• R Pineda and S I Rennard.
• University of Nebraska Medical Center, Omaha, Nebraska, USA.
• Expert Opin Pharmacother. 2000 Dec 1; 1 (7): 1281-7.

AbstractChronic obstructive pulmonary disease (COPD), which affects approximately 14 million Americans, is the fourth leading cause of death in the United States and is responsible for an estimated US$6.5 billion in direct and indirect costs per year [1,2]. Its usual course is a slow deterioration of lung function and progressive breathlessness with activities. The age-adjusted death rate for COPD rose 71% from 1967 to 1987, and the 10 year mortality rate is about 50%. Bronchodilators form one of the mainstays of therapy in COPD patients. The judicious use of these agents increases airflow and reduces dyspnea in patients with COPD. Patients often experience a reduction in symptoms and improvement in their quality of life. There are several classes of bronchodilators available for the treatment of COPD, each with specific clinical benefits: anticholinergics, short-acting beta 2 agonists, combination anticholinergic and short-acting beta 2 agonist, long-acting beta 2 agonists and methylxanthines. This chapter reviews the use of an anticholinergic (ipratropium bromide) concomitantly with other bronchodilators, focusing on patients with COPD.

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