Table 1.

Current pharmacologic options for the management of COPD¹

Class	Agent/s	Mode of action	Clinical effect
Long-acting β2-agonist (LABA)	Salmeterol Formoterol	Stimulate B2-adrenergic receptors in airway smooth muscle Cause increased levels of cAMP Increase the rate of ciliary transport of mucus Decreased mast cell degranulation	Bronchodilation by relaxing smooth muscle and opening airways
LAMA	Tiotropium	Inhibit muscarinic receptors Block the parasympathetic nervous system Reduce viscous mucus secretions Act on cholinergic tone, the only reversible mechanism of COPD	Bronchodilation by reducing contraction of airway smooth muscle Reduce hyperinflation
Methylxanthines (phosphodiesterase inhibitors)	Theophylline	Phosphodiesterase inhibition Raised cAMP	Limited use due to safety profile
LABA-ICS combinations	Formoterol-budesonide Salmeterol-fluticasone	As above plus ICS-associated anti-inflammatory effects	Reduce risk of exacerbation in patients with severe/very severe disease who experience repeated exacerbations
Short-acting LABA-LAMA combinations	Fenoterol/ipratropium Salbutamol (albuterol)- ipratropium	As above for long-acting agents	Only indicated as rescue medication and not maintenance therapy May be associated with increased risk of cardiovascular events

Abbreviations: cAMP, cyclic adenosine monophosphate; COPD, chronic obstructive pulmonary disease; LAMA, long-acting muscarinic antagonist; LABA, long-acting β₂-agonist; ICS, inhaled corticosteroids.