Optimizing treatment of chronic obstructive pulmonary disease: An assessment of current therapies

Bronchodilators are the mainstay of chronic obstructive pulmonary disease ( COPD) therapy. Inhaled short-acting beta 2-agonists generally have a more rapid onset of effect and shorter duration of action than short-acting anticholinergic agents, and are usually prescribed as "rescue" medication to relieve acute bronchospasm. For patients with persistent symptoms, maintenance therapy with inhaled long-acting beta 2-agonists is preferable to short-acting beta 2-agonists because long-acting beta 2-agonists provide more predictable, longer-lasting improvements in lung function. Long-acting anticholinergic agents can provide similar prolonged improvement in lung function with once-daily dosing. Inhaled corticosteroids reduce the frequency of acute exacerbations and are recommended for patients with severe COPD and frequent exacerbations. Combining different classes of bronchodilators or combining a bronchodilator with a corticosteroid provides greater improvements in lung function and symptoms than the individual agents given alone. Nonpharmacologic interventions, including pulmonary rehabilitation, oxygen therapy, and surgery, can benefit patients at various stages of disease. A treatment algorithm that combines both pharmacologic and nonpharmacologic interventions for the management of COPD is presented. (c) 2007 Elsevier Inc. All rights reserved.