COPDX: an update of guidelines for the management obstructive pulmonary disease with a review of recent evidence

Abstract

• Long-acting β2 agonists are an effective and convenient treatment for chronic obstructive pulmonary disease (COPD), but do not significantly improve lung function. • The long-acting anticholinergic tiotropium, which can be taken once daily, decreases exertional dyspnoea and increases endurance by reducing hyperinflation. • The role in COPD of the combination of a long-acting β2 agonist and a glucocorticoid in a single inhaler remains unclear. • The minimum duration of an effective pulmonary rehabilitation program that includes exercise training is 6 weeks. • Long-term treatment with inhaled glucocorticoids may reduce the rate of decline in lung function, but the effect is small. • Aminophylline should no longer be routinely used in acute exacerbations of COPD. • Non-invasive positive pressure ventilation (NPPV) reduces mortality and hospital stay in patients with acute hypercapnic ventilatory failure; it is also an effective weaning strategy for patients who require intubation. • Further studies are required to clarify the role of NPPV in the long-term management of stable COPD.