Understanding and Using your COPD Medications – Part II

  • 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)

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    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®

    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:
    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
    Advair® HFA – a combination of Flovent and Serevent
    Symbicort® – a combination of Pulmicort and Foradil

  • Dulera® – a combination of Asmanex and Foradil

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    Seretide® (UK) a combination of Fluticasone (the active ingredient in Flovent) and  Salmeterol (the active ingredient in Serevent)

    Oral Breathing Medications (Pills you swallow)
    When you put a medicine in your mouth and swallow it, it must first go to your stomach and through your digestive system. Medications you swallow are referred to as “systemic” because they passes through these systems; and because they can cause side effects throughout your body, more so than the inhaled medicines which go straight to the source of the problem, your lungs. However, they may still have a place in your treatment plan.

    Daliresp (Roflumilast) is a new oral medication for COPD that works by decreasing swelling in the lungs, and is meant to reduce the number of COPD flare-ups (acute exacerbations).

    Prednisone is often used short term if you have a bad breathing episode. It decreases inflammation and works very well within a day or two, and is then tapered down once the exacerbation is resolving. Long-term use of oral prednisone should be avoided if possible. But if you have severe COPD, are on maximum use of inhalers and you’re still having trouble getting through your day, you may need to be on a low dose daily prednisone.

    Common Prednisone Side Effects – Short term use:
    •    Fluid retention often in the ankles, but sometimes all over 
    •    Increased appetite (for some people who struggle to keep weight on, this can be good)
    •    Anxiety, agitation, nervousness, and irritable mood
    •    Trouble sleeping
    •    Elevation of blood sugar
    •    Suppression of the immune system

    Common Prednisone Side Effects – Long term use:
    •    Weight gain
    •    Bone density loss
    •    Moon shaped face
    •    Fat deposition on the upper back called a buffalo hump
    •    Thin skin that bruises and bleeds easily
    These medicines have been around for a long time and were some of the first effective breathing medications. They work well for some people but are less often prescribed.

    Common Methylxanthine side effects:
    •    Stomach upset
    •    Heartburn
    •    Trouble sleeping
    •    Headache
    •    Nervousness or irritability
    •    Rapid heart rate
    •    Rapid breathing

    Watch for Part III when we’ll talk about MDI inhaler technique, spacers and holding chambers and how to tell how many doses are left in your MDI.

    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 21, 2012