• COPD pharmacology

Although the definition of chronic obstructive pulmonary disease (COPD) is now more elaborate than in the past,1 the presence of persistent airflow obstruction is still a cardinal feature of this illness, and improved lung emptying, usually expressed as an increase in forced expiratory volume in 1 s (FEV₁), is a key goal of chronic disease management. This can be achieved in several ways, ranging from lung volume reduction surgery2 to anti-inflammatory treatments such as inhaled corticosteroids or phosphodiesterase type IV (PDE IV) inhibition3 4 even on a background of existing inhaled bronchodilators.5 However, for most patients, inhaled bronchodilator drugs remain the cornerstone of drug treatment for this disease. Historically, shorter acting bronchodilators, and especially the antimuscarinic agent ipratropium, were the mainstay of treatment. Although these drugs were initially recommended for use twice or three times per day, later data based on the time course of FEV₁ change showed that their effects only lasted for 4–6 h at best. Combining β-agonists with antimuscarinic drugs increased the peak values for FEV₁ change without greatly changing this limited period of activity.6 The development of long-acting inhaled β-agonists, such as salmeterol7 and formoterol,8 showed that it was possible to improve lung function and health status, although their …