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 beta2-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 beta2-agonists is preferable to short-acting beta2-agonists because long-acting beta2-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.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA. rwise@welchlink.welch.jhu.edu
Robert A
RA
Wise
Donald P
DP
Tashkin
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents