Over the past few years, new drugs have been added to the bronchodilators and inhaled corticosteroids used for treating COPD. There is no strong evidence to say that one drug within a class is better than another and the decision about which drugs to use is mainly about patient preference, although multiple drugs from the same class should not be used in the same patient.
There are four main components in the long-term management of patients with chronic obstructive pulmonary disease (COPD): smoking cessation, regular exercise with or without pulmonary rehabilitation, medications, and influenza and pneumococcal vaccinations. This article focuses on medications, but this does not imply that they are more important than the other components. In fact, smoking cessation is the most important aspect of COPD management as it is the only treatment that has been convincingly shown to slow the progressive decline in lung function in those who continue to smoke. Indeed, when patients participate in a full pulmonary rehabilitation program the benefits are at least as great as with use of the full range of medications.
Each of the four components should be applied simultaneously. COPD medications have benefits in both past and current smokers, and also have added benefits when combined with regular exercise. This article addresses the long-term management of patients with COPD; it does not cover the management of acute exacerbations.
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