Two types of drugs are used in the treatment of obstructive airway diseases:
- Relievers (bronchodilators) give immediate reversal of airway obstruction, largely by directly relaxing airway smooth muscle.
- Controllers (preventers) suppress the underlying disease process and provide long-term control of symptoms. These drugs include antiinflammatory treatments, such as corticosteroids.
Both asthma and COPD are characterized by airway narrowing secondary to a chronic inflammatory process. In asthma, eosinophilic (and sometimes neutrophilic) inflammation occurs throughout the respiratory tract, although the proximal airways are predominantly affected. In COPD, there is inflammation and narrowing of small airways (chronic obstructive bronchiolitis) and destruction of lung parenchyma (emphysema), resulting in loss of support for the airways, early closure on expiration, and air trapping.
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