I’m sure most of you with COPD (Chronic Obstructive Pulmonary Disease) have heard of Spiriva, and I am quite sure, as well, that many of you are taking it. Since it is still a relatively new medicine, I wrote this article to answer questions, clear up any confusion, and help you get on with your life by achieving the most effective COPD management possible.
First a little background. I’d been hearing about Spiriva for a while before it became available in the United States. I heard that it worked like Atrovent, a staple of COPD treatment (most of my patients were on Combivent, a combination of Atrovent and Albuterol) and that Spiriva was supposed to be sort of a “super Atrovent.” A more powerful medication in a once-a-day dose! At the time, a patient of mine was able to obtain Spiriva from Germany, so it was nice to have a preview by hearing how it worked for him – and he said that he was breathing a lot better. I was excited at the prospect of it being FDA (Food and Drug Administration) approved and made available here in the US and to patients in our pulmonary rehab program.
Rescue and Prevention
When I ask patients what their inhalers do, they always respond, at first, by saying, “They open up my lungs.” Well, yes, but, what’s really important for all patients with COPD to know and understand is that there are different kinds of inhaled medicines that open the airways in different ways.
There are two different, very basic, ways that medicines act to open up the airways in your lungs: Prevention, also referred to as Maintenance or Controlling – and Rescue also referred to as Relief. For the sake of this discussion, let’s use the words Prevention and Rescue and we’ll refer to the medicines as either Preventers or Rescuers.
There are four main categories of inhaled medicines: Corticosteroids, Fast-acting bronchodilators (beta-2 agonists), Long-acting bronchodilators (beta-2 agonists), and Anticholinergics. In this article we’re going to talk about just two of these: Anticholinergics and Bronchodilators. I know this is sounding kind of complicated, but stay with me here.
An easy way to understand Prevention and Rescue in pulmonary medicines is looking at it just as we look at fire.
Prevention: You do your best to prevent fires by maintaining your home to keep the electrical wires operating safely, turning the stove off when you’re done using it, and putting hot matches in a ceramic dish or water. All these things prevent a fire from occurring. If you skip any of these steps, what might happen? Well, a fire might start. And we all know it makes a lot more sense to prevent a fire than to let one start and then have to put it out!
Rescue: If and when a fire does start, you do (or certainly should) have a fire extinguisher handy. And you also have the 911 system to call for help. Thank goodness for these resources! But, if you can prevent a fire from starting – even knowing all the while that you have help to put it out – you would do it.