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Editorials |

Optimizing Bronchodilator Therapy for COPD

Brian J. Lipworth, MD
Author and Funding Information

Affiliations: Dundee, Scotland 
 ,  Dr. Lipworth is Professor of Allergy and Respiratory Medicine, Ninewells Hospital and Medical School, University of Dundee. Dr. Lipworth and the Asthma and Allergy Research group have received financial support for equipment, clinical trials, attending meetings, or giving occasional postgraduate lectures from the following pharmaceutical companies who make long-acting β2-agonists or theophylline: GlaxoWellcome, AstraZeneca, Boehringer Ingelheim, Innovata Biomed, Novartis, Aventis, and 3M Healthcare.

Correspondence to: Brian J. Lipworth, MD, Professor of Allergy and Respiratory Medicine, Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland DD1 9SY; e-mail: b.j.lipworth@dundee.ac.uk



Chest. 2001;119(6):1628-1630. doi:10.1378/chest.119.6.1628
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The current American and British guidelines for COPD highlight the limited available treatment options for this condition.12 This was also shown in a 1999 evidence-based systemic review3 of interventions in patients with stable COPD, where randomized controlled trials found short-term benefits from anticholinergics and β2-agonists administered alone or in combination, with the need for frequent blood monitoring limiting the usefulness of theophyllines. Long-term trials with high doses of inhaled corticosteroids have been disappointing, as they do not seem to arrest the progressive decline in lung function and only have small and inconsistent effects on symptoms, quality of life, or exacerbations, while at the same time having the propensity for producing systemic adverse effects, including skin bruising, adrenal suppression, or loss of bone density.6 To date, only two interventions, namely smoking cessation and long-term oxygen administration, have been found to alter the long-term course in COPD.

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