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COPD - control drugs

Chronic obstructive pulmonary disease - control drugs; Bronchodilators - COPD - control drugs; Beta agonist inhaler - COPD - control drugs; Anticholinergic inhaler - COPD - control drugs; Long-acting inhaler - COPD - control drugs; Corticosteroid inhaler - COPD - control drugs

Control medicines for chronic obstructive pulmonary disease (COPD) are drugs you take to control or prevent symptoms of COPD. You must use them every day for them to work well.

These medicines are not used to treat flare-ups. Flare-ups are treated with quick-relief (rescue) drugs.

Depending on the medicine, control drugs help you breathe easier by:

  • Relaxing the muscles in your airways
  • Reducing any swelling in your airways
  • Helping the lungs work better

You and your doctor can make a plan for the control drugs that you should use. This plan will include when you should take them and how much you should take.

You may need to take these drugs for at least a month before you start to feel better. Take them even when you feel OK.

Ask your doctor about the side effects of any medicines you are prescribed. Be sure you know which side effects are serious enough that you need to call your doctor right away.

Follow instructions on how to use your medicines the right way.

Make sure you get your medicine refilled before you run out.

Anticholinergic Inhalers

Anticholinergic inhalers include:

  • Aclidinium (Tudorza Pressair)
  • Glycopyrronium (Seebri Neohaler)
  • Ipratropium (Atrovent)
  • Tiotropium (Spiriva)
  • Umeclidinium (Incruse Ellipta)

Use your anticholinergic inhalers every day, even if you do not have symptoms.

Beta-agonist Inhalers

Beta-agonist inhalers include:

  • Arformoterol (Brovana)
  • Formoterol (Foradil; Perforomist)
  • Indacaterol (Arcapta Neohaler)
  • Salmeterol (Serevent)
  • Olodaterol (Striverdi Respimat)

DO NOT use a spacer with beta-agonist inhalers.

Inhaled Corticosteroids

Inhaled corticosteroids include:

  • Beclomethasone (Qvar)
  • Fluticasone (Flovent)
  • Ciclesonide (Alvesco)
  • Mometasone (Asmanex)
  • Budesonide ( Pulmicort)
  • Flunisolide (Aerobid)

After you use these drugs, rinse your mouth with water, gargle, and spit.

Combination Inhaled Medicines

Combination medicines combine two drugs and are inhaled. They include:

  • Albuterol and ipratropium (Combivent Respimat; Duoneb)
  • Budesonide and formoterol (Symbicort)
  • Fluticasone and salmeterol (Advair)
  • Fluticasone and vilanterol (Breo Ellipta)
  • Formoterol and mometasone (Dulera)
  • Tiotropium and olodaterol (Stiolto Respimat)
  • Umeclidinium and vilanterol (Anoro Ellipta)
  • Glycopyrrolate and formoterol (Bevespi Aerosphere)
  • Indacaterol and glycopyrrolate (Utibron Neohaler)
  • Fluticasone and umeclidinium and vilanterol (Trelegy Ellipta)

Phosphodiesterase Inhibitor

Roflumilast (Daliresp) is a tablet that is swallowed.

Antibiotics

Azithromycin is a tablet that is swallowed.