Pharmacologic treatment of COPD. Optimum therapy for ambulatory patients.

Chronic obstructive pulmonary disease (COPD) has a wide variety of pathophysiologic mechanisms that involve the bronchi, bronchioles, and acini. For typical patients, first-line treatment with inhaled beta 2-selective agonists or ipratropium bromide (Atrovent) significantly improves lung function with minimal side effects. Theophylline is no longer routinely used as a first-line agent for the treatment of COPD but may be a useful addition to therapy if proper attention is given to serum drug levels and symptoms of toxicity. Oral prednisone is useful as an adjunctive agent for patients with serious disease who do not respond to other agents; a therapeutic trial showing objective evidence of benefit from this drug is essential. Mucolytics have recently been shown to have a role in improving lung function and also may be useful as adjunctive therapy.