Lessons from Cecil

Medications For COPD
General Information:
It is important to know that every medicine has two names -- a generic name and a brand name. The generic name is the scientific name of the drug. The brand name is the name that a specific company uses when it makes that drug. As an example, look at a common headache medicine. Many people use acetaminophen for a headache. Acetaminophen is the generic name of the drug. The brand names include Anacin Aspirin Free, Bayer Select
Headache, Panadol Maximum Strength
, and Tylenol.

When your doctor prescribes a new medicine for you, you should review all of the medicines you take - both prescribed and over the counter -- with your doctor. Everytime you go to the doctor, take a list of all of your medicines with you, including inhalers and over the counter meds. If your doctor changes your medicines and you start to feel any adverse side effects, call your doctor at once.

Bronchodilators:
Bronchodilators relax and open your airways to increase the flow of air. They let you exhale more completely. The preferred way to take these medicines is by inhalers.
Others may be taken as pills, liquids, or nebulized liquids. Bronchodilators may be given on an as-needed basis for relief of symptoms that persist or worsen. They may also be given on a regular basis to prevent or reduce symptoms. When you use inhalers, it's very important to talk to your doctor about a treatment plan.

Short-Acting Bronchodilators:
These drugs are short-acting bronchodilators that provide quick relief - they are fast-acting. They start to work in minutes, but last only 4 to 6 hours.They are sometimes called "rescue medicines" or "rescue inhalers." Keep one of these inhalers, if prescribed, with you at all times. Use it as prescribed when you have shortness of breath. If you need a fast-acting inhaler more than 1 or 2 times a day, call your doctor.
Possible side effects of fast-acting bronchodilators include faster heart beat, headache, and shaking (tremors). If you have side effects that bother you, talk to your doctor.
*An item of note with these medications albuterol is well known for its side effects of heart acceleration and effects on the central nervous system. If you have this problem you may ask your doctor about substituting xopenox for albuterol. It now has inhalers as well as nebulizer treatment.

Some short-acting Bronchodilators are: albuterol,Proventil, Proventil, HFA, Ventolin,
metaproterenol, Alupent, pirbuterol, Maxair, terbutaline, Brethaire, bitolterol, Tornalate,levalbuterol, and Xopenex.

Long-Acting Inhaled Bronchodilators:
Long-acting bronchodilators last about 12 hours or as long as 24 hours. It depends on their type. These medicines help to keep your symptoms under control. So they sometimes are called "controllers." They're also called "maintenance" bronchodilators. Usually these medicines are used on a regular basis (not "as needed"). They generally do not provide quick relief. They should not be used for immediate relief of breathing problems.
The two types of long-acting bronchodilators are beta-2 agonists and anticholinergics.
These long acting medicines include: salmeterol(Serevent ), formoterol (Foradil),
fluticasone and salmeterol (Advair).

Salmeterol:
This beta-2 agonist is inhaled by a dry-powder inhaler or a metered-dose inhaler (MDI). Salmeterol is usually taken 2 times a day, 12 hours apart. It begins to work in about 20 to  30 minutes. Do not take this medicine for an attack.
Possible side effects include headaches in the first few weeks of use, shaking (tremors), higher blood pressure, or faster heart beat. Care should also be used in diskus inhalers if you are lactose intolerant.

Ipratropium Bromide (Atrovent):
This is an anticholinergic bronchodilator that helps relieve the tightening of the airways, which is called bronchospasms. Ipratropium helps to keep the airways open. It works in 5 to 15 minutes and lasts for 4 to 6 hours. This drug is short-acting (but not fast-relief). Ipratropium comes both as a metered-dose inhaler (MDI) and as a liquid for a nebulizer. Take this medicine only as directed by your doctor. Usually this means 2 puffs from your inhaler every 4 to 6 hours. Unless your doctor tells you otherwise, you should not take more than 2 puffs more than 4 to 6 times a day. Side effects may increase from too frequent use.

Ipratropium is not a rescue medicine. Be sure to talk to your doctor about a treatment plan when you use ipratropium. You should not use ipratropium if you have an allergy to soy products or peanuts. Tell your doctor and pharmacist of all your allergies. Be sure to include any allergies to medicine and food.
Possible side effects of ipratropium include dry mouth and bitter taste. Do not allow the spray to get into your eyes. Be very careful. When you activate the inhaler, close your eyes. If you get ipratropium in your eye, it may cause blurred vision or worsen narrow-angle glaucoma. A spacer can help to keep spray out of your eyes.

