title: [Bronchodilators in chronic obstructive pulmonary disease (COPD)].
abstract: Bronchodilators form the foundation of the pharmacotherapy of patients with chronic obstructive pulmonary disease (COPD). Scores of information from numerous large-scale clinical trials, mechanistic differences between classes of bronchodilators, and anti-inflammatory/bronchodilator fixed combinations make the decision what compound primarily to prefer in COPD treatment a challenge. In this review of large, double-blind, clinical trials with anticholinergic drugs, long- and short-acting beta(2)-agonists, xanthines and different application forms and combination of these compounds will be examined for clinical efficacy. The following practical objectives were accepted to define effective disease management: improvement of lung function, physical parameters such as 6-min walking distance, reduction of exacerbation rate and severity, improvement of quality of life and dyspnea score. Based on this review, inhalation therapy with a long-acting bronchodilator such as tiotropium, formoterol or salmeterol is proposed for early treatment algorithm. The combination of an anticholinergic compound and a long-acting bronchodilator may have an additive effect on bronchodilatation. The addition of inhaled corticosteroids is only recommended in stages III and IV. Besides, pharmacotherapy of COPD should always be flanked by smoking prevention programs, and supportive therapy, if indicated in severe disease stages.
authors.affiliation: Robert-Koch-Klinik, Klinikum "St. Georg", Leipzig. adrian.gillissen@sanktgeorg.de
authors.forename: Adrian
authors.initials: A
authors.lastname: Gillissen
authors.forename: Roland
authors.initials: R
authors.lastname: Buhl
authors.forename: Klaus Friedrich
authors.initials: KF
authors.lastname: Rabe
authors.forename: Claus
authors.initials: C
authors.lastname: Vogelmeier
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D016896:Treatment Outcome; D014970:Xanthines / Q000627:therapeutic use
chemical_list: D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D014970:Xanthines