Therapeutic approaches to chronic obstructive pulmonary disease: an emerging consensus

In response to reports of rising asthma morbidity and mortality, several consensus statements have been drafted to guide the treatment of asthma. More recently, attempts have been made to develop similar guidelines for the management of chronic obstructive pulmonary disease (COPD). Just as the two diseases differ in their pathophysiology, their treatment algorithms have differed. For both disease groups, avoidance of further airway injury is the initial step in treatment. For asthmatics, this is often allergen avoidance, but for patients with COPD the usual inciting factor is cigarette smoking, thereby making smoking cessation the necessary first step. Whereas beta 2-agonist bronchodilators are used as needed in asthma management, regular bronchodilator therapy with anticholinergic drugs is the first-line approach in COPD. The role of anti-inflammatory drugs differs markedly between the two disease groups. Asthmatic patients benefit dramatically from inhaled anti-inflammatory drugs; little or no benefit can be demonstrated for the majority of patients with COPD. In COPD, the role of exercise rehabilitation programs can improve exercise tolerance. For selected patients with COPD with persistent hypoxemia, the use of supplemental oxygen can reduce mortality. For both patient groups, educational interventions can play a valuable role in making patients patients effective partners in their own care.