Bronchodilators in COPD: latest recommendations, recent data and perspectives

DEMONSTRATED EFFICACY: Inhaled bronchodilators improve the quality of life of COPD patients by reducing dyspnea and exacerbation frequency. There is no data supporting the superiority of one of the families of inhaled bronchodilators (i.e. beta 2 agonists and anticholinergic agents) over the other. Thus, the choice has to be based on the individual symptomatic response. These agents can be combined. OTHER POSSIBILITIES: Long-acting beta 2 agonists are already available and long-acting anticholinergics should be marketed soon. Theophylline has a lower efficacy/tolerance ratio than inhaled bronchodilators but can provide additional benefits when associated with the latter in some patients. Phosphodiesterase inhibitors with both bronchodilating and anti-inflammatory effect are being developed. THE BENEFITS OF CORTICOSTEROIDS: Finally, in symptomatic patients with FEV1<50% predicted and repeated exacerbations despite bronchodilators, inhaled corticosteroids can be added.