Current concepts in pharmacologic management of chronic obstructive pulmonary disease

The goals of pharmacologic management of COPD are to enhance smoking cessation, alleviate dyspnea by promoting bronchodilatation, treating exacerbations, and preserving lung function. The step approach to the use of bronchodilators based upon the degree of dyspnea is reviewed with particular attention to anticholinergic agents and beta agonists, Bronchodilators are useful not only to improve lung function but also to enhance health-related quality of life. Although inhaled steroids may prevent decline in lung function and reduce the number of exacerbations, their precise role awaits completion of further studies currently in progress. Exacerbations should be treated with antibiotics, and the choice of agents depends upon the severity of the underlying lung disease.