The mainstay of pharmacological treatment of chronic obstructive pulmonary disease (COPD) treatment is inhalers, consisting of bronchodilators, both long-acting muscarinic antagonists and long-acting beta agonists, and inhaled corticosteroids. While the muscarinic antagonists and beta agonists act to open up the airways and have bronchodilating effects on smooth muscle thus decreasing breathlessness, inhaled corticosteroids dampen down the inflammatory process. COPD is considered a systemic disease and is associated with cardiovascular co-morbidities, but people with COPD who have cardiovascular disease (CVD) are often the very patients who are excluded from participating in randomized controlled trials of these medications thus making ascertainment of the true relationship between CVD and COPD treatments difficult. Trials suggest that long-acting muscarinic antagonists and long-acting beta agonists are safe when used in appropriate doses in people with COPD who do not have uncontrolled CVD, but in patients with underlying CVD or who use higher doses or more pharmacologically active medications the implications are less clear. Some people would argue that the data that currently exist from trials are not representative of real life and the long-term safety of COPD treatments is not known in the people in whom it matters most.
Once-daily long-acting beta₂-agonists/inhaled corticosteroids combined inhalers versus inhaled long-acting muscarinic antagonists for people with chronic obstructive pulmonary disease
