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The Proceedings of the American Thoracic Society 5:501-505 (2008)
© 2008 The American Thoracic Society
doi: 10.1513/pats.200708-131ET
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Optimizing Bronchodilator Therapy in Emphysema

Philip T. Diaz1, Aaron S. Bruns1, Michael E. Ezzie1, Nathaniel Marchetti2 and Byron M. Thomashow3

1 Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio; 2 Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania; and 3 Columbia University Medical Center, New York, New York

Correspondence and requests for reprints should be addressed to Philip T. Diaz, M.D., 201 Davis Heart Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210. E-mail: philip.diaz{at}osumc.edu

ABSTRACT

The treatment objectives for chronic obstructive pulmonary disease (COPD) include relieving symptoms such as dyspnea and cough, slowing the accelerated decline in lung function, decreasing exacerbations, and improving quality of life. All major guidelines for COPD management recommend beginning treatment with bronchodilators. There are several classes of bronchodilators, including β-agonists, anticholinergics, and phosphodiesterase inhibitors, each with a specific mechanism of action. The overall approach to managing stable COPD involves a stepwise increase in treatment. Because of the progressive nature of emphysema, such an approach often involves combining bronchodilators from different pharmacologic classes. This review focuses on the pharmacologic properties of various bronchodilators and on recent studies that have examined combination therapy as a means to optimize treatment.

Key Words: chronic obstructive pulmonary disease • β-agonists • anticholinergics • theophylline






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