COPD in extensive contexts, the clinician must be willing to apply powers of observation and reasoning: *deduction* (what works for the whole or in principle, should work for the individual), *induction* (observe what works for an individual to form a general conclusion), as well as *abduction* (to infer based on observation and assumption).
