We are fortunate to live in a world full of many great medicines for people with respiratory disorders, especially chronic obstructive pulmonary disease (COPD). Here is a list of the top ten COPD medicines currently on the market.
1. Albuterol (Ventolin): It’s a fast-acting beta adrenergic medicine that rapidly opens air passages, releasing trapped secretions, and makes breathing easier. It can be taken by inhaler or nebulizer, and side effects are generally considered negligible. Ideally, it should only be used on an as-needed basis for shortness of breath.
2. Aformoterol (Brovana): This is a fast-acting and long-acting beta adrenergic (LABA) that rapidly opens air passages, releasing trapped secretions, making breathing easier. It’s available as a solution, and is inhaled using a nebulizer. It’s ideal for COPD because it only needs to be taken twice a day, albuterol can still be used between doses, and is easily inhaled even by people with severe airflow limitation. When taken with Pulmicort (see below) a patient can get the same benefits as from inhalers like Advair, Symbicort and Dulera. It, therefore, replaces those inhalers.
3. Tiotropium Bromide (Spiriva): It is a long-acting anticholinergic medicine that helps keep air passages open and improve lung function. Studies show it works better and lasts longer than ipatropium bromide (Atrovent). It can be safely taken with other COPD preventative medicines. It replaces Ipatropium Bromide, the active ingredient in Combivent Respimat and Duoneb.
4. Budesonide (Pulmicort): It is an inhaled corticosteroid that is only available as a solution to be inhaled using a nebulizer. The medicine helps to control underlying inflammation present in the air passages. Like Brovana, it’s easier to inhale than similar medicines available only in inhaler form. It can be used twice daily in combination with aformoterol for the daily maintenance of COPD, replacing Advair, Symbicort, Dulera, Breo, and Duoneb.
5. Fluticasone/ Salmeterol (Advair), Budesonide/ Formoterol (Symbicort), Mometasone/ Formoterol (Dulera), Philicasone/ Vilanterol (Breo): These are combination inhalers that contain both an inhaled corticosteroid and a LABA. They are preventative medicines to keep air passages open long term. As COPD progresses, it may become increasingly difficult to inhale the medicine, making Brovana a better alternative. Still, for those able to use them, these are convenient medicines to control COPD.
6. Oxygen: Despite contrary belief, it is a medicine. When COPD advances to the point where lungs start to lose their ability to allow adequate oxygen into the bloodstream, supplemental oxygen is proven to help. Improved technology allows any person to take their oxygen just about anywhere with ease.
7. Antibiotics: Due to increased sputum production, thick secretions, and loss of natural mechanisms for coughing and moving secretions, COPD patients are prone to developing lung infections, such as pneumonia. Antibiotics are still the best mode of preventing and treating such infections.
8. Albuterol/ Ipatropium Bromide (Duoneb/ Combivent Respimat): With negligible side effects, low cost, and proven results, these original combination medicines have been a top line COPD medicine since the early 1990s. However, with the emergence of Spiriva, Brovana, and Pulmicort, all of which work better and only need to be taken twice a day, there seems to be little room left for old mainstays like Duoneb or Combivent.
9. Levalbuterol (Xopenex): This medicine is similar to albuterol in that it is a fast-acting beta adrenergic medicine, although it lasts one to two hours longer. Initial studies showed it was safer than albuterol, but subsequent studies showed this not to be true. A major disadvantage is that it’s still under patent, making it significantly more expensive than albuterol. Still, it’s a viable alternative to albuterol, and, quite honestly, will probably replace albuterol some day.
10. Systemic Corticosteroids: If it were not for the risky side effects induced by this medicine, it would most likely be tops on this list. However, when needed, this is a great medicine for reducing inflammation and opening air passages, and remains a viable option for those inevitable flare-ups.
Newer, better, safer, longer lasting COPD medicines are constantly being introduced to the market. Keep your options open, and discuss with your physician the possibility of trying new medicines. Because, while ipatropium bromide and theophylline may have topped this list ten years ago, 10 better drugs may be on this list in another 10 years.
A Registered Respiratory Therapist and asthmatic