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Inhaled Bronchodilators

Bronchodilators are medications that cause the smooth muscles of the airway to relax and, thereby, open up the airway to make breathing easier. Bronchodilators are a mainstay of therapy for COPD because they can:

• Improve airflow to the lungs
• Reduce symptoms of COPD
• Reduce the incidence of acute exacerbations of COPD
• Improve exercise tolerance

There are several types of bronchodilators that are available for the managment of patients with COPD:

• Short-Acting Beta Agonists

  • the most commonly used medication in this class is albuterol (e.g., Proventil; Ventolin; Volmax)
  • rapid onset of action - acts within 5 minutes
  • maximum effect in about 30 minutes
  • effective for up to 4 hours with a single inhalation dose
  • most common side-effects are heart palpitations and tremor

• Long-Acting Beta Agonists

  • examples include salmeterol (e.g., Serevent; Advair) and formoterol (Foradil)
  • onset of action is about 30 minutes
  • maximum effect in about 2 hours
  • effective for up to 8-12 hours with a single inhalation dose
  • these medications are more convenient and more effective for COPD patients than the short-acting beta agonist inhalded bronchodilators
  • most common side-effects are heart palpitations and tremor

• Anticholinergic Bronchodilators

  • Ipratropium (Atrovent) - a short-acting anticholinergic inhaled bronchodilator that works within 15 minutes to relieve bronchospasm and lasts for up to 6 hours.

  • Tiotropium (Spiriva) - a long acting (up to 24 hours) anticholinergic inhaled bronchodilator that has been shown to be effective in COPD by controlling symptoms, reducing acute exacerbations, and improving overall quality of life.

In February 2008, the U.S. Food and Drug Administration (FDA) issued a MedWatch Safety Summary informing healthcare professionals and consumers of the correct way to use Spiriva and Foradil inhalation powder capsules. FDA and the National Poison Control Center received many reports of patients swallowing Spiriva and Foradil capsules rather than placing the capsules in the inhalation devices. Both medications are to be used in the HandiHaler (Spiriva) and Aerolizer (Foradil) devices to deliver the drugs to the lungs to improve breathing in patients with asthma, COPD, and bronchitis. Both medications will NOT treat a patient's breathing condition if the contents of a capsule are swallowed rather than inhaled. Healthcare professionals should discuss with patients how to correctly use the Spiriva HandiHaler and Foradil Aerolizer.

Theophylline

Theophylline is a medication that may sometimes be prescribed for patients with COPD whose symptoms cannot be adequately controlled with inhaled bronchodilators alone. Wnen used in conjunction with inhaled bronchodilators, theophylline can improve lung function and better control symptoms of COPD. Patients who are taking theophylline must be monitored carefully for adverse side effects that may include:

• Nausea
• Vomiting
• Seizures
• Irregular heart beats (arrhythmias)
• Interactions with other medications

Glucocorticoids

Inhaled Glucocorticoids

Examples of inhaled glucocorticoids include:

• Beclomethasone (Beclodisk; Becloforte)
• Budesonide (Pulmicort, Turb)
• Flunisolide (Bronalide, MDI)
• Fluticasone (Flovent, MDI)
• Triamcinolone (Azmacort, MDI)

The role of inhaled glucocorticoids in the management of patients with stable COPD is still the subject of debate among medical experts. Several studies have found that inhaled glucocorticoids do not alter the rate of decline of lung function over the long-term in people with COPD and, for this reason, they are not recommended for routine use in patients with stable COPD. Inhaled glucocorticoids can, however, reduce the frequencly of acute exacerbations (flare-ups) of COPD and are, therefore, recommended for COPD patients who experience frequent exacerbation of COPD symptoms.