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Long-term effects of inhaled bronchodilators in stable chronic obstructive pulmonary disease

Sabina A Antoniu

In chronic obstructive pulmonary disease (COPD) the inhaled bronchodilators represent the basis of the maintenance therapy, the therapeutic recommendations being made and adjusted based on the long-term therapeutic effects. This review focuses on the results of long-term (>1 year) studies with inhaled bronchodilators in COPD. Based on the data reviewed it can be concluded that long-acting bronchodilators such as tiotropium are most effective as individual therapy in milder COPD stages and also demonstrate added value when associated with other therapies in more advanced COPD stages. Long-acting b2 agonists are most effective not as standalone but when combined with inhaled corticosteroids for severe and very severe COPD stages. Despite the long-term efficacy and safety of inhaled long-acting bronchodilators being demonstrated in the existing studies, and despite these having contributed a great deal to a more appropriate positioning of such therapies in the management of stable COPD, several pending issues, such as long-term effects of combined bronchodilators regimens and of bronchodilators/corticosteroids triple combinations on disease outcome, remain to be documented by the subsequent studies.