Current Evidence on the Usefulness of Potential Therapies in the Prevention of COPD Exacerbations: Beyond the Use of Bronchodilator Therapy and Inhaled Corticosteroids

doi:10.1016/j.opresp.2025.100438

Review

. 2025 May 7;7(2):100438.

doi: 10.1016/j.opresp.2025.100438. eCollection 2025 Apr-Jun.

Current Evidence on the Usefulness of Potential Therapies in the Prevention of COPD Exacerbations: Beyond the Use of Bronchodilator Therapy and Inhaled Corticosteroids

Juan Marco Figueira-Gonçalves¹, Francisco Javier Callejas-González², Rafael Golpe³, Luis Máiz-Carro⁴, Marta Marín-Oto⁵, Javier de Miguel-Díez^{6

7}, Guillermo Samuel Loscertales-Vacas⁸, José María Tordera-Mora⁹, Álvaro Hurtado-Fuentes¹⁰

Affiliations

¹ Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
² Department of Respiratory Medicine, Albacete University Hospital Complex, Albacete, Spain.
³ Pneumology Department, Lucus Augusti University Hospital, Lugo, Spain.
⁴ Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.
⁵ Pulmonary Division, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain.
⁶ Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁷ Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.
⁸ Pneumology Department, Hospital Universitario San Pedro, Logroño, Spain.
⁹ Pneumology Department, Manises Hospital, Valencia, Spain.
¹⁰ Pneumology Department, Hellín Hospital, Albacete, Spain.

PMID: 40510241
PMCID: PMC12159216
DOI: 10.1016/j.opresp.2025.100438

Review

Current Evidence on the Usefulness of Potential Therapies in the Prevention of COPD Exacerbations: Beyond the Use of Bronchodilator Therapy and Inhaled Corticosteroids

Juan Marco Figueira-Gonçalves et al. Open Respir Arch. 2025.

. 2025 May 7;7(2):100438.

doi: 10.1016/j.opresp.2025.100438. eCollection 2025 Apr-Jun.

Authors

Affiliations

¹ Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
² Department of Respiratory Medicine, Albacete University Hospital Complex, Albacete, Spain.
³ Pneumology Department, Lucus Augusti University Hospital, Lugo, Spain.
⁴ Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.
⁵ Pulmonary Division, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain.
⁶ Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁷ Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain.
⁸ Pneumology Department, Hospital Universitario San Pedro, Logroño, Spain.
⁹ Pneumology Department, Manises Hospital, Valencia, Spain.
¹⁰ Pneumology Department, Hellín Hospital, Albacete, Spain.

PMID: 40510241
PMCID: PMC12159216
DOI: 10.1016/j.opresp.2025.100438

Abstract
in English, Spanish

Prevention of exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. The adverse effects of an exacerbation include a negative impact on patient quality of life and symptoms, an accelerated rate of decline in lung function, hospital admissions, and increased mortality. Clinical guidelines related to COPD management recommend smoking cessation and inhaled therapy (bronchodilators with or without corticosteroids) as the mainstay for these patients. Apart from the above-mentioned treatment, other potential therapies, such as mucolytic agents, antibiotics (oral or inhaled), phosphodiesterase-4 inhibitors or vaccination, are available and have been shown to reduce the incidence of exacerbations. In this brief narrative review, we will examine the efficacy of various treatments for preventing COPD exacerbations, beyond the use of bronchodilator therapy and inhaled corticosteroids.

La prevención de las exacerbaciones es un objetivo clave en el tratamiento de la enfermedad pulmonar obstructiva crónica (EPOC). Los efectos adversos de una exacerbación incluyen un impacto negativo en la calidad de vida y los síntomas del paciente, un deterioro acelerado de la función pulmonar, un mayor riesgo de ingresos hospitalarios y un aumento de la mortalidad. Las guías de práctica clínica relacionadas con el tratamiento de la EPOC recomiendan el cese tabáquico y la terapia broncodilatadora con o sin corticosteroides inhalados como tratamiento base para estos pacientes. Aparte de los tratamientos mencionados, existen otras terapias potenciales, como son los agentes mucolíticos, los antibióticos (orales o inhalados), los inhibidores de la fosfodiesterasa-4 o la vacunación, entre otros, que han demostrado su papel en la prevención de las agudizaciones. En esta breve revisión narrativa examinaremos la eficacia de estos tratamientos más allá del uso de la terapia broncodilatadora y los corticosteroides inhalados.

Keywords: Antibiotics; Biologics; COPD; Exacerbations; Mucolytics; Nebulized antibiotics; Probiotics; Vaccine.

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References

1. Global Initiative for Chronic Obstructive Lung Disease; Fontana, WI: 2025. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Available from: https://goldcopd.org/2025-gold-reports/. [Accessed 6 January 2025]
1. Hurst J.R., Skolnik N., Hansen G.J., Anzueto A., Donaldson G.C., Dransfield M.T., et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. Eur J Intern Med. 2020;73:1–6. - PubMed
1. Halpin D.M., Miravitlles M., Metzdorf N., Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis. 2017;12:2891–2908. - PMC - PubMed
1. Montes de Oca M. Smoking cessation/vaccinations. Clin Chest Med. 2020;41:495–512. doi: 10.1016/j.ccm.2020.06.013. [PMID: 32800202] - DOI - PubMed
1. Willemse B.W., Postma D.S., Timens W., ten Hacken N.H. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J. 2004;23:464–476. - PubMed

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[1] Global Initiative for Chronic Obstructive Lung Disease; Fontana, WI: 2025. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Available from: https://goldcopd.org/2025-gold-reports/. [Accessed 6 January 2025]

[2] Global Initiative for Chronic Obstructive Lung Disease; Fontana, WI: 2025. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Available from: https://goldcopd.org/2025-gold-reports/. [Accessed 6 January 2025]

[3] Hurst J.R., Skolnik N., Hansen G.J., Anzueto A., Donaldson G.C., Dransfield M.T., et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. Eur J Intern Med. 2020;73:1–6. - PubMed

[4] Hurst J.R., Skolnik N., Hansen G.J., Anzueto A., Donaldson G.C., Dransfield M.T., et al. Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life. Eur J Intern Med. 2020;73:1–6. - PubMed

[5] Halpin D.M., Miravitlles M., Metzdorf N., Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis. 2017;12:2891–2908. - PMC - PubMed

[6] Halpin D.M., Miravitlles M., Metzdorf N., Celli B. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis. 2017;12:2891–2908. - PMC - PubMed

[7] Montes de Oca M. Smoking cessation/vaccinations. Clin Chest Med. 2020;41:495–512. doi: 10.1016/j.ccm.2020.06.013. [PMID: 32800202] - DOI - PubMed

[8] Montes de Oca M. Smoking cessation/vaccinations. Clin Chest Med. 2020;41:495–512. doi: 10.1016/j.ccm.2020.06.013. [PMID: 32800202] - DOI - PubMed

[9] Willemse B.W., Postma D.S., Timens W., ten Hacken N.H. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J. 2004;23:464–476. - PubMed

[10] Willemse B.W., Postma D.S., Timens W., ten Hacken N.H. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J. 2004;23:464–476. - PubMed

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Current Evidence on the Usefulness of Potential Therapies in the Prevention of COPD Exacerbations: Beyond the Use of Bronchodilator Therapy and Inhaled Corticosteroids

Affiliations

Current Evidence on the Usefulness of Potential Therapies in the Prevention of COPD Exacerbations: Beyond the Use of Bronchodilator Therapy and Inhaled Corticosteroids

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Abstract
in English, Spanish

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Abstract in English, Spanish

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Abstract
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