R E V I E W Pharmacological treatment of chronic obstructive pulmonary disease Paolo Montuschi Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy Correspondence: Paolo Montuschi Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, 00168 Rome, Italy Tel +39 06 3015 6092 Fax +39 06 3015 6292 Email pmontuschi@rm.unicatt.it Abstract: None of the drugs currently available for chronic obstructive pulmonary disease (COPD) are able to reduce the progressive decline in lung function which is the hallmark of this disease. Smoking cessation is the only intervention that has proved effective. The current pharmacological treatment of COPD is symptomatic and is mainly based on bronchodilators, such as selective β2-adrenergic agonists (short- and long-acting), anticholinergics, theophylline, or a combination of these drugs. Glucocorticoids are not generally recommended for patients with stable mild to moderate COPD due to their lack of efﬁcacy, side effects, and high costs. However, glucocorticoids are recommended for severe COPD and frequent exacerbations of COPD. New pharmacological strategies for COPD need to be developed because the current treatment is inadequate. Keywords: Chronic obstructive pulmonary disease, pharmacological treatment, bronchodilators, glucocorticoids, theophylline, antibiotics. Introduction The objective of pharmacological treatment of chronic obstructive pulmonary disease (COPD) is to prevent and control symptoms, reduce the frequency and severity of exacerbations, and improve general health status and exercise tolerance. None of the classes of drugs currently used in the treatment of COPD are able to modify the progressive decline in lung function which is the hallmark of this disease (Anthonisen et al 1994; Pauwels et al 1999; Vestbo et al 1999; Burge et al 2000). Smoking cessation is currently the only intervention which has been shown to reduce the progression of COPD (GICOPD 2001). To achieve this objective, behavioral therapy and pharmacological treatment such as the administration of bupropion (an antidepressant), and nicotine replacement therapy have proved useful (Jorenby et al 1999; Tashkin et al 2001). However, it is important to try to control symptoms of COPD with pharmacological treatment using the following general proposals (GICOPD 2001): 1) There should be a stepwise increase in treatment, according to the severity of the disease. The step-down approach used in the chronic treatment of asthma is not applicable to COPD. 2) Treatment needs to be chronic and maintained at the same level for long periods of time, unless signiﬁcant side effects or exacerbations occur. 3) Since individual patient response to the pharmacological treatment is variable, it is important to monitor pharmacological treatment closely and, if necessary, adjust it frequently. Drugs currently recommended for the treatment of COPD are: 1) Bronchodilators (selective β -agonists, anticholinergic antimuscarinic agents and 2 methylxanthines); 2) glucocorticoids; International Journal of COPD 2006:1(4) 409–423 © 2006 Dove Medical Press Limited. All rights reserved 409