Key points

  • The main risk factor for the development and deterioration of chronic obstructive pulmonary disease (COPD) is smoking.
  • It is unclear whether inhaled anticholinergics or inhaled beta2 agonists are the more consistently effective drug class in the treatment of COPD.
  • Short-acting anticholinergics seem to be associated with a small improvement in quality of life compared with beta2 agonists.
  • Long-acting inhaled anticholinergics may improve lung function compared with long-acting beta2 agonists.
  • Combined treatment with inhaled anticholinergics plus beta2 agonists may improve symptoms and lung function and reduce exacerbations compared with either treatment alone, although long-term effects are unknown.
  • Inhaled corticosteroids reduce exacerbations in COPD and reduce decline in FEV1, but the beneficial effects are small.
  • Long-term domiciliary oxygen treatment may improve survival in people with severe daytime hypoxaemia.
  • Theophylline may improve lung function compared with placebo, but adverse effects limit its usefulness in stable COPD.