[Drug therapies of COPD]

In patients with COPD bronchodilators improve lung function to some extent and relieve dyspnoea. Within short-acting bronchodilators, ipratropium (anticholinergic agent) is as effective as salbutamol (sympathomimetic agent) with fewer adverse effects. Presently, maintenance therapy is based on long-acting inhaled bronchodilators. Tiotropium (anticholinergic agent) once a day has a better efficacy to adverse effects ratio than salmeterol or formoterol (sympathomimetic agents) twice a day. Inhaled steroids (fluticasone, budesonide) are also able to improve lung function slightly and to relieve symptoms, but have no beneficial effect on the accelerated rate of decline in lung function that characterizes COPD. A short course (10 days) of systemic steroids is useful to treat an exacerbation. On the other hand, potential toxicity of oral steroids is a definite contra-indication for maintenance therapy.