Medications
Anticholinergic Medications
Anticholinergic medications relax the bronchial muscles. They are generally inhaled and act as a bronchodilator over time. Bronchodilation does not have much effect on lung function and does not change the overall course of the disease. However, the medication helps improve breathlessness, ability to exercise, and quality of life.
Brands and Benefits. Anticholinergics used for COPD include short-acting ipratropium (Atrovent) and long-acting tiotropium (Spiriva). They are considered standard maintenance medications for COPD. Tiotropium has recently been approved for reducing COPD exacerbations.
A single inhaler containing both ipratropium and the common beta2-agonist albuterol (Combivent) may prove to be better than either medication alone. Anticholinergics target the central airways, and beta-agonists target the smaller airways, which explains the possible additive benefits of the combination.
Other combinations are being explored. Long-acting anticholinergic medications are being given along with inhaled corticosteroids and long-acting beta-agonists. Although the combination may not reduce the number of exacerbations, it improves lung function and quality of life, and reduces hospitalizations.
Side Effects. Anticholinergics have few severe side effects. They are less likely to interfere with sleep than the other standard inhaled medications. The side effects include mild cough and dry mouth.
Beta2-Agonists
When anticholinergics are no longer enough -- and sometimes in place of an anticholinergic -- health care providers will prescribe a beta2-agonist. GOLD guidelines recommend that all patients with COPD stages II - IV take a long-acting beta2-agonist.
Short-Acting Beta2-agonists. Short-acting bronchodilators are the primary medications for most COPD patients. Albuterol (Proventil, Ventolin) is the standard short-acting beta2-agonist. Others include:
- Bitolterol (Tornalate)
- Isoetharine (Bronkometer, Bronkosol), which is available in nebulizers
- Isoproterenol (Isuprel, Norisodrine, Medihaler-Iso)
- Metaproterenol (Alupent, Metaprel)
- Pirbuterol (Maxair)
- Terbutaline (Brethine, Brethaire, Bricanyl)
Newer beta2-agonists, including levalbuterol (Xopenex), have more specific actions than the older medications. Most are inhaled and are effective for 3 - 6 hours.
Long-Acting Beta2-Agonists. Long-acting beta2-agonists salmeterol (Serevent) and formoterol (Foradil) are proving to be particularly effective as long-term maintenance therapy for COPD. They reduce exacerbations by 20 - 25%, may help prevent bacteria from building up on the airways and may offer real improvements in lung function. A nebulized formulation of formoterol is also available for the treatment of COPD.
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Review Date: 04/10/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
