Management of chronic obstructive pulmonary disease: Moving beyond the asthma algorithm

• Published in: Journal of allergy and clinical immunology Vol. 124; no. 5; pp. 873 - 880
• Main Authors: Gordon, Erin, Lazarus, Stephen C.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2009; Elsevier; Elsevier Limited
• Subjects: Acetylcholine receptors; Administration, Inhalation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - therapeutic use; airflow obstruction; Albuterol - administration & dosage; Albuterol - analogs & derivatives; Albuterol - therapeutic use; Algorithms; Allergy and Immunology; Androstadienes - administration & dosage; Androstadienes - therapeutic use; anticholinergics; antioxidants; Antioxidants - administration & dosage; Antioxidants - therapeutic use; Asthma; Asthma - drug therapy; Asthma - immunology; Bacterial Vaccines - immunology; Biological and medical sciences; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - therapeutic use; bronchodilators; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clinical trials; Clinical Trials as Topic; Corticoids; Drug addiction; Drug therapy; Fluticasone; Frustration; Fundamental and applied biological sciences. Psychology; Fundamental immunology; home oxygen; Humans; immunization; Immunological tolerance; Immunopathology; Inflammation; inhaled corticosteroids; long-acting bronchodilators; Medical sciences; Mortality; mucolytics; oral corticosteroids; Physical training; Pneumology; Pneumonia; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - immunology; pulmonary rehabilitation; Quality of life; salmeterol; Salmeterol Xinafoate; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scopolamine Derivatives - administration & dosage; Scopolamine Derivatives - therapeutic use; Smoking; smoking cessation; Studies; Tiotropium Bromide; Viral Vaccines - immunology; β 2-agonists; ISOLDE; OR; antioxidants; bronchodilators; asthma; oral corticosteroids; FVC; smoking cessation; immunization; mucolytics; TORCH; long-acting bronchodilators; Chronic obstructive pulmonary disease; airflow obstruction; pulmonary rehabilitation; anticholinergics; home oxygen; inhaled corticosteroids; β 2-agonists; COPD; Forced vital capacity; Towards a Revolution in COPD Health; Odds ratio; Inhaled Steroids in Obstructive Lung Disease; Agonist; Lung; Vaccination; Tobacco smoking; Respiratory system; Obstruction; Immunology; Bronchus disease; Obstructive pulmonary disease; Anticholinesterase agent; Lung disease; Corticosteroid; Immunopathology; Immunization; Oxygen; Poison withdrawal; Respiratory disease; Bronchodilator; Oral administration; Antioxidant; Algorithm; Asthma; Inhalation; Mucolytic; β; Clinical management; agonists; Shutdown; Rehabilitation(human); Rehabilitation
• ISSN: 0091-6749; 1097-6825; 1097-6825
• DOI: 10.1016/j.jaci.2009.09.040

For many years, chronic obstructive pulmonary disease (COPD) was considered a disease of fixed airflow obstruction for which there was no good treatment. Out of desperation and frustration, health care providers extrapolated from asthma to COPD, and standard asthma therapy was adopted without evidence for efficacy. In recent years, we have gained a better understanding of the pathophysiologic differences between asthma and COPD, and prospective controlled trials have provided a rationale for therapy. Smoking cessation is critically important, both as primary prevention and as an effective way to slow the decrease in lung function in patients with established disease. β 2-Adrenergic and anticholinergic agonists improve lung function and relieve symptoms in most patients. Tiotropium improves exercise tolerance and quality of life and reduces exacerbations and hospitalizations. The increase in lung function seen with tiotropium is sustained with continued use over at least 3 to 4 years. Inhaled corticosteroids decrease exacerbations and improve quality of life, and their effect seems greatest in patients with lower lung function and in exacerbation-prone patients. There is no evidence that inhaled corticosteroids alone affect mortality, despite the reduction in exacerbations and increased risk of pneumonia. In some patient populations, inhaled fluticasone, salmeterol, or the combination might slow the rate of loss of lung function. Rather than reflexively using effective asthma therapy in the patient with COPD, current and future therapy for COPD is increasingly evidence based and targeted to specific inflammatory pathways that are important in patients with COPD.