Drugs for airway disease

Drugs for obstructive airway diseases include relievers and controllers. Inhaled β2-agonists are the most effective bronchodilators. Short-acting inhaled β2-agonists should be used as required for symptom relief rather than regularly. Long-acting inhaled β2-agonists may be added to inhaled corticosteroids if asthma control is poor on low doses of inhaled corticosteroids and are conveniently taken as a fixed combination inhaler combined with a corticosteroid and are effective bronchodilators in COPD. Anticholinergics are the bronchodilators of first choice in COPD and tiotropium once daily is preferred. Inhaled corticosteroids are the first-line controller treatment for chronic asthma but are much less effective in COPD. Anti-leukotrienes may be used as an add-on therapy in patients with asthma that is not controlled by inhaled corticosteroids, but are less effective than adding a long-acting β2-agonist and the response is unpredictable. Theophylline is a useful add-on therapy in severe asthma and COPD. Anti-IgE antibody (omalizumab) reduces exacerbations in patients with severe asthma not controlled on maximal does of inhaled therapy, but response is unpredictable and the treatment is very expensive.