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Speaker 1: The material contained in this video presentation provides general information on the management of chronic obstructive pulmonary disease. This information is for reference purposes only and should not be considered medical advice. For specific information and recommendation based on your health condition, please consult your medical provider.
Bryan Brubaker: Hi, my name is Bryan Brubaker, I'm a pharmacy clinical specialist who focuses on respiratory illness, and we're going to talk about COPD medications.
Types of medications. Bronchodilators, steroids, phosphodiesterase blockers, methylxanthines, antibiotics, mucous treatments.
Bronchodilators. Bronchodilators relax the muscles in the airways to make it easier to breathe. Bronchodilators come in many forms, including tablets, liquid and injections, but the most common form are inhaled bronchodilators. You may need to use short-acting bronchodilators, long-acting bronchodilators or a combination of both, depending on the severity of your illness. There are two primary types of bronchodilators, beta agonists and muscarinic antagonists. There are three main types of short-acting bronchodilators, Albuterol which is trade named Ventolin, Levalbuterol which is Xopenex and Ipratropium which is also called Atrovent. The long-acting versions have many, some examples are Salmeterol, trade name Serevent, Formoterol, trade name Perforomist, Tiotropium which is Spiriva and Umeclidinium which is Incruse.
Steroids. Steroids are sometimes used in COPD to help control inflammation. When you have a flare up of COPD symptoms, oral steroids can be prescribed for a short time period of five to 14 days. Most commonly prescribed product in this case is Prednisone. Patients who have chronic inflammation in their lungs can also be prescribed inhaled steroids to use every day, examples are Fluticasone and Budesonide.
Combination inhalers. Many products are combined into combination inhalers to make it easier to use multiple medications at once. There are a variety of combinations available, including two types of bronchodilators in one inhaler like Stiolto. Bronchodilators combined with steroids like Symbicort and there's even one that has all three types of medications available called Trelegy.
Phosphodiesterase blockers. There's only one type of phosphodiesterase blocker available and that is Roflumilast, which is trade name Daliresp. It's sometimes prescribed in patients with severe COPD symptoms. It can help to control inflammation in the lungs and can also help to increase bronchodilation. Most common side effects Daliresp is GI discomfort or diarrhea.
Methylxanthines. Theophylline is sometimes used for the same reasons as Roflumilast or Daliresp. It can cause bronchodilation at high doses, but it's much more likely to cause side effects like nausea, tremor, or increased heart rate at those doses. It's possible that theophylline can decrease lung inflammation at lower doses as well.
Antibiotics. Like steroids, antibiotics can be used to treat acute illness like pneumonia or they can be prescribed in certain patients to prevent flare-ups of COPD symptoms. The most common medication used for prevention of flare-ups is Azithromycin or Zithromax, but side effects can limit the long-term use of this medication, things like heart rhythm changes, skin rashes or bacterial resistance.
Mucous treatments. During flare-ups, drugs are sometimes given to help break down and loosen mucous in the lungs. Removing excessive amounts of mucous can make it easier to breathe and speed up recovery. There are two drugs that are given for this reason, Mucomyst and Hypersal, both medications are given with a nebulizer and you should use a bronchodilator before you use these medications to help prevent lung spasms.
Devices. There are many types of delivery devices for inhaled medications, and they should be tailored specifically to you. If you feel that the device that you're using is challenging for any reason, you should talk to your doctor or pharmacist about another alternative that could work better for you. The four main types are pressurized meter dose inhalers, dry powder inhalers, soft mist inhalers and nebulizers.
Pressurized meter dose inhalers. pMDIs or pressurized meter dose inhalers are the most common type of device used for delivering inhaled medications. They do require timing of coordination between the actuation and the actual inspired breath. That can be challenging for patients with arthritis or with muscle weakness for any reason, and they're the only type of inhaler that can be used with a spacer.
Dry powder inhalers. Dry powder inhalers do not require coordination with actuation because it's going to be driven entirely by your breath, that means there's no propellant required for these medications either. There are many varieties of this type of inhaler, so if you struggle with one, there's a chance that there's another type that may work for you.
Soft mist inhalers. There's only one type of commercially available soft mist inhaler and it goes under the trade name of Respimat. It's a spring loaded device that provides propulsion for the inhaled mist over one to two seconds and therefore does not require any type of propellant. This can be challenging for patients to use if you have arthritis or muscle weakness, because it requires fine actuation.
Nebulizers. Nebulizers are powered devices that aerosolize liquid medication for inhalation. These devices are very easy to use and are ideal for people who have trouble using other devices. Nebulizers do take the longest amount of time to deliver medication compared to other delivery devices, but there are a variety of nebulizer types, some with shorter delivery times.
I hope you found this information useful, and if you have any further questions or concerns about your medications, I recommend that you reach out to your physician or your pharmacist with concerns. Thank you.