MedicationsPharmacologic therapy for patients that suffer from Chronic Obstructive pulmonary disease is intended to either relieve the symptoms caused by or exacerbated by the disease and/or stop disease progression.87,29 Most people with COPD take medications on a regular basis to decrease breathing difficulty. Other medications are used only on an as needed basis to decrease shortness of breath. Medications generally prescribed for people with COPD fall into one of three groups: bronchodilators, Steroids and antibiotics. BronchodilatorsBronchodilators are a mainstay of treatment for COPD. They work by relaxing smooth muscle around the airways and fall in one of two main categories: beta-agonists and anticholinergics. Beta-agonistsThere are two types of beta-agonists: short-acting and long-acting. Short-acting beta-agonists work fast (within 10-20 minutes) to relieve shortness of breath but their duration of action is short (3-6 hours). They are commonly known as “rescue” medications. Some examples include:
More informatin can be found in our short-acting inhalers section. Long-acting beta-agonists, as the name implies, have a prolonged effect (about 12 hours) but do not begin to work immediately. Therefore these medications should not be used for Acute attacks of shortness of breath or in an emergency. Some examples include:
AnticholinergicsAnticholinergics help open the airways by blocking specific receptors found in the lung that promote constriction. They may also decrease secretions. Examples include: ipratropium (Atrovent®) and a new long acting preparation, tiotropium (Spiriva®). Most bronchodilators are given in an inhaled form using a metered dose inhaler (MDI) or a dry powder inhaler (DPI). It is important that patients understand how to use the inhaler properly in order to ensure that the correct dose of medication is delivered and to avoid complications. If you need information on how to use your inhaler, call the Respiratory Health Association of Metropolitan Chicago [add phone number] to talk to an expert or to order a brochure. CorticosteroidsCorticosteroids work as anti-inflammatories. They help reduce Airway Inflammation and decrease mucus production. They are not prescribed for everyone with COPD, but they can improve symptoms in some patients with mild to severe COPD. If symptoms do not improve as expected with bronchodilators, steroids by inhaler may be tried. Oral steroids can have more serious side effects, but some patients may require them especially when hospitalized with severe Exacerbations. Side-Effects Because of the potential for adverse effects, long term treatment is usually only used for patients with definite improvement in air flow or exercise performance. Side effects include loss of bone mineral density (Osteoporosis) muscle weakness, cough, and hoarseness among many others. A common side effect is also the appearance of Thrush, a yeast infection of the mouth or throat that causes white discoloration of the tongue. The risk of thrush can be reduced by using a Spacer with inhaled corticosteroids and rinsing the mouth after inhaling the medication. Examples of inhaled corticosteroids include:
There are also combination inhalers available which contain a Beta-agonist and an anticholinergic like albuterol and ipratropium (Combivent®) or an inhaled corticosteroid and a long actining beta –agonist like fluticasone and salmeterol (Advair®). AntibioticsAntibiotics have no role in the routine management of COPD but have proven beneficial in patients with worsening symptoms in the setting of a respiratory infection or exacerbation. A physician may order a Sputum analysis to help determine if antibiotics are indicated in a particular case. Common agents that cause exacerbations in COPD patients include Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis among others. |
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