Pharmacological treatment of stable COPD: need for a simplified approach

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is one of the most common diseases worldwide. Although different guidelines regarding therapeutic algorithms exist, the most widely adopted approach is the one suggested by the Global Initiative in Chronic Obstructive Lung Disease in which patients are stratified according to their dyspnea severity and their exacerbation history during the previous year. This combined assessment of COPD, which takes into consideration all aforementioned characteristics of COPD patients as well as the number of blood eosinophils, results in a proposed therapeutic algorithm which is complex and hard to memorize. This complexity is probable one of the causes that most health care professionals are not adherent to the guidelines when treating COPD patients. Here, we propose a simplified therapeutic algorithm for the treatment of COPD patients taking into consideration the current evidence on the use of bronchodilators and inhaled corticosteroids.

KEYWORDS:

• Chronic Obstructive Pulmonary Disease
• long acting bronchodilators
• dual bronchodilation
• inhaled corticosteroids
• acute exacerbations of COPD
• blood eosinophils

Authors contribution

GH organized the manuscript and the references. GH, AIP, AP, and KD wrote the manuscript. GH provided the therapeutic algorithm. All authors have read and approved the final version of the manuscript

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

A reviewer on this manuscript has disclosed that they have received research, consulting and lecturing fees from GlaxoSmithkline, Sepracor, Schering Plough, Altana, Methapharma, AstraZeneca, ONO pharma, Merck Canada, Forest Laboratories, Novartis Canada/USA, Boehringer Ingelheim (Canada) Ltd, Pfizer Canada, SkyePharma,, and KOS Pharmaceuticals and Almirall, Sanofigenzyme. Another of the reviewers has performed consulting, served on advisory boards, or received travel reimbursement from Amphastar, AstraZeneca, Boehringer Ingelheim, Cipla, Chiesi, GlaxoSmithKline, Mylan, Novartis, Pearl, Sunovion and Theravance. They have also conducted multicenter clinical research trials for some 40 pharmaceutical companies.

Declaration of interest

All authors report no conflicts of interest in this work