In Part I we talked about the difference between controllers and relievers, inhaled corticosteroids (one type of controller) and inhaled short (fast) acting beta-agonists (relievers). We learned that the goal is for controller medications is for them to work well enough so you need rescue medications as little as possible, or not at all.

Today we’re going to talk about
•    Long-acting bronchodilators
•    Combination inhalers
•    Anticholinergics
•    Oral medications (pills you swallow)
•    Side effects of COPD medications

Long-acting Bronchodilators (beta-agonists)
These medicines work to relax the muscles in your airways and keep them from squeezing. Yes, they do the same thing that the reliever medications do – but this long-acting type does not begin to work as soon as you take it. It begins to take effect in about 20 minutes and then lasts for about 12 hours. So, if you take it 12 hours apart you should have around the clock coverage for preventing those muscles from acting up and squeezing your airways.

Long-acting bronchodilators (beta-agonists):
Foradil® Aerolizer®
Serevent® Diskus®
Brovana®
Perforomist®
Arcapta®


Anticholinergics
Inside our bodies, there is a constant stream of messages being sent to keep us safe and well. If you touch something hot, a message is sent through your nerves to pull your hand away. If you have an infection, a message is sent to your white blood cells to go to that part of your body and fight it. How does this work? Messages are sent, they travel, then they latch onto receptors, parts of the nerves that receive, that are open, to let that specific message get through.

Scientists are not sure why, but in many people with COPD, there are messages going to the bronchial tubes, telling them to spasm, squeeze and tighten. This is where Anticholinergics come in. Anticholinergic medicines are especially made to latch onto those specific receptors, taking up space on those receptors and preventing that message from getting through. This blocks the message for the airway to squeeze before it even starts. Remember what you’re learning about receptors because we’ll talk about this again in Part III.

Anticholinergics are:
Atrovent®
Spiriva® (a newer and more powerful form of Atrovent)


Combivent is a combination of Atrovent and Albuterol so it is both a controller and a reliever. This is the same combination of medications that is in DuoNeb, in liquid form used in a nebulizer.


Combination Corticosteroids and Long-acting Bronchodilators
There are many folks who have COPD and asthma who benefit from both an inhaled corticosteroid and a long-acting bronchodilator. This is such a common combination, and it works so well, it makes sense to put these two medications into one inhaler.

Combination Corticosteroids and Long-acting Bronchodilators:
Advair® Diskus® – a combination of Flovent and Serevent