Pharmacologic therapy: novel approaches for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is increasing in the United States and throughout the world. There have been a number of advances in the treatment of this disease within the last several decades, and these improved therapies continue to become available, making the prospects for the future encouraging. Bronchodilation is the treatment of choice, and we point out in this article the potential availability of many new bronchodilators. There will be several options in the beta(2)-agonist and the anticholinergic categories for once-a-day preparations. There will also be a number of products combining these categories of bronchodilators and inhaled steroids, and the combination products will be available in once-a-day preparations. Also under development are several candidates for specific and effective antiinflammatory agents in COPD. It is likely that our ability to control the inflammation underlying COPD will be a reality in the future. Although many new cases of COPD are being diagnosed in former smokers, for patients who smoke, the most important treatment is smoking cessation. A number of new drugs are available, and more will be brought to market in the future. We have highlighted the details of this important area.