Medications for Chronic Obstructive Pulmonary Disease (COPD)
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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Numerous medications may be prescribed to treat COPD. These medications may be taken by mouth or inhaled into the lungs. Some work by opening the airways, whereas others are designed to reduce inflammation, eliminate infections, thin secretions, or reduce fluid build-up. The list below is a sample of some of these medications. Doctors may often use drugs closely related to those listed or combinations of drugs, such as ]]>Combivent]]> or ]]>Advair]]> .
- ]]>Mucolytics, Expectorants, and Bland Aerosols]]>
Common names include:
- Albuterol]]> (Proventil or Ventolin inhalers)
- ]]>Salmeterol]]> (Serevent inhaler)
- ]]>Terbutaline]]> (Brethine tablets)
- ]]>Ipratropium]]> bromide (Atrovent inhaler)
- ]]>Theophylline]]> (Theobid duracaps, Theo-Dur, Slo-Bid, Uni-Dur)
These drugs work by relaxing the smooth muscles of the respiratory tract, which causes the bronchial passages to open, making breathing easier. Depending on the specific medication that is prescribed, these drugs may be taken by mouth, inhaled, injected, or given intravenously (into a vein).
In a review, salmeterol reduced episodes of worsening symptoms in patients with stable COPD who did not respond well to short-acting inhalers, like Albuterol. ]]> * 1 ]]>
Possible side effects include:
- Fast heartbeat
- Nervousness, trembling
- Heartburn or nausea
Common names include:
- Beclomethasone]]> (Beclovent or Vanceril inhalers)
- ]]>Triamcinolone]]> (Azmacort inhaler)
- ]]>Budesonide]]> (Pulmicort inhaler)
- ]]>Flunisolide]]> (AeroBid inhaler)
- ]]>Fluticasone]]> (Flovent inhaler)
Corticosteroids reduce inflammation in the airway walls and are frequently used if airway obstruction cannot be kept under control with bronchodilators. They are often provided in an inhaled form that works directly on inflamed lung tissue. Few serious side effects are associated with their use if inhaled. In more advanced stages of COPD, corticosteroids may be prescribed in pill form; while this presents a greater risk of complications, the benefit to an individual seriously ill with COPD usually outweighs these risks. During severe flare of symptoms, or as COPD progresses, IV or oral steroids (such as prednisone) may be required.
Possible side effects from inhalation therapy include:
- Dry throat or mouth
- Mouth or throat fungus ( ]]>thrush]]> )
In a review, researchers found that long-term use of inhaled corticosteroids did not slow the decline in lung function, nor did it reduce mortality from COPD. However, it did modestly reduce the number of exacerbations and slow the decline in overall quality of life. ]]> * 2 ]]>
Systemic corticosteroids (by mouth or intravenously) may also be used to treat COPD exacerbations. Although, long-term use in COPD is not recommended.
- Tetracycline]]> or ]]>Doxycycline]]> (Achromycin, Sumycin)
- ]]>Ampicillin]]> or ]]>Amoxicillin]]> (Polycillin, Amoxil)
- ]]>Trimethoprim-sulfamethoxazole]]> (Bactrim, Septra)
- ]]>Clarithromycin]]> (Biaxin)
- ]]>Azithromycin]]> (Zithromax)
- Cephalosporin (Keflex, Ceftin, Cefzil)
- ]]>Erythromycin]]> (Emycin, EES)
- Quinolone ( ]]>Cipro]]> , Levaquin)
Antibiotics kill bacteria and are used to treat infections that could further compromise breathing. They are frequently prescribed at the first sign of a respiratory infection, such as increased production of green or yellow sputum. They are usually taken by mouth for 7-10 days. Some are taken with food or on an empty stomach. It is usually best to avoid alcohol while taking antibiotics. Some antibiotics, such as tetracycline, should not be taken if you are pregnant.
If you have chronic bronchitis and mild-to-moderate COPD, you may not need antibiotics. If you do need them, a study found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days). ]]> * 3 ]]>
Some of the more likely side effects include:
- Stomach ache
- Sore mouth or tongue
- Vaginal itching due to growth of fungus or yeast
- Increased sensitivity to sunlight (tetracycline)
A review of 21 trials found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days) in people with chronic bronchitis and mild-to-moderate COPD episodes. ]]> * 3 ]]>
Mucolytics, Expectorants, and Bland Aerosols
Common names include:
- Acetylcysteine]]> (Mucomyst)
- ]]>Guaifenesin]]> (Humibid LA, Robitussin, Duratuss G, Organidin NR)
- Saline, bicarbonate of soda
Mucolytics are drugs that help to dissolve mucus in the respiratory tract. They are given by inhalation of nebulization (aerosol) to reduce the thickness of respiratory tract fluid. The loosened material can then be coughed up more effectively.
Expectorants also help to thin mucus and phlegm. They are usually provided as capsules or as syrup.
Bland aerosols are made from solutions of salt or bicarbonate of soda. These aerosols, which thin and loosen mucus, are inhaled. Treatments usually last 10-15 minutes and are taken 3-4 times daily. Bronchodilators are sometimes added to the aerosols. Although some of these medicines are available over-the-counter, others require a prescription.
Possible side effects include:
Consult your doctor before using any over-the-counter medications if you have COPD.
Whenever you are taking a prescription medication, take the following precautions:
- If you have COPD due to an alpha-1 antitrypsin deficiency, new treatment can boost your alpha-1 antitrypsin levels, which can have a protective effect on your lungs
- Take them as directed—not more, not less, not at a different time.
- Do not stop taking them without consulting your doctor.
- Don’t share them with anyone else.
- Know what effects and side effects to expect, and report them to your doctor.
- If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
- Plan ahead for refills so you don’t run out.
When to Contact Your Doctor
Contact your doctor if you:
- Have serious side effects, such as increased shortness of breath or signs of an allergic reaction (swelling of the face, lips, or eyelids)
- Have prolonged nausea, vomiting, or diarrhea
- Develop white spots in your mouth or vaginal itching (possible ]]>yeast infection]]> )
- Have severe or prolonged muscle cramps or heart palpitations
- Need help with medicine-related dietary changes
American Lung Association website. Available at: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22542 .
National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .
National Library of Medicine website. Available at: http://www.nlm.nih.gov/ .
* 1 Updated Bronchodilators section on 9/14/06 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Appleton S, Poole P, Smith B, et al. Long-acting beta2-agonists for poorly reversible chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2006;3.
* 2 Updated Corticosteroids section on 7/6/07 according to the following study, as cited by DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Yang IA, Fong KM, Sim EHA, Black PN, Lasserson TJ. Inhaled corticosteroids for stable chronic obstructive pulmonary disease [review]. Cochrane Database of Systematic Reviews. 2007;2:CD002991.
* 3 6/4/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : El Moussaoui R, Roede BM, Speelman P, Bresser P, Prins JM, Bossuyt PM. Abstract Short-course antibiotic treatment in acute exacerbations of chronic bronchitis and COPD: a meta-analysis of double-blind studies. Thorax. 2008;63:415-422. Epub 2008 Jan 30. Review.
Last reviewed June 2008 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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