- The main risk factor for the development and deterioration of chronic obstructive pulmonary disease (COPD) is smoking.
- Inhaled anticholinergics and beta2 agonists improve lung function and symptoms and reduce exacerbations in stable COPD compared with placebo.
- 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.
- Oral corticosteroids may improve short-term lung function, but have serious adverse effects.
- Combined inhaled corticosteroids plus long-acting beta2 agonists improve lung function, symptoms, and health-related quality of life, and reduce exacerbations compared with placebo, and may be more effective than either treatment alone.
- 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.
- We don't know whether mucolytic drugs, prophylactic antibiotics, or alpha1 antitrypsin improve outcomes in people with COPD compared with placebo.
- Combined psychosocial and pharmacological interventions for smoking cessation can slow the deterioration of lung function, but have not been shown to reduce long-term mortality compared with usual care.
- Multi-modality pulmonary rehabilitation can improve exercise capacity, dyspnoea, and health-related quality of life in people with stable COPD; general physical exercises and peripheral muscle training can improve exercise capacity; inspiratory muscle training may improve lung function and exercise capacity; but nutritional supplementation has not been shown to be beneficial.