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Drugs (including oxygen) in severe COPD

Division of Infection and Immunity, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.

CORRESPONDENCE: P. M. A. Calverley, Division of Infection and Immunity, Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK. Fax: 44 1515295888. E-mail: pmacal{at}liverpool.ac.uk

Keywords: Chronic obstructive pulmonary disease, combining, oxygen, drug therapy, exacerbation

Received: October 5, 2007
Accepted October 25, 2007

Access to comprehensive guidelines on the management of chronic obstructive pulmonary disease (COPD) is now available, and several treatment goals of therapy have been identified from these guidelines, which have since been studied in clinical trials.

Drug therapy is a key component of an individual patient’s management plan, particularly in more severe disease. During the past few years, a number of new drug treatments have become available, although these are not always appropriately prescribed; this is particularly the case for oxygen.

For patients with a history of exacerbations, there is good evidence for the use of inhaled long-acting anticholinergic agents or combined inhaled steroids and long-acting β-agonists. Evidence for prophylactic antibiotics and antioxidant agents is lacking. Nutritional and calorie supplementation have not been shown to improve exercise capacity. Statins may improve outcomes in COPD, but prospective trials are needed to confirm this.

The evidence for the use of long-term oxygen therapy in hypoxaemic patients is robust. Ambulatory oxygen improves exercise capacity, but whether it is used appropriately is in doubt. Overall, short burst oxygen therapy does not offer a benefit and therefore cannot be recommended.