Chronic Obstructive Pulmonary Disease: An Evidence-Based Approach to Treatment With a Focus on Anticholinergic Bronchodilation

November 2008
Mayo Clinic Proceedings;Nov2008, Vol. 83 Issue 11, p1241
Academic Journal
Chronic obstructive pulmonary disease is a prevalent condition associated with a high societal burden. Despite a decrease in the prevalence of smoking in the United States, the rates of morbidity and mortality associated with chronic obstructive pulmonary disease are expected to continue to increase. Appropriate treatment can have an important impact on many facets of the disease. This article reviews evidence gathered in a PubMed search of papers published from January 1, 2004, to December 31, 2007. The search terms used were chronic obstructive pulmonary disease, epidemiology, practice guidelines, cilnical trial, and meta-analysis. Selection of pharmacological therapy is based on severity of disease and differences among the effects of drugs on various end points, including the criterion standard, forced expiratory volume In the first second of expiration. Other important variables, which are closely related to patients' perception of their condition, include reduction in acute exacerbations, improved quality of life, improved exercise performance, and reduced hyperinflation. When maintenance therapy is indicated, ciinlcal evidence suggests initiating treatment with a long-acting agent, either a once-daliy anticholinergic or a twice-daily β²-agonist. If combination therapy is indicated, data support using long-acting drugs from different classes that provide complementary modes of action β²-agonist, anticholinergic, inhaled corticosteroid). in this setting, inhaled corticosteroids may further reduce exacerbations when given with a β²-agonist, an anticholinergic, or both.


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