The main goals of treatment for chronic obstructive pulmonary disease (COPD) are to relieve symptoms, reduce the frequency and severity of exacerbations, and prevent disease progression. Several guidelines and review articles on COPD treatment have been published in recent years. Treatment of acute exacerbations is not discussed here.

Smoking tobacco remains the primary preventable cause of death in the US. Smoking cessation often requires both pharmacotherapy and behavioral support.

View the Expanded Table: Some Drugs for Smoking Cessation

Tobacco dependence remains the primary preventable cause of death in the United States. It is a chronic disorder that often requires pharmacologic therapy, but counseling may be equally effective and can add to the effectiveness of any treatment for this indication. Abrupt cessation of smoking appears to be as effective as gradual reduction.

The most effective drugs available for treatment of tobacco dependence are bupropion (Zyban, and others and varenicline (Chantix). The FDA recently ordered the manufacturers of both to add boxed warnings about the risk of psychiatric symptoms and suicide to their prescribing information (FDA Alert, 7/1/2009).

Many drugs can cause psychiatric symptoms, but a causal connection is often difficult to establish. Psychiatric symptoms that emerge during drug treatment could also be due to the underlying illness, previously unrecognized psychopathology, or psychosocial factors. The withdrawal of some drugs can cause symptoms such as anxiety, psychosis, delirium, agitation or depression.

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