Chronic obstructive pulmonary disease (COPD) affects about 14 million persons in the United States and is the only common cause of death that is increasing in incidence. Chronic management of this disorder includes nonpharmacologic interventions such as smoking cessation, immunization, nutritional support, and pulmonary rehabilitation. The pharmacotherapy of COPD is based on regular administration of bronchodilators, when symptoms are persistent. Long-acting bronchodilators have been shown to improve quality of life in patients with COPD. Ipratropium remains the anticholinergic of choice, but more specific agents with a longer duration of action should become available. Four recent large clinical trials on the use of inhaled corticosteroids (ICS) have been published. The results demonstrate that ICS do not alter the decline in lung function in patients with COPD. Patients with more severe COPD and frequent exacerbations may have a better quality of life and a reduced rate of exacerbations with ICS. Management of acute exacerbations involves three major pharmacologic treatment modalities: antibiotics, short-acting bronchodilators, and systemic steroids. Recent data shows the benefits of systemic corticosteroids in the management of acute exacerbations.
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