Pharmacological management of COPD.

The pharmacological management of chronic obstructive pulmonary disease (COPD) focuses on the alleviation of symptoms coupled with exacerbation prevention. Inhaled treatments are the mainstay of management, ensuring adequate lung delivery while minimising the potential for adverse systemic effects. Combination inhalers with long acting bronchodilators, with and without inhaled corticosteroids (ICS), are in widespread use to treat COPD on the basis of clinical trial evidence alongside the practical advantages associated with using a single inhaler in the real life world. There is also a personalised approach to ICS use, as blood eosinophil counts can help identify individuals with a greater probability of responding to treatment. Biological treatments have demonstrated positive results in COPD clinical trials, and will also be used in a precision approach in future. The positive clinical trial results for dupilumab (a monoclonal antibody directed against the shared IL-4 and IL-13 receptor) and ensifentrine (an inhibitor of phosphodiesterase 3 and 4) represent significant advances in the pharmacological management of COPD. This review describes the recent progress in COPD pharmacology, covering novel molecules, new evidence and changes in clinical practice.