Drug Treatment Options for COPD..Asthma

Don Martin (at the beautiful Lake of the Ozarks in Missouri) <nnmartin@mail.usmo.com>
takes full responsibility for all material printed on this page.  All usual disclaimers apply.

Reference materials are:
"Merck Manual of Medical Information" 1997 Home Edition....also "Family Medical and Prescription Drug Guide" by the editors of Consumer Reports....and  "The Essential Guide to Prescription Drugs" by James W. Long, M.D. 1993 edition....I also sometimes use the various Web Sites that are available and of course my own personal experiences with someof the  subjects.

Part 1
Some have COPD (Chronic Obstructive Pulmonary Disease) and some have Asthma...Some
have COPD with an Asthma component.....Since COPD can be Emphysema or Chronic Bronchitus or both.  You can see that the possible combinations multiply when Asthma and or
chronic Asthma are thrown into the mix.....( as if that were not enough we also have other conditions such as diabetes, thyroid problems, heart problems, arthritus etc; all of which are conditions that may or may not affect our drug treatment options).

Drug Treatment Options for any combination of the conditions listed above are pretty much dependant on the goals the Doctor is trying to achieve......Prompt relief of acute attacks of breathing distress,......Prevention of recurrent acute attacks.......Stabilization of lung function
and freedom from acute attacks to the greatest degree possible, with a minimal use of drugs,
and finally prevention of later complications such as bronchiestasis, emphysema, cor pulmonale (heart disease) congestive heart failure and others......

To keep this explanation simple,  the drugs that are used to treat COPD..or Astma fall into  different classes of drugs which can be easily identified as.......Xanthine Preparations (such
as aminophylline, oxtriphylline, theophylline....Beta-Adrenergic Drugs (albuterol is the most
common in use)......Cortisonelike Steroids (prednisone is one ..this class also includes the
Steroidal Inhalers or MDIs (metered dose inhalers) and the discus delivery systems
(Turbocort is one example).......the last class we will just designate Others (this class includes
the combination inhalers such as Combivent and Advair, also  iprotroprium bromide  (Atrovent)....cromolyn (Intal) and oxygen).......

As you start to understand which of the different classes of drugs are used for  which of the Treatment Goals the Doctor is trying to achieve  and the Drug treatment options that are
available perhaps all of this will become a little less confusing and you will become better
equipped to partner with your Doctor in getting the best treatment for You......and aren't
You the most important person to You??????  Just my opinion of course and all of the
usual disclaimers apply.

Part 2
Because of the interest shown recently in the subject of corticosteroids such as Prednisone
and the steroidal MDIs (metered dose inhalers) and the fact that corticosteroids are some
times used in providing prompt relief of acute attacks of breathing distress

Steroids are produced in our bodies by the Adrenal Glands. There are basically two types; anabolic or androgenic (testosterone and similar hormones), and corticosteroids. There are
times when Doctors use corticosteroids (such as Prednisone) to treat COPD and /or
Asthma.  Corticosteroids reduce inflammation in the bronchials, lungs and other parts of
the body. Prednisone is also used to treat many other conditions....Prednisone is systemic,
it is not site selective and it goes to the inflammations via the blood stream.....Corticosteroids
 used in MDIs are inhaled and go directly to the inflammation in the bronchials and lungs
with only very minute amounts of systemic transmission. The side effects of the two delivery systems are different and  this often causes confusion and concern among patients...

Long term corticosteroid usage is more effective when used in patients with Asthma. It is
useful in only about 20 percent of patients that have Emphysema only. (Remember, Asthma
is reversible, Emphysema is not.  Long term corticosteroid usage is effective in helping to accomplish the treatment goal of preventing future acute attacks....and the treatment goal of  stabilizing lung function and providing freedom from acute attacks to the greatest extent

If you are taking large dosages of cortiicosteroids (Prednisone) and quit usage without
tapering down you may cause your adrenal glands to stop functioning and producing corticosteroids for weeks, sometimes months. The resulting corticosteroid deficiency can
lead to many problems  Addisons disease is but one complication........If you take more corticosteroids than your body needs you can also have complications...Cushings disease
is one...

In Part 3
The only thing I feel I must include in the discussion on corticosteroids before we leave the subject
are the possible side effects. (natural, expected, and unavoidable drug actions) In the case of Prednisone these include; increased appetite, weight gain, (DuH)......retention of salt and water, excretion of potassium, increased susceptibility to infections. There are additional mild and severe
side effects that can occur and you can discuss these with your Doctor or Pharmacist.......and since there are so many different types of inhaled coricosteroids, possible side effects of each should be
discussed with your Doctor or Pharmacist as they are made a part of your treatment regimen....

Let us now pick up our discussion with the drug treatment options for the treatment goal of
providing prompt relief of sudden acute attacks of breathing distress.  Treatment should be
started with Beta-Adregeneric Inhalers (either in MDIs (metered dose inhalers) or by use of a nebulizer. Albuterol is the most common of the drugs used for this. in addition a large dose of Prednisone may be administered either intravenously or orally to bring the respiration under
control and relieve the distress. In some cases a Theophylline preparation may also be added
to this treatment routine....Once the breathing distress is brought under control an anticholinergic
drug (Iprotroprium Bromide) Atrovent may be added.

Albuterol is a fast acting Broncho Dilator with short term results....Atrovent is also a Broncho
Dilator but is slower acting with longer term results....Theophylline also acts as a Broncho Dilator.
All can be used in the treatment goals of stabilizing lung function and providing freedom from acute attacks to the greatest degree possible, however there is controversy over the consistant use of Albuterol as a maintenance drug for this purpose...Albuterol is more effective as a
rescue medication.   Other  slow acting but long lasting Beta-Andregeneric inhalers such as
Salmeterol (Serevent) are also Broncho Dilators and can be used to stabilize lung function and
provide freedom from acute attacks to the greatest degree possible...

That brings us full circle now to the last bunch of drugs I designated as other.....Oxygen
(supplemental Oxygen) is one of our most important medicines.....Combivent is a combination
of half Albuterol and half Atrovent...it is a Broncho Dilator and convenient to patients that may
be prescribed both medicines. It can be used in nebulizer or MDI (metered dose inhaler)  Advair
is also a combination of Serevent and FloVent. Serevent is a Broncho Dilator and FloVent is
a cortico steroid... Both Combivent and Advair  can be useful in the treatment goal of stabilyzing
lung function and providing freedom from acute attacks to the greatest degree possible...
Combivent can also be used for prompt relief of acute breathing distress.

That pretty much wraps up the garden variety drug treatment options that most of us use for COPD.......or Asthma......There are new drugs being tested all the time and some may be released soon.... Your Doctor should always be the one that prescribes the drugs and medicines you use
but it helps if you know why you are using them and what they are supposed to do for you.  It will also help you understand why you may not be using some of the drugs that others of us use.....As responsible patients it is our duty to keep as up to date as possible on everything that might help us cope with our disease better

Breathe easy and for a long time,
Don Martin,(at the beautiful Lake of the Ozarks in Missouri).


last edited on 2-11-2001