[Pharmacologic treatments of COPD depending on disease severity]

Depending on decreases in lung function and severity of symptoms, treatment with bronchodilators, including beta2-agonists and anticholinergics, is performed in pharmacologic treatments of COPD. Methylxanthines are also frequently used in Japan. As-needed use of short-acting bronchodilators is recommended for patients with mild COPD for relief of symptoms. Regular treatment with long-acting bronchodilators is more effective than treatment with short-acting bronchodilators. Inhaled beta2-agonists and anticholinergics in combination are more effective than either agent alone. Combining bronchodilators with different mechanisms of action may increase the effects of bronchodilation, may improve symptoms and quality of life, and reduce the frequency of exacerbations. Inhaled corticosteroids reduce the frequency of exacerbations and improve symptoms in severe COPD.