Quite a few years ago now asthma experts realized asthma was much better controlled when a combination of medicines were used, as compared to just one. Recent evidence seems to suggest the same might be true regarding the treatment of COPD.
Combination therapy generally refers to the use of both an inhaled corticosteroid and a long acting beta adrenergic (LABA). The steroids help to reduce inflammation in air passages, while the LABA works to relax muscles that surround the air passages in order to keep air passages dilated long term. Together these work to improve lung function, thus reducing the need for rescue medicine, and reducing the risk for COPD flare-ups.
While these medicines can be taken as separate inhalers, they can usually be taken together by using one of the following convenient and easy to use combination inhalers:
1. Advair. It includes the steroid furosimide and LABA salmeterol. It comes as as an Advair Discus, and requires two puffs twice a day
2. Symbicort. It includes the steroid budesonide and LABA formoterol. It’s an inhaler that requires two puffs twice a day.
3. Dulera. It includes the steroid mometasone furoate and LABA formoterol. It’s an inhaler that requires two puffs twice a day.
4. Breo. It includes the steroid fluticasone furoate and LABA vilanterol. It comes as the Breo elipta and requires only one puff once a day.
Which one of these inhalers works best for you is generally a manner of trial and error. Some doctors are willing to give out free samples so that you can use one for a while to see how it works. If it works, great. If you have problems with it, or if it doesn’t work, then you can try another.
Another option that is available for COPD patients is to take simlar medicines via a nebulizer. This is a nice option especially for those patients with severe airflow limitation, or patients who cannot create enough flow to activate the inhalers (patients in the end stages of the disease).
If this is the desired option, then two medicines will have to be combined in a twice a day breathing treatment. These medicines are:
Budesonide (Pulmicort) and Arformoterol (Brovana)
These may be combined in a single nebulizer treatment, and it usually lasts anywhere from five to ten minutes. Still, the nice thing about it is it only needs to be done twice a day.
The key here is that your doctor can only prescribe one of the above five options. It is very important that you never take a LABA more than recommended. Otherwise, if used as prescribed, they are safe, and have proven very effective for improving lung function.
A frequently asked questoin is: If I’m taking a LABA, can I still use my rescue medicine? Yes you can. It is absolutely safe to use your rescue medicine, as prescribed, between doses of LABA (or combination inhaler). However, there are three things you must consider here:
The LABA in Symbicort and Dulera is fast acting, so if you just used it you shouldn’t need to use your rescue inhaler. The same is true for Brovana. So don’t use your rescue inhaler if you just used these medicines, you shouldn’t need to.
While the LABA in Advair and Beo is slower acting, it may be wise to wait 15 minutes after using it to see if your breathing improves. If it doesn’t improve, feel free to use your rescue inhaler or revert to your COPD action plan.
Ideally, however, the use of combination therapy should reduce, and possibly eliminate altogether, your need to use your rescue medicine. Still, you should always have your rescue medicine nearby just in case you need it.
There. Any questions? That’s pretty much all you need to know about COPD combination therapy. Studies seem to show it works pretty well, and the patients I’ve seen using it seem to feel that it works well for them.
So, if you’re not doing so already, and your COPD is not as controlled as you’d like, combination therapy might be something to discuss with your COPD physician.
A Registered Respiratory Therapist and asthmatic