Chronic Obstructive Pulmonary Disease Part II A Review of Pharmacological Managements of Chronic Obstructive Pulmonary Disease

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Joyce Akwe, MD, MPH Nadene Fair, MD Tatah Fongeh, MD


Over the years, the management of chronic obstructive pulmonary disease has evolved, but given the high mortality and morbidity of COPD, much work still needs to be done. To date, none of the existing pharmacological therapies for COPD has been shown conclusively to modify the long-term decline in lung function. Several trials have been completed to evaluate options that can improve patient symptoms and quality of life.

Optimal management for patients with COPD requires both pharmacological and non-pharmacological managements. Some of the non-pharmacological options for the management of COPD like Oxygen therapy have proven reduction in mortality and mortality, and an improvement in the quality of life. Lung transplant is the only treatment that can stop the decline in lung function. Smoking cessation is the non-pharmacological intervention with the greatest capacity to influence the natural course of COPD. Pulmonary rehabilitation programs are evidence based, multidisciplinary and comprehensive interventions for patients with COPD. These programs involve patient assessment, exercise training, education, nutrition and psychosocial support. Pulmonary rehabilitation programs are designed to reduce symptoms, optimize functional status, increase participation and reduce health care cost through stabilizing or reversing systemic manifestations of the disease.

This article discusses the most used non pharmacological management of COPD and their usefulness in relieving symptoms and improving the quality of life for patients with severe COPD. These treatment options are used in addition to optimal pharmacological therapy.

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AKWE, Joyce; FAIR, Nadene; FONGEH, Tatah. Chronic Obstructive Pulmonary Disease Part II A Review of Pharmacological Managements of Chronic Obstructive Pulmonary Disease. Medical Research Archives, [S.l.], v. 8, n. 2, feb. 2020. ISSN 2375-1924. Available at: <>. Date accessed: 29 jan. 2023. doi:
Research Articles


1. Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J. 2019;53(5).
2. Ferguson GT. Recommendations for the Management of COPD. CHEST. 2000;117(2):23S-28S.
3. Tarpy SP, Celli BR. Long-term oxygen therapy. N Engl J Med. 1995;333(11):710-714.
4. Fishman A, Fessler H, Martinez F, et al. Patients at high risk of death after lung-volume-reduction surgery. N Engl J Med. 2001;345(15):1075-1083.
5. Murciano D, Auclair MH, Pariente R, Aubier M. A randomized, controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease. N Engl J Med. 1989;320(23):1521-1525.
6. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. Jama. 1994;272(19):1497-1505.
7. Niewoehner DE. Clinical practice. Outpatient management of severe COPD. N Engl J Med. 2010;362(15):1407-1416.
8. Munari AB, Gulart AA, Dos Santos K, Venancio RS, Karloh M, Mayer AF. Modified Medical Research Council Dyspnea Scale in GOLD Classification Better Reflects Physical Activities of Daily Living. Respir Care. 2018;63(1):77-85.
9. Dixit D, Bridgeman MB, Madduri RP, Kumar ST, Cawley MJ. Pharmacological Management and Prevention Of Exacerbations of Chronic Obstructive Pulmonary Disease in Hospitalized Patients. P t. 2016;41(11):703-712.
10. Dixit D, Bridgeman MB, Madduri RP, Kumar ST, Cawley MJ. Pharmacological Management and Prevention Of Exacerbations of Chronic Obstructive Pulmonary Disease in Hospitalized Patients. P & T : a peer-reviewed journal for formulary management. 2016;41(11):703-712.
11. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. 1959;2(5147):257-266.
12. Jones PW, Tabberer M, Chen WH. Creating scenarios of the impact of COPD and their relationship to COPD Assessment Test (CAT™) scores. BMC Pulm Med. 2011;11:42.
13. Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: a systematic review. Eur Respir J. 2014;44(4):873-884.
14. Folch Ayora A, Macia-Soler L, Orts-Cortés MI, Hernández C, Seijas-Babot N. Comparative analysis of the psychometric parameters of two quality-of-life questionnaires, the SGRQ and CAT, in the assessment of patients with COPD exacerbations during hospitalization: A multicenter study. Chron Respir Dis. 2018;15(4):374-383.
15. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179-191.
16. Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med. 2005;142(4):233-239.
17. O'Donnell DE, Webb KA, Harle I, Neder JA. Pharmacological management of breathlessness in COPD: recent advances and hopes for the future. Expert Rev Respir Med. 2016;10(7):823-834.
18. Roche N, Chapman KR, Vogelmeier CF, et al. Blood Eosinophils and Response to Maintenance Chronic Obstructive Pulmonary Disease Treatment. Data from the FLAME Trial. Am J Respir Crit Care Med. 2017;195(9):1189-1197.
19. Joyce Akwe NF, Tatah Fongeh. An Overview of the Non- Pharmacological and Non-surgical Management of Chronic Obstructive Pulmonary Disease. . 2020;ISSN 2375-1924. Available at: < >. Date accessed: 21 apr. 2020. doi: .
20. Heffner JE, Mularski RA, Calverley PM. COPD performance measures: missing opportunities for improving care. Chest. 2010;137(5):1181-1189.
21. Stoller JK, Panos RJ, Krachman S, Doherty DE, Make B. Oxygen therapy for patients with COPD: current evidence and the long-term oxygen treatment trial. Chest. 2010;138(1):179-187.
22. Sapey E, Stockley RA. COPD exacerbations . 2: aetiology. Thorax. 2006;61(3):250-258.
23. Boixeda R, Bacca S, Elias L, et al. Pneumonia as comorbidity in chronic obstructive pulmonary disease (COPD). Differences between acute exacerbation of COPD and pneumonia in patients with COPD. Arch Bronconeumol. 2014;50(12):514-520.
24. Matkovic Z, Huerta A, Soler N, et al. Predictors of adverse outcome in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. Respiration. 2012;84(1):17-26.
25. Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J. 2005;26(2):234-241.
26. Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2013;10(2):81-89.
27. Jennings JH, Thavarajah K, Mendez MP, Eichenhorn M, Kvale P, Yessayan L. Predischarge bundle for patients with acute exacerbations of COPD to reduce readmissions and ED visits: a randomized controlled trial. Chest. 2015;147(5):1227-1234.
28. Katajisto M, Koskela J, Lindqvist A, Kilpeläinen M, Laitinen T. Physical activity in COPD patients decreases short-acting bronchodilator use and the number of exacerbations. Respir Med. 2015;109(10):1320-1325.
29. Au DH, Bryson CL, Chien JW, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med. 2009;24(4):457-463.
30. Kessler R, Ståhl E, Vogelmeier C, et al. Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study. Chest. 2006;130(1):133-142.
31. Greening NJ, Williams JE, Hussain SF, et al. An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial. Bmj. 2014;349:g4315.
32. Anthonisen NR, Connett JE, Enright PL, Manfreda J. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med. 2002;166(3):333-339.
33. Alvarado-Gonzalez A, Arce I. Tiotropium Bromide in Chronic Obstructive Pulmonary Disease and Bronchial Asthma. J Clin Med Res. 2015;7(11):831-839.
34. Koch A, Pizzichini E, Hamilton A, et al. Lung function efficacy and symptomatic benefit of olodaterol once daily delivered via Respimat® versus placebo and formoterol twice daily in patients with GOLD 2-4 COPD: results from two replicate 48-week studies. Int J Chron Obstruct Pulmon Dis. 2014;9:697-714.
35. Gross NJ. Ipratropium bromide. N Engl J Med. 1988;319(8):486-494.
36. Carter NJ. Inhaled glycopyrronium bromide: a review of its use in patients with moderate to severe chronic obstructive pulmonary disease. Drugs. 2013;73(7):741-753.
37. Tashkin DP, Cooper CB. The role of long-acting bronchodilators in the management of stable COPD. Chest. 2004;125(1):249-259.
38. Joyce Akwe NF. Chronic Obstructive Pulmonary Disease: An Overview of Epidemiology, Pathophysiology, Diagnosis, Staging and Management. . In. International Journal of Clinical and Experimental Medical Sciences 2.2 (2016): 13-252016.
39. Sin DD, Man SF, Tu JV. Inhaled glucocorticoids in COPD: immortal time bias. In: Am J Respir Crit Care Med. Vol 168. United States2003:126-127.
40. Lipson DA, Barnhart F, Brealey N, et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med. 2018;378(18):1671-1680.
41. Papi A, Vestbo J, Fabbri L, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet. 2018;391(10125):1076-1084.