Recent advances in pharmacotherapy for dyspnea in COPD

Dyspnea is the most distressing symptom experienced by those suffering from advanced stages of chronic obstructive pulmonary disease (COPD). Activity-related dyspnea in COPD is multifactorial but is associated with increased central neural drive, impaired dynamic respiratory mechanics and abnormal respiratory muscle function. Each of these components can potentially be targeted for pharmacotherapy. Recent advances in the pharmacotherapy of COPD include the development of new long-acting bronchodilators which, when combined, provide sustained improvements in dyspnea. Additionally, novel applications of older therapies such as opiates, furosemide, helium-oxygen, and statins show early promise as dyspnea-relieving interventions in COPD. Effective pharmacological manipulation of the affective dimension of dyspnea remains an important challenge. In this review of the recent literature in this field, we highlight the main advances that have been achieved.

► We review recent advances in the pharmacotherapy of dyspnea in COPD. ► Combining long-acting bronchodilators provides additive benefit in relieving dyspnea. ► New data is emerging on a possible beneficial role of anti-inflammatory agents. ► Preliminary results support further exploration of inhaled furosemide and heliox. ► Further study is required to clarify the role of opiates and anxiolytics in COPD.