title: Pharmacological treatment of COPD.
abstract: Approximately seven million Brazilians over 40 years of age have COPD. In recent years, major advances have been made in the pharmacological treatment of this condition. We performed a systematic review including original articles on pharmacological treatments for COPD. We reviewed articles written in English, Spanish, or Portuguese; published between 2005 and 2009; and indexed in national and international databases. Articles with a sample size < 100 individuals were excluded. The outcome measures were symptoms, pulmonary function, quality of life, exacerbations, mortality, and adverse drug effects. Articles were classified in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria for the determination of the level of scientific evidence (grade of recommendation A, B, or C). Of the 84 articles selected, 40 (47.6%), 18 (21.4%), and 26 (31.0%) were classified as grades A, B, and C, respectively. Of the 420 analyses made in these articles, 236 were regarding the comparison between medications and placebos. Among these 236 analyses, the most commonly studied medications (in 66, 48, and 42 analyses, respectively) were long-acting anticholinergics; the combination of long-acting β(2) agonists and inhaled corticosteroids; and inhaled corticosteroids in isolation. Pulmonary function, adverse effects, and symptoms as outcomes generated 58, 54, and 35 analyses, respectively. The majority of the studies showed that the medications evaluated provided symptom relief; improved the quality of life and pulmonary function of patients; and prevented exacerbations. Few studies analyzed mortality as an outcome, and the role that pharmacological treatment plays in this outcome has yet to be fully defined. The medications studied are safe to use in the management of COPD and have few adverse effects.
authors: Graduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas School of Medicine, Pelotas, Brazil. anamene@terra.com.br
authors: Ana Maria Baptista
authors: AM
authors: Menezes
authors: Silvia Elaine Cardozo
authors: SE
authors: Macedo
authors: Ricardo Bica
authors: RB
authors: Noal
authors: Jussara
authors: J
authors: Fiterman
authors: Alberto
authors: A
authors: Cukier
authors: José Miguel
authors: JM
authors: Chatkin
authors: Frederico Leon Arrabal
authors: FL
authors: Fernandes
mesh_terms: D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D010919:Placebos; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000401:mortality; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D010919:Placebos