Pharmacotherapy for chronic obstructive pulmonary disease

In Ae Kim; Yong Bum Park; Kwang Ha Yoo

doi:10.5124/jkma.2018.61.9.545

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Kim, Park, and Yoo: Pharmacotherapy for chronic obstructive pulmonary disease

Focused Issue of This Month

Global and regional strategies for COPD management

Journal of the Korean Medical Association 2018; 61(9): 545-551.

Published online: 18 September 2018

DOI: https://doi.org/10.5124/jkma.2018.61.9.545

Pharmacotherapy for chronic obstructive pulmonary disease

In Ae Kim, MD¹

, Yong Bum Park, MD^1,²

, Kwang Ha Yoo, MD³

¹Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

²Lung Research Institute, Hallym University College of Medicine, Chuncheon, Korea.

³Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

Corresponding author: Corresponding author: Yong Bum Park. bfspark2@gmail.com

Received 13 August 2018 Accepted 20 August 2018

Korean Medical Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The goals of management of stable chronic obstructive pulmonary disease (COPD) are to reduce both current symptoms and future risks with minimal side effects from treatment. Identification and reduction of exposure to risk factors are important in the treatment and prevention of COPD. Appropriate pharmacologic therapy can reduce symptoms and exacerbations, and improve health status and exercise tolerance. To date, none of the existing medications for COPD has been shown to modify disease progression or reduce mortality. The classes of medication are bronchodilators including beta2-agonist, anticholinergics and anti-inflammatory drug including inhaled corticosteroid and phosphodiesterase-4 inhibitor such as roflumilast. Each treatment regimen needs to be individualized as the relationship between severity of symptoms, airflow limitation and severity of exacerbation can differ between patients.

Keywords: Pulmonary disease, chronic obstructive, Beta2-agonist, Cholinergic antagonists, Inhaled corticosteroid, Phosphodiesterase 4 inhibitors

Figures and Tables

Figure 1

Classification of patients with chronic obstructive pulmonary disease. FEV1, forced expiratory volume in 1 second; mMRC, modified Medical Research Council dyspnea score; CAT, COPD Assessment Test score.

Figure 2

Pharmacologic treatment algorithms. FEV₁, forced expiratory volume in one second; mMRC, modified Medical Research Council dyspnea score; CAT, COPD Assessment Test score; AE COPD, acute exacerbation of chronic obstructive pulmonary disease; SABA, short acting bronchodilator; LABA, long acting bronchodilator; LAMA, long acting muscarinic antagonist; ICS, inhaled corticosteroid; PDE4, phosphodiesterase-4. ^a)Postbronchodilator FEV₁ <50%, symptoms of chronic bronchitis, and a history of exacerbations. ^b)Asthma overlap or high blood eosinophil.

Table 1

Available inhaled bronchodilators in Korea (2018)

SABA, short acting bronchodilator; LABA, long acting bronchodilator; SAMA, short acting muscarinic antagonist; LAMA, long acting muscarinic antagonist; MDI, metered dose inhaler; DPI, dry powder inhaler.

Table 2

Insurance standard of inhaled bronchodilators and inhaled steroids in Korea

LAMA, long acting muscarinic antagonist; LABA, long acting bronchodilator; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in one second.

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ORCID iDs

In Ae Kim
https://orcid.org/0000-0002-8994-2891

Yong Bum Park
https://orcid.org/0000-0002-5814-6104

Kwang Ha Yoo
https://orcid.org/0000-0001-9969-2657

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