Are 2-Agonists Safe in Patients with Acute Exacerbations of COPD?
Guy F. Joos, M.D., Ph.D. Ghent University Hospital, Ghent, Belgium Exacerbations, particularly those that result in hospitalization, are significant events in the natural history of chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality (1, 2). According to the ATS/ERS guidelines, bronchodilators, corticosteroids, and antibiotics form the cornerstone of the treatment of acute COPD exacerbations (3). There is substantial evidence showing that both inhaled -adrenergic agonists and anticholinergic agents can improve airflow during acute exacerbations. Indeed, an increase in the FEV1 and the forced vital capacity by 15 to 29 percent over a period of 60 to 120 minutes after administration of such therapy has been observed in several studies (4). Available data do not support the use of methylxanthines as first line bronchodilators in view of an unfavorable benefit/risk ratio. In severe exacerbations, however, methylxanthines might be added as
