Treatment for Chronic Obstructive Lung Disease

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A major concern is that patients who perceive beta2-agonists as being less effective may overuse them. Overdose can be serious and, in rare cases, even life threatening, particularly in patients with heart disease or asthma.

Corticosteroids

Corticosteroids are powerful anti-inflammatory drugs.

Oral Corticosteroids. Oral corticosteroids are reserved for treating COPD exacerbations, and research finds that they are better than inhaled corticosteroids for this purpose. They speed the time to recovery and reduce the length of the hospital stay, but they do not reduce mortality or affect the long-term progression of the disease. They shouldn't be regularly used for stable disease because of the increased risk of side effects.

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Inhaled Corticosteroids. Inhaled corticosteroids (ICS) are the mainstay of asthma therapy. However, their use in COPD is controversial. During the first 6 months of use, ICS may improve lung function. After 6 months, lung function begins to decline again. Although inhaled corticosteroids can help prevent COPD exacerbations, the benefits may not be as significant as was once thought. In one analysis of studies, the benefit was only noted in patients with a FEV1 of less than 50% of predicted.

There has been some concern that ICS might increase the risk of developing and dying from pneumonia in patients with COPD. However, recent evidence has not shown pneumonia to be a risk.

Theophylline and Other Methylxanthines

Methylxanthines (primarily slow-release theophylline) are also bronchodilators, which relax the airways of the lungs. These drugs are used in patients with more severe exacerbations that do not respond completely to corticosteroids, oxygen, or antibiotics.

These drugs do not significantly improve lung function, symptoms, or overall outcomes when used for acute exacerbations. Some experts believe that the modest benefits do not outweigh the risk of toxic side effects from these drugs. Side effects are generally related to the amount of theophylline in the blood, and can include: