Pharmacotherapy of asthma and chronic obstructive pulmonary disease

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are both characterized by airway inflammation, reduction in maximal expiratory flow, and episodic exacerbations of airflow obstruction. Compared with asthma, COPD occurs in older patients, is associated with neutrophilic rather than eosinophilic inflammation, is poorly responsive even to high dose inhaled corticosteroid therapy, and is associated with progressive loss of pulmonary function over time, especially with continued cigarette smoking. Despite these findings, the approaches to treatment are similar for asthma and COPD, although the benefits expected are less for COPD than for asthma. The most useful drugs in asthma and COPD are bronchodilators (β2-agonists, muscarinic antagonists and theophylin) and antiinflammatory drugs (glucocorticoide).

Astmi i hroničnoj opstruktivnoj bolesti pluća (HOBP) zajednička su sledeća svojstva: inflamacija disajnih puteva, smanjenje maksimalnog ekspirijuma i epizode pogoršanja opstrukcije disajnih puteva. Za razliku od astme, međutim, HOBP nastaje u starijem životnom dobu, u inflamaciji dominiraju neutrofili a ne eozinofili kao u astmi, slabo reaguje i na visoke doze inhalacionih kortikosteroida, vremenom dolazi do progresivnog gubitka funkcije pluća, posebno ukoliko pacijent nastavi da puši. Uprkos ovim razlikama, terapijski pristupi u HOBP i astmi su slični, mada su efekti terapije HOBP slabiji nego kod astme. Najefikasniji lekovi koji se koriste u obe bolesti su bronhodilatatori (β2-agonisti, antiholinergici i teofilin) i antiinflamatorni lekovi (glukokortikoidi).