An Update on Pharmacologic Management of Chronic Obstructive Pulmonary Disease

Hetal J. Patel

Disclosures

Curr Opin Pulm Med. 2016;22(2):119-124. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Chronic obstructive pulmonary disease (COPD) is a widespread disease process with important clinical and economic implications. This review will summarize new pharmacotherapy for the treatment of COPD.

Recent findings Several recent clinical trials have led to the approval of new inhaler therapies for COPD. Many of these are specifically targeting combination long-acting β-agonists and long-acting muscarinic antagonists for late stage COPD.

Summary Several new bronchodilators are available on the market, especially in combination form. The new drug combinations have positive data though clinical relevance, and comparisons to available and well established therapies are still needed. Specifically, translating improved forced expiratory volume into meaningful clinical outcomes remains challenging.

Introduction

Chronic obstructive pulmonary disease (COPD) causes airflow limitation through a variety of processes. Chronic airway inflammation and alveolar surface destruction are just two contributors. COPD affects more than 15 million Americans and is the third leading cause of death in the United States. Moreover, the World Health Association estimates that COPD is the fourth leading cause of death worldwide.

While tobacco smoke remains the main culprit in the United States, other indoor and outdoor exposures such as wood burning can lead to COPD, especially in developing areas (http://www.who.int/respiratory/copd/en/).

Diagnosis and treatment of COPD is largely guided by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Appropriate diagnosis and classification of disease severity then directs the clinician through a stepwise treatment regimen. The most recent staging system takes into account not only the severity of airflow limitation (Fig. 1), but also adds in measurement of symptoms via the modified Medical Research Council dyspnea scale or COPD assessment test along with exacerbations within the last year (http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html) (Fig. 2). The category in which the patient falls can be used to guide therapy. The mainstay of nonpharmacologic treatment has smoking cessation at its core, and is complimented by oxygen therapy and pulmonary rehabilitation. Pharmacotherapy includes bronchodilators, inhaled corticosteroids (ICS), combination inhalers, phosphodiesterase inhibitors, and even macrolides. The purpose of this review will be to concentrate on recent publications discussing pharmacotherapy for COPD, with an emphasis on combination long-acting bronchodilators.

Figure 1.

Global Initiative for Chronic Obstructive Lung Disease staging based on severity of airflow limitation (http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html).

Figure 2.

Risk assessment categories for chronic obstructive pulmonary disease–global Initiative for chronic obstructive lung disease guidelines (http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html). CAT, COPD assessment test; mMRC, modified Medical Research Council questionnaire.

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