COPD is a multifactorial disease. Thinking about its treatment requires to consider this reality. It’s not a knot in the hair that you can cut and nothing else happens. Since most of the cases are associated to cigarette smoking there’s no doubt that the best management starts with this measure. However, its several components need to be addressed when planning its follow up.
… cigarette-cigarette: stop doing that!
After taking into account the reality of cigarette smoking as the physical and chemical element responsible for the origin, it’s necessary to consider the response of the organism as a target for management. The classical response of the organism after a repetitive injury is the protection. In case of lungs what they can do (if we accept the similitude with an entire being) is to close the airways.
Closing the door to protect
Although there’s no doubt that the irritation leads to some type of inflammation, the persistent feature will be the airways closure (bronchoconstriction). If this is the situation, the most open we can keep the airways the most we help to ease breathe. Medications which mechanism of action implies the relaxation of the muscles around the lung airways are called bronchodilators.
It seems reasonable that as soon as a diagnosis of chronic airways obstruction in the lung is made, it should be initiated therapy with bronchodilators. The point of sensitivity with bronchodilators is that they should be inhaled to allow a most effective local action and less general consequences. Guidelines have been recommended to start with bronchodilators soon after diagnosis. Unfortunately, the scientific evidence has not been enough to support an early continuous therapy with bronchodilators and they are being suggested to be used as on a needed basis (as if there were not chronic disease).
Bronchodilators can be of short action or long acting. Short acting agents only help to relieve sudden symptoms while long acting point toward a prolonged relieve. Since the disease is chronic and progressive, all COPD patients will require long acting bronchodilators to maintain their symptoms under control.
Effects of Bronchodilators
Bronchodilators have shown to increase the airflow in and out of the lungs. This effect is seen in the improvement of FEV1 values. The improvement in FEV1 will eventually lead to reductions in the air trapped inside lungs that is said to be responsible for breathlessness. If the air trapping is reduced, dyspnea decreases and patients may tolerate more physical activities, which has been demonstrated in trials associating increases in airflow and exercise tolerance in the laboratory.
More than bronchodilators
However, it’s also relevant to mention that the complex nature of the disease may require adjustments of therapy according to patient responses, incidence of exacerbations, presence of other diseases (comorbidities), etc.
Said this, it should be consider that some patients may require more than one medication to cope with excess risk of exacerbations, infections, physical attiude, etc.
So, let’s keep in mind: there’s no better treatment for COPD but key elements to cover followed by the consideration of the complexity of the illness and individual features that will help address the different aspects of the disease.