[New drugs in chronic obstructive pulmonary disease].

Inhaled bronchodilators such as beta(2)-agonists and muscarinic antagonists help to prevent and control symptoms in COPD patients, reduce the frequency and severity of exacerbations, improve health status and exercise tolerance and have an acceptable safety profile. For patients with moderate to severe COPD combining bronchodilators from different classes long acting beta(2)-agonists or long acting muscarinic antagonists (LABA/LAMA) are recommended. Indacaterol with 24 hours duration and fast onset of bronchodilation is the first once daily dosing LABA. Indacaterol used alone or in combination with LAMA may be advantageous through simplification of treatment regimens as well as improvement the efficacy. As COPD progresses and patient has repeated exacerbations triple therapy LABA/LAMA/ICS may be required. The addition of PDE4 inhibitor (roflumilast) to LABA or LAMA in patients with severe COPD, improves lung function and reduces exacerbation frequency. The reduction in exacerbation frequency is similar to that seen in the studies on bronchodilators and inhaled corticosteroids therapy. PDE4 inhibitors have been shown to play a role in severe COPD and they are effective particularly in combination with other pharmacological agents. Based on the results of studies combining different classes of the drugs seems to be an important step towards the goal of optimal control for COPD patients.