Pharmacological treatment of patients with chronic obstructive pulmonary disease (COPD) aims to reduce disease burden and prevent future risk, especially exacerbations, hospitalizations, decline of lung function and quality of life, and mortality. This review will describe the basic pharmacology of the different classes of agents, followed by the effects they exert in patients with COPD, and the side effects. Targets for pharmacological treatments include airway smooth muscle contraction, inflammation, mucus production, alpha-1-antitrypsin deficiency and respiratory infection. Inhaled bronchodilators are the mainstay, with methylxanthines as secondary choice agents. Anti-inflammatory therapy can be administered as corticosteroids, phosphodiesterase inhibitor, and long-term macrolides such as azithromycin. Mucus production is addressed by use of mucolytics. In some countries, alpha-1-antitrypsin augmentation therapy is available for severe alpha-1-antitrypsin deficiency. The treatment of bacterial infection and/or colonization can be attempted with antibiotics; there is a dire need for effective anti-viral agents for the common viruses causing exacerbations of COPD. Since clinicians need to choose medications for their individual patients, algorithms for how to choose and change medication are increasingly being presented with more elements of treatable traits and personalized medicine.
Keywords: Chronic obstructive pulmonary disease (COPD); pharmacology; review; treatment.
2019 Journal of Thoracic Disease. All rights reserved.
Conflict of interest statement
Conflicts of Interest: HA Kerstjens reports research grants from GSK, Novartis, and Boehringer, and fees for consultancies in advisory boards from other from GSK, Novartis, and Boehringer, all paid to his institution. JW Upham has served on Advisory Boards for GSK, AZ, Novartis and Boehringer Ingelheim and has received speaker fees from GSK, AZ, Novartis and Boehringer Ingelheim. IA Yang has no conflicts of interest to declare.
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