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Therapeutic options for chronic obstructive pulmonary disease: present and future.

By 2020, chronic obstructive pulmonary disease (COPD) will become the third leading cause of mortality and fifth leading cause of disability worldwide. Although traditionally therapeutic nihilism has dominated the approach to the management of COPD patients, it is becoming increasingly clear that COPD is a highly preventable and treatable condition. Smoking cessation is the most important therapy because it is the only intervention that has been shown to modify the accelerated decline in lung function that is characteristic of COPD. Domiciliary oxygen therapy for those who are hypoxemic at rest results in improved survival. Vaccinations and immunizations against influenza and pneumococcus should be encouraged. Bronchodilators are used for symptomatic relief. Recent introduction of long-acting bronchodilators facilitates good control of dyspnea with once or twice daily dosing. In conjunction with inhaled corticosteroids, they appear to produce added clinical benefits. Pulmonary rehabilitation and lung transplantation are other therapeutic options for select groups of patients. Many promising compounds are in various stages of development as future therapies in COPD. Drugs such as phosphodiesterase 4 inhibitors, tyrosine kinase blockers and peroxisome proliferator-activated gamma receptor agonists show great promise as disease-modifying agents in COPD.