BMJ  2006;332:1439-1441 (17 June), doi:10.1136/bmj.332.7555.1439

Practice

ABC of chronic obstructive pulmonary disease

Pharmacological management—inhaled treatment

¹ Respiratory Unit, Aberdeen Royal Infirmary, Aberdeen., ² Asthma and Allergy Research Group, Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee.

The first 150 words of the full text of this article appear below.

Chronic obstructive airways disease (COPD) is a heterogeneous condition, and all patients should be viewed as individuals—not only in terms of presentation, history, symptoms, and disability, but also in response to treatment. Acceptability to the patient, possible adverse effects, and efficacy of treatment are important factors to consider when prescribing inhaled drugs. The titration of drug treatment in COPD is usually based on the degree of airflow obstruction, severity of symptoms, exercise tolerance, and frequency of exacerbations.

All patients with established COPD should be prescribed a short acting inhaled bronchodilator for use as required

 

Short acting bronchodilators

For all patients with established COPD, prescribe a short acting inhaled bronchodilator (₂ agonist or anticholinergic, or both in combination).

View larger version (26K): [in this window] [in a new window]   Patients with COPD have pulmonary hyperinflation, with increased functional residual capacity (red) and decreased inspiratory capacity (white). This increases the volume at which tidal breathing (oscillating line) occurs and places the respiratory muscles at mechanical disadvantage. . . . [Full text of this article]

 

Long acting bronchodilators

Long acting ₂ agonists
Long acting anticholinergics

Inhaled corticosteroids

Combined corticosteroid plus long acting ₂ agonist inhalers

Summary of inhaled treatment

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