Chronic obstructive pulmonary disease or COPD is a chronic inflammation of the respiratory tract, with the gradual and partially irreversible deterioration of the airways. Patients generally suffer from a chronic cough, expectoration and shortage of breath (dyspnoea), punctuated by acute attacks. COPD causes a number of severe, sometimes life-threatening complications. Halting exposure to tobacco smoke and other irritants, especially occupational, is the only measure that has proved effective in slowing the progression of COPD. Physical exercise is also beneficial.

Drug treatments for BPCO should be adapted to the symptoms experienced and the frequency of exacerbations. Inhaled short-acting beta-2 agonists should be used as a first-line option, or long-acting if these are not sufficiently effective, or even tiotropium, an atropine-like medication.

In cases of persistent symptoms or repeated exacerbations, the addition of a corticosteroid is effective, at the price however of adverse effects such as pneumonia, candidiasis, dysphonia or adrenal insufficiency.

The harm-benefit balance of theophylline and roflumilast is too unfavourable for these to be an option.

It is helpful to train the patient in the better use of inhaled medication.

©Prescrire 1 November 2016

"Chronic obstructive pulmonary disease. Useful medications for patients with recurrent symptoms" Prescrire Int 2016; 25 (176): 272-277. (Pdf, subscribers only).