Bronchodilators for COPD

Theophyllines can also have a beneficial effect as bronchodilators in patients with COPD. However, they are associated with dose-related adverse effects that include nausea, vomiting, seizures, or arrhythmias. They also interact with a long list of other medications, including antibiotics. Blood levels of 8-15 mg/L are recommended, with much of the therapeutic effects occurring at the lower blood levels. Although theophyllines are still used as adjunctive therapy in addition to long-acting bronchodilators, they are considered to have only a small effect in advanced COPD. 

Corticosteroids are effective through their anti-inflammatory properties and the more acute the exacerbation, the more they are of benefit. There is general agreement that short course of corticosteroids increases the rate of recovery from acute exacerbations (8-10). They may be started intravenously, if necessary, and then continued orally as soon as the patient is able to swallow safely. A short course of corticosteroids may also be of benefit in chronically obstructed COPD patients. The optimum duration is not known, although 10-14 days of therapy is commonly prescribed. Dosage is usually tapered over this time, the exact schedule varying with the clinician s experience and practice location. 

Large doses of oral steroids have similar effects as moderate doses. Prednisolone in doses of 25-50 mg once or twice a day have been used effectively in acute exacerbations 

COPD sometimes occurs concomitantly with other disorders, such as scoliosis, fibrosis, or post-tuberculosis sequelae. A short course of corticosteroids can still be useful during acute infective exacerbations with prompt tapering as recovery occurs. 

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