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Abstract: Various pharmacologic agents are available for the long-term maintenance management of chronicobstructive pulmonary disease (COPD). The efficacy of these agents is based on their ability to decrease COPD symptoms, improve pulmonary function and quality of life, and reduce the frequency of acute exacerbations. Bronchodilators form the foundation of COPD therapy. Anticholinergic bronchodilators, such as ipratropium bromide and especially tiotropium, are first-line anticholinergic agents that can be used alone or in combination with long-acting or short-acting β2-agonists to achieve these primary goals of COPD treatment. Methylxanthines are useful primarily for their nonbronchodilatory (ie, positive) effects on pulmonary arterial pressure, pulmonary vascular resistance, renal blood flow, and glomerular filtration rate. Inhaled corticosteroids are reserved only for the few patients with severe disease who experience symptoms and acute exacerbations despite optimized multiple bronchodilator therapy. This article reviews agents that are currently available and those that are in development for the long-term management of COPD, with special emphasis on the anticholinergic bronchodilators. [Copyright &y& Elsevier]

Abstract: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United Statesand is increasing in incidence. COPD is easily identified in its early stages by spirometry, yet it is still underdiagnosed, largely because this simple test is not being done in patients at risk for the development of COPD. The most important risk factor by far is cigarette smoking—smoking cessation or even a decrease in smoking can substantially reduce the risk for the development and/or rate of progression of COPD. Increased public awareness, early diagnosis and intervention, and secondary prevention by primary care providers may help reverse the trend of escalating prevalence, mortality, and premature morbidity associated with COPD. [Copyright &y& Elsevier]