Abstract
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 language | English (US) |
|---|---|
| Pages (from-to) | 33-42 |
| Number of pages | 10 |
| Journal | Journal of Critical Illness |
| Volume | 18 |
| Issue number | 1 |
| State | Published - Jan 1 2003 |
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Keywords
- 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
Cite this
Taking pharmacologic management of COPD into the future. / Manda, Winfred; Rennard, Stephen Israel.
In: Journal of Critical Illness, Vol. 18, No. 1, 01.01.2003, p. 33-42.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Taking pharmacologic management of COPD into the future
AU - Manda, Winfred
AU - Rennard, Stephen Israel
PY - 2003/1/1
Y1 - 2003/1/1
N2 - 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.
AB - 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.
KW - Bronchodilators
KW - Bronchodilatory responses to tiotropium
KW - COPD severity classification
KW - Clinical Conclusions
KW - Corticosteroids
KW - Mechanisms of pharmacologic action
KW - Staged treatment
UR - http://www.scopus.com/inward/record.url?scp=0037241522&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037241522&partnerID=8YFLogxK
M3 - Review article
VL - 18
SP - 33
EP - 42
JO - Journal of Critical Illness
JF - Journal of Critical Illness
SN - 1040-0257
IS - 1
ER -