brand logo

Am Fam Physician. 2004;69(6):1506-1507

Clinical Question: What treatments are effective for chronic obstructive pulmonary disease (COPD)?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this study thoroughly reviewed the literature for randomized controlled trials (RCTs) evaluating treatments of COPD. Data sources included MEDLINE, the Cochrane Registry, bibliographies, and experts in the field. Only randomized, placebo-controlled trials with blinded outcome assessments and nearly complete follow-up were included. The authors did not specify the percentage of RCTs with or without concealed allocation assignment.

Long-acting beta2 agonists, inhaled corticosteroids, and anticholinergics reduced exacerbation rates in patients with moderate to severe COPD, but did not affect overall mortality rates. The combination of steroids with long-acting beta2 agonists was more effective than either agent alone. Pulmonary rehabilitation improved health status in patients with moderate to severe disease but had no effect on long-term survival or hospitalization rates. Home oxygen therapy significantly improved survival, but only in patients with partial pressure of arterial oxygen (PaO2) less than 60 mm Hg, and not in those without hypoxia at rest. Disease management programs had mixed results, and no benefits were found with non-invasive mechanical ventilation.

Bottom Line: Effective treatments for COPD include smoking cessation, long-acting beta2 agonists, inhaled corticosteroids, anticholinergics, pulmonary rehabilitation, and home oxygen therapy (but only in patients with PaO2 less than 60 mm Hg at rest). Uncertain or non-beneficial interventions include disease management programs and noninvasive mechanical ventilation. (Level of Evidence: 1a)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

Copyright © 2004 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.