Modern treatment of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a major cause of ill health and medical expenditure worldwide. Despite recent increases in the knowledge about the nature of the disease process and recognition of cytokine-mediated pathways of inflammation, current management is focussed on patient outcomes that relate to physiological measures of dysfunction. The new Global initiative in Obstructive Lung Disease (GOLD) management guidelines are evidence-based and stress both pharmacological and nonpharmacological therapy. Effective drug therapy can help smoking cessation in motivated patients (nicotine replacement, bupropion). Bronchodilator therapy is best given by inhaler, can use either beta-agonists or anticholinergics and is more effective if long acting. Health status and exercise performance can improve without parallel changes in forced expiratory volume in one second. Inhaled corticosteroids are indicated if there is a significant bronchodilator response or the patient has more severe disease with frequent exacerbations. Antioxidant therapy remains controversial but may reduce exacerbation number. Acute exacerbations require higher doses of bronchodilators and short courses of oral corticosteroids. New drug treatment is a major priority for chronic obstructive pulmonary disease research.