2nd of 3 parts reviewing COPD........this week we discuss Treatment options
Posted by Eamonn Brady on
Chronic obstructive pulmonary disease (COPD) Part 2
Treatment
There is no cure for COPD, so treatment involves relieving the symptoms. Stopping smoking is an important first step.
Short-acting bronchodilator inhalers
Short-acting bronchodilator cause bronchodilation (open the lungs).
Two types of short-acting bronchodilator inhalers:
- beta-2 agonist inhalers, such as salbutamol and terbutaline
- anti-cholinergic inhalers, such as ipratropium and exotropia .
For mild COPD, a single bronchodilator inhaler used when required may be enough to relieve symptoms. But as the disease progresses a beta-2 agonist bronchodilator and an anti-cholinergic inhaler, four times a day may be needed
Long-acting bronchodilator inhalers (LABAs)
The effect of a long-acting bronchodilator inhaler is approximately 12 hours compared to a short-acting bronchodilator (e.g. salbutamol) which lasts 4 to 5 hours.
Two types of long-acting bronchodilator inhalers:
- Beta-2 agonist inhalers, such as salmeterol (Serevent®) and formoterol (Oxis®). Beta-2 agonist have rarely prescribed on their own due to poor results and are used more commonly in combination with corticosteroids (e.g.) Seretide® Diskhaler, Symbicort® Turbohaler
- Anti-cholinergic inhalers, such as tiotropium (Spiriva®), glycopyrronium (Seebri®) and Aclidinium (Eklira®).
Effectiveness of Anti-cholinergic LABAs
Compared to ipratropium bromide, inhaled tiotropium (Spiriva®) gave better lung function, less hospitalisations, fewer acute exacerbations of COPD and better quality of life. There were both fewer serious side and better control with tiotropium, but no big difference in deaths with ipratropium bromide compared to tiotropium. Tiotropium is a favoured treatment option instead of ipratropium with stable COPD.
Corticosteroid inhalers
Corticosteroid inhalers reduce the inflammation in the airways. If a bronchodilator inhaler is not giving adequate breathing relief, the patient should be prescribed a combination of a long-acting bronchodilator and a corticosteroid inhaler.
There are several types of corticosteroid inhalers:
- beclomethasone
- budesonide,
- fluticasone
Each corticosteroid appears to be equally effectiv (e.g.) Seretide® Diskhaler, Symbicort® Turbohaler.
Newer Combination Inhalers
There are many newer combination inhalers:
- Combination of anti-cholinergic and long-acting beta-2 agonist (e.g.) Glycopyrronium/ Indacaterol (Ultibro®), Tiotropium/ Olodaterol (Spiolto®), Umeclidinium/ Vilanterol (Anoro Ellipta®)
Effectiveness: combinations of anti-cholinergic and long-acting beta-2 agonists give better outcomes when compared to single agents .
- Combination of cortico-steroid and long-acting beta-2 agonist (e.g.) Fluticasone fluorate/ Vilanterol (Relvar Ellipta®).
Effectiveness: Combined inhaler therapy led to around 25% fewer COPD exacerbations. Studies indicate no major differences in the effectiveness of different inhalers brands.
Theophylline
Theophylline allows the muscles of the airways to relax and open-up and speeds up the clearance of mucus and phlegm from the lungs. It is more effective as a bronchodilator in stable COPD rather than acute bouts of COPD so is mostly added to inhaler therapy if inhalers so not control symptoms sufficiently. Due to the risk of potential side effects such as increasing heart rate and headaches, other options should be tried before considering theophylline. Side effects can also include nausea and other gastrointestinal problems, palpitations, and insomnia.
Covid Booster Vaccine
If you have COPD, you may be at more risk from COVID-19. Ask your doctor if you are eligible for the next Covid 19 booster. Whelehans Pharmacy Pearse St have a weekly walk-in clinic for Covid-19 boosters. Call 0449334591 for more.
Convenient Flu Vaccination Service at Whelehans
Whelehans offer flu vaccine at our Pearse St and Clonmore store most days for adults and children. You can book online on the Whelehans Pharmacy website or ring either pharmacy. Flu vaccine is €25 (€20 if you book online) or free with medical or doctor visit card. It is free for older people and those with long term conditions (including COPD) and healthcare workers.
To be continued…next week
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore). Email queries to info@whelehans.ie. Find us on Facebook.