Formoterol (Foradil):
This beta-2 agonist is usually taken two times a day. It begins to work in less than 5 minutes, but it is not a rescue medicine. Do not take formoterol for an attack. It is sometimes prescribed for people who have tightening of the airways brought on by exercise.
This medicine comes as a dry powder in a gelatin capsule. It is taken using a special type of inhaler that is packaged with the medicine. Possible side effects include shaking (tremors), trouble sleeping, faster heartbeat, muscle cramps, and nausea.

Tiotropium Bromide (Spiriva):
Spiriva HandiHaler is indicated for the long-term, once-daily, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
The recommended dosage of Spiriva HandiHaler is the inhalation of the contents of one SPIRIVA capsule, once-daily, with the HandiHaler inhalation device. Spiriva capsules are for inhalation only with the handihaler and must not be swallowed.
Spiriva capsules contain 18 mcg tiotropium.
The HandiHaler inhalation device is gray colored with a green button.
It is imprinted with Spiriva HandiHaler (tiotropium bromide inhalation powder). Six Spiriva capsules are packaged in an aluminum/PVC/aluminum blister card. One blister card consists of two blister strips, each containing 3 capsules and joined along a perforated-cut line. After using the first capsule, the 2 remaining capsules should be used over the next 2 consecutive days.
Capsules should always be stored in the blister and only removed immediately before use. The foil lidding should only be peeled back as far as the STOP line printed on the blister foil to prevent exposure of more than one capsule.
The drug should be used immediately after the packaging over an individual capsule is opened. The capsules should not be exposed to extreme temperature or moisture. Do not store capsules in the HandiHaler device.

Theophylline:
This drug is an oral bronchodilator that belongs to a group of drugs called methylxanthines (meth-ill-ZAN-theenz). These oral bronchodilators also relax the muscles around the airways and may also help the diaphragm to work better. Smoking can change the way your body uses these medicines. You may need to have regular blood tests to check if your dosage is right for you or needs to be changed. At low dosages, blood tests are not normally required.
This medication is also known as theophylline,Slo-Bid, Theochron, Theo-Dur, Theo-24, and Uniphyl. Some of the generic names of these oral beta-2 agonists are the same as those for inhaled beta-2 agonist bronchodilators. The possible side effects are similar and include faster heart beat, head-ache, trouble sleeping, and shaking (tremors).

Corticosteroids:
Corticosteroids (KOR-ti-ko-STEER- oyds) are often referred to simply as "Steroids"(STEER-oyds) and should not be confused with the controversial (and often illegal) abuse of "steroids" by athletes and others. Those are anabolic-androgenic steroids.They are man-made substances related to male sex hormones and are a totally different substance from corticosteroids.
Corticosteroids may help to reduce swelling and inflammation and are beneficial for treating asthma. Experts believe that inhaled steroids may also be beneficial for treating COPD. Steroids may decrease the number of episodes that cause symptoms get worse. In COPD, these episodes are called exacerbations (eg-zass-er-BAY-shuns).
Steroids are available as inhalers, which include metered-dose inhalers (MDIs) and dry-powder inhalers. Steroids also come as liquid for nebulizers, as pills, and as injections (shots).

Inhaled Corticosteroids :
Of all the types of steroids, inhaled steroids usually cause the fewest side effects because very little enters your blood stream. Most of the inhaled steroid goes to your lungs where you need it. Do not use steroids for fast relief of shortness of breath.
Possible side effects of these medicines include hoarseness or a yeast infection in the mouth. There are several things you can do to avoid these side effects.Gargling with mouth wash or even water after taking these steroids helps to prevent side
effects.

Oral Corticosteroids:
The oral steroid is: prednisone, beclomethasone,Beclovent, dipropionate, QVAR, Vanceril, budesonide, Pulmicort Turbuhaler, flunisolide, AeroBid, fluticasone, Flovent, triamcinolone, Azmacort.

Any steroid medicine may have side effects. Possible short-term side effects include: bigger appetite,retaining fluids,weight gain, nausea or vomiting, stomach upset or ulcers, blood sugar changes. Possible long-term side effects include: high blood pressure, thinning bones, cataracts, muscle weakness, easier bruising,slower wound healing, Oral steroids slow down the work of your adrenal glands. But when COPD symptoms suddenly get worse, oral or intravenous (IV) steroids are often needed. It's important to take steroids exactly as your doctor says.
NOTE: You can become seriously ill if you stop taking steroids suddenly. Do not stop taking any steroid medicines without talking to your doctor.

