Taking pharmacologic management of COPD into the future

Winfred Manda, Stephen I. Rennard

Research output: Contribution to journalReview articlepeer-review


Chronic obstructive pulmonary disease (COPD) is disabling and often fatal, and acute exacerbations are a primary reason for ICU admission and use of emergency department services. Prompt restoration of airflow is imperative. A primary challenge is coming up with an individualized management strategy that reduces risk factors, is useful when a patient's symptoms are stable, and also helps reduce episodes of exacerbations. Current pharmacologic therapies, which have been based on objective improvements in expiratory airflow, include inhaled bronchodilators such as the anticholinergic ipratropium, short- and long-acting β2-agonists, and theophylline. Tiotropium, which is not yet available in the United States, may become a useful addition to the therapeutic choices. Novel phosphodiesterase 4 inhibitors, including roflumilast, piclamilast, and cilomilast, are being investigated. As pathophysiologic mechanisms become clearer, combining drugs that have different mechanisms and durations of action may prove key in lever-aging the greatest symptom control with the fewest side effects. Giving a first-generation β2-adrenergic agonist, such as albuterol, for example, together with an antimuscarinic agent is pharmacologically reasonable from the standpoints of both efficacy and safety.

Original languageEnglish (US)
Pages (from-to)33-42
Number of pages10
JournalJournal of Critical Illness
Issue number1
StatePublished - Jan 1 2003


  • Bronchodilators
  • Bronchodilatory responses to tiotropium
  • COPD severity classification
  • Clinical Conclusions
  • Corticosteroids
  • Mechanisms of pharmacologic action
  • Staged treatment

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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