Understanding and Using your COPD Medications – Part I

  • When I ask patients what their inhalers do, they almost always respond by saying, “They open up my lungs.” Yes, that’s true. But what’s really important to know - and understand – about COPD medications is that there are different types of medications that open the airways in different ways. This might sound kind of complicated but it’s not all that hard to understand if we break it down into pieces.

    This is Part I of a four-part series on Understanding and Using Your COPD Medications.


    In Part I:
    •    The difference between two main types of inhalers: Controllers   (maintenance/preventers) and relievers (rescuers)

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    •    Inhaled corticosteroids
    •    Short (fast)-acting bronchodilators

    In Part II:
    •    Long-acting bronchodilators
    •    Combination inhalers
    •    Anticholinergics
    •    Oral medications (pills you swallow)
    •    Side effects of COPD medications

    In Part III:
    •    MDIs (Metered Dose Inhalers) technique
    •    Spacers and Holding Chambers
    •    How to tell how many doses are left in your MDI

    In Part IV:
    •    DPIs (Dry Powder Inhalers)
    •    Nebulizers
    •    Timing and sequencing of inhaled medicines

    To get the most out of this article, I recommend you print it out, circle the names of the medicines your doctor has prescribed for you (even if you don’t take them everyday), and highlight the categories they are in. This will help you understand how each of these breathing medicines are supposed to work in your lungs so you can and take them with maximum effectiveness. Feel free to take the list to your next appointment and discuss this with your lung health care professional.

    Fire Prevention and Calling 911
    There are two different, very basic ways that medications act to open up the airways in your lungs: They act as Controllers (maintenance or preventers) or Relievers (rescue). For the sake of this discussion, we’ll refer them as either Controllers or Relievers. An easy way to understand how these medications work is to look at this in the same way we look at fire.

    Controllers (Maintenance-Prevention): As a responsible person, you do your best to prevent fires by maintaining your home, keeping the electrical wires operating safely, turning off the stove when you’re not using it, and putting hot matches in a ceramic dish or in water. All these things help you control your environment by preventing a fire from starting. If you’re not careful, what might happen? A fire could start, and even if it starts small, it could quickly become a raging inferno. As we all know, it makes a lot more sense to prevent a fire than allow one to start!

    Relievers (Rescue):  If and when a fire does start, however, you have (or should have) a fire extinguisher handy. And we also have the 911-system to call for help. But, again, if you can prevent a fire from starting – even knowing all the while that you have help to put it out – you should do it.

    Think of the medicines for your lungs in the same way. Use your controller medications as directed to be as effective as possible in keeping your bronchial tubes, the airways inside your lungs from swelling up, having spasms and getting tight. If, however, you do all you can to prevent airway tightness and increased shortness of breath and you still run into problems, that’s the time to reach for your reliever medication.


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    Inhaled medications that work as controllers come in three different types. They are: Corticosteroids, Anticholinergics, and Long-acting Bronchodilators. Today we’ll talk about Corticosteroids.

    Corticosteroids work to reduce inflammation, swelling, on the insides of your bronchial tubes. Consider this: If you get a sunburn, would you think about going in the house and then putting on sunscreen? Of course not! That wouldn’t make sense. Think of corticosteroids as sunscreen for your sensitive bronchial airways. You should take them everyday to protect the insides of your bronchial airways, preventing them from becoming inflamed and swollen. 

    ***You may have heard about some athletes taking anabolic steroids to increase their strength. These are corticosteroids, not the same type of steroids. 


    Corticosteroid Inhalers:
    Asmanex® Twisthaler®
    Flovent® Diskus
    Flovent® HFA

    Important note: We’ll talk about side effects in Part II, but for now to prevent one common side effect, make sure to rinse your mouth and spit the water out after each use of your corticosteroid inhaler.

    Short (fast)-acting Bronchodilators (Beta-agonists)
    These medicines work to relax the muscles in your airways from squeezing. They go to work as soon as you take them and you can feel relief within minutes. This is good, but they last for only about 4-6 hours - the exception is Xopenex® - which works for 6-8 hours. Remember, our goal is to keep your airways open without giving them the chance to flare up and to use these medicines as little as possible. Some research suggests that flare-ups over time cause permanent lung damage.

    Reliever Inhalers:
    Xopenex® HFA
    Proventil® HFA
    Ventolin® HFA
    ProAir® HFA
    Maxair® Autohaler

    Combivent is a combination medication and in a class by itself because it contains both a controller (Atrovent) and a reliever (Albuterol). We’ll talk about Atrovent in Part II of our series on medications.

    Watch for Part II when we talk about: Long-acting bronchodilators, combination inhalers, anticholinergics, oral medications (pills you swallow) and side effects.

    Jane M. Martin is a licensed respiratory therapist, teacher and the founder and director of http://www.Breathingbetterlivingwell.com . She is the author of Live Your Life With COPD: 52 Weeks of Health, Happiness and Hope and Breathe Better, Live in Wellness: Winning Your Battle Over Shortness of Breath.

Published On: February 13, 2012