Update on Current and Future Pharmacologic Therapy of COPD

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world and the impact of this respiratory pathology is expected to increase over the coming years. Currently available information suggests that genetic factors, environmental factors and genotype-environment interactions influence the disease. This complex pathology is characterised by airflow obstruction, which is generally progressive and largely irreversible. It is always associated with structural remodeling and chronic inflammation of the respiratory tract and neutrophils, macrophages and CD8+ lymphocytes all appear to participate in the inflammatory process. Several therapeutic classes of compounds are used in the treatment of COPD such as bronchodilators, corticosteroids and antibiotics (in the treatment of exacerbations caused by bacterial infections). Although these therapies improve the clinical symptoms and decrease the airway inflammation, they do not reduce significantly the long-term progression of the disease. Thus, new drugs that may affect the underlying causes of COPD such as the inflammatory and destructive processes of the disease are required. The aim of this review is to provide a critical evaluation of current pharmacotherapy in COPD and an overview of new therapeutic strategies for the treatment of this progressive disorder.