Combined inhaled medicines:
Many inhaled medicines are available for COPD. Some people with COPD may need to take several of these medicines to manage their disease. To simplify taking these medicines, some have been combined into one inhaler. For example, some inhalers combine a maintenance (controller) inhaler and a rescue inhaler.Others combine two maintenance inhalers.
Some combined inhalers include:
Combivent (Atrovent & Albuterol):
If it becomes less effective over time in relieving your symptoms, call your doctor. Be careful about taking this medicine with other fast-acting bronchodilators. Combivent already includes a fast-acting rescue medicine.It's important to tell your doctor if you are using rescue medicines.
Do not allow the Combivent spray to get into your eyes. Be very careful. When you activate the inhaler,close your eyes. Remember that Combivent contains ipratropium. If you get any spray into your eye, it may cause blurred vision or worsen narrow-angle glaucoma. A spacer can help to prevent this. If you are allergic to soy products or peanuts, do not take Combivent. Talk to your doctor about these allergies.
NOTE: Be sure to discuss the use of this medication with your doctor if you are using Spiriva.

DuoNeb:
This medicine also combines albuterol and ipratropium.You take DuoNeb with a nebulizer. It gives the same benefits as Combivent, but it is in liquid (nebulizer) form.

Advair:
This medicine is sometimes prescribed for people with COPD. Advair combines two controllers: salmeterol (a bronchodilator) and fluticasone (a steroid). Advair offers the long-acting bronchodilator effects of salmeterol and the steroid's ability to reduce swelling in one inhaler. It is usually prescribed 2 times a day, morning and evening, about 12 hours apart. Do not exceed this dosage.
Note: Advair comes in 3 different strengths that are color-coded. The fluticasone (steroid) dosage is different in each. These include 100/50, 250/50, 500/50. The salmeterol always remains the same. When you go to the doctor, take your Advair with you. Ask the doctor to check if you are taking the right dosage.

Expectorants and Mucolytics :
Expectorants (ex-PECK-ter-ents) and mucolytics(myu-ko-LIT-iks) are medicines that may help move secretions out of the lungs and airways. How well they work is not clear. For some people, drinking 6 to 8 glasses of water a day can have the same effect, and it costs less. Check with your doctor before trying this. If you retain fluids or have heart failure, you must be careful about drinking fluids.

Expectorants: These medicines increase fluid in your lungs and airways, and this helps secretions to liquefy and thin. These medicines come as pills and liquids. The most common one is: Guaifenesin

Mucolytics: These medicines break down mucus to make it easier to clear the lungs and airways. The most common one is: Mucomyst which is taken with a nebulizer and is prescribed along with a bronchodilator.

Antibiotics:
Antibiotics are used to treat infections caused by bacteria. Your doctor will choose the medicine that is best to attack the kind of infection you have. It is very important to take all the medicine prescribed. If antibiotics are not taken as directed, the bacteria may become weakened, but not destroyed. This leads to antibiotic resistance. Always take antibiotics as your doctor prescribed.
The following are signs of infection:
Your mucus changes in color, consistency, or amount. Your wheeze, cough, or shortness of breath gets worse. You get fever or chills.

Nebulizers:
A nebulizer is a small machine that changes liquid medicine into a fine mist. You then inhale the mist into your lungs. Directions for use are supplied by each company that makes these devices. To prevent infection, it is important to clean your device as the company recommends. Talk to your doctor about the best way for you to take inhaled medicines. Also check with your insurance company.Some insurance plans require a co-payment for nebulized medicines.

When should you seek help?


If any of the following occur, get medical care:

Your mucus changes in color,consistency, or amount.
Your wheeze, cough, or shortness of breath gets worse,even after you take your medicine and it has time to work.
Your breathing gets difficult.
You have trouble walking or talking.

Call 911 right away if any of the following occur:
You get confused.
You have trouble staying awake.
Your lips or fingernails are blue or gray.

SUMMARY:
In summary I would like to impress upon each of you that medications are a life and death subject.
They should never be altered without the consent/knowledge of your physician.
They should always be checked to insure they are taken as required, such as with meals, so many hours before meals or after meals. These instructions are important because they can alter the medications pharmacology. In addition, all meds should be checked for food and drug interactions. Never depend entirely on your doctor or pharmacist. Beware of grapefruit in a large number of cases and also the body's chemical reaction to meds as well as drug interactions.