Pharmacological Therapy: Bronchodilators

•Bronchodilators play a pivotal role in the treatment of symptomatic patients with chronic obstructive pulmonary disease (COPD). •Inhaled short-acting bronchodilators are currently recommended for rescue of symptoms in patients with mild disease, while inhaled long-acting bronchodilators are recommended as first-line agents for maintenance therapy in patients with moderate and severe disease and those with daily symptoms. •Long-acting bronchodilators which include long-acting β2-agonists and long-acting anticholinergic agents improve symptoms, exercise tolerance, health status and reduce exacerbations in patients COPD. However, they have no significant effects on long-term decline in lung function or mortality. •The use of theophylline has declined in recent years because of its narrow therapeutic index and should be reserved as a third-line option in patients with very severe disease. •When symptoms are not sufficiently controlled by the use of one bronchodilator, combining bronchodilators of different classes may be a more effective approach. •Evidence supports the regular use of a combination of a long-acting β2-agonist (LABA) and a long-acting anti-cholinergic agent (LAAC) in patients with severe COPD. •Combining a long-acting β2-agonist (LABA) with an inhaled corticosteroid has also been shown to be more effective than the use of either agent alone. •Several novel bronchodilators are now in different stages of development for use alone or in combination with other agents.