New approaches to pharmacotherapy in patients with stable chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is predicted to become the third leading cause of death worldwide by the year 2020. Although available evidence-based guidelines facilitate the management of patients with COPD, few therapeutic interventions other than smoking cessation and long-term oxygen therapy have proven to change the course of the disease. New drug development has also proven to be challenging and costly. The development of new once-daily or ultra β2 adrenergic agents, long-acting antimuscarinic agents, and their combination supports the fact that bronchodilators are still considered the mainstay of therapy for COPD. However, a better understanding of the pathophysiology of the disease over the last ten years has resulted in identification of new biologic pathways and the development of novel therapies for patients with COPD that include new anti-inflammatory agents, more effective anti-oxidants, agents that promote lung regeneration, antibiotics, and statin therapy. This manuscript reviews some of the most recent evidence that supports the emerging trends in the pharmacotherapy for the management of patients with stable COPD.