Novel concepts in the pharmacotherapy of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is highly prevalent and will continue to be an increasing cause of morbidity and mortality worldwide. COPD is now viewed under a new paradigm as preventable and treatable. In addition, it has become accepted that COPD is not solely a pulmonary disease but also one with important measurable systemic consequences. It follows, that patients diagnosed with COPD have to be comprehensively evaluated to determine the extent of disease so that therapy can be adequately individualized. We now know that smoking cessation, oxygen for hypoxemic patients, lung reduction surgery for selected patients with emphysema, and non-invasive ventilation during severe exacerbations have an impact on mortality. The completion of well planned pharmacological trials have shown the importance of patient centered outcomes and the possible impact on mortality and rate of decline of lung function. This monograph presents an update on the pharmacological therapy of COPD. The future for patients with COPD is bright as primary and secondary prevention of smoking becomes more effective and air quality improves. In addition, current research will unravel the pathogenesis, clinical and phenotypic manifestations of COPD thus providing exciting therapeutic targets. Ultimately, the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health.