Intended for healthcare professionals

Clinical Review Clinical evidence

Stable chronic obstructive pulmonary disease

BMJ 1999; 319 doi: (Published 21 August 1999) Cite this as: BMJ 1999;319:495
  1. Huib A M Kerstjens, pulmonary physician, on behalf of Clinical Evidence (
  1. Department of Pulmonary Diseases, University Hospital Groningen, PO Box 30 001, 9700 RB Groningen, Netherlands

    This review is taken from Issue 1 of Clinical Evidence, a new information resource for clinicians published by BMJ Publishing Group. The compendium will be updated and expanded every six months. Future issues of Clinical Evidence will cover respiratory stimulants, DNAse, α1 antitrypsin augmentation, and vaccination against influenza and streptococcus.

    Key messages

    • To date, only two interventions—smoking cessation and long term treatment with oxygen (in people with hypoxaemia)—have been found to alter the long term course of chronic obstructive pulmonary disease

    • RCTs found short term benefits (as opposed to long term effects on progression) from anticholinergic drugs, β2 agonists, and oral steroids; the effects of anticholinergic drugs and β2 agonists are not seen in all people with chronic obstructive pulmonary disease, and the two agents combined are slightly more effective than either alone.

    • Adverse effects and the need for frequent monitoring of blood concentrations limit the usefulness of theophyllines

    • Data from one RCT provide no evidence that anticholinergic agents affect decline in lung function; mucolytics have been shown to reduce the frequency of exacerbations but with a possible deleterious effect on lung function; β2 agonists, oral corticosteroids, and antibiotics have not yet been evaluated for their long term effects.

    • No other drug has been shown to affect progression of the disease or survival—but there is some evidence from RCTs that maintenance treatment with inhaled corticosteroids may improve lung function.


    Definition: Chronic obstructive pulmonary disease (COPD) is characterised by airflow obstruction caused by chronic bronchitis, emphysema, or both Emphysema is defined as abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis. Chronic bronchitis is defined as chronic cough, mucus production, or both, for at least three months for at least two successive years where other …

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