Choice of bronchodilator therapy in chronic obstructive pulmonary disease

The majority of patients with chronic obstructive pulmonary disease may derive benefit from bronchodilator therapy, particularly those patients with severe disease. Currently, three classes of bronchodilator are available: anticholinergics, β₂-adrenergic agonists and methylxanthines. Several factors should be considered when choosing a bronchodilator. Inhaled therapy is generally preferred over oral treatment as the inhaled route reduces systemic exposure to the drug, whereas oral therapy has the advantages of convenience and ease of use. The anticholinergics (e.g. ipratropium bromide) and β₂-agonists (e.g. salbutamol) are used via the inhaled route and have approximately equivalent acute bronchodilator effects; they differ pharmacokinetically in onset of effect and duration of action and the anticholinergic may be superior in its long-term effects on lung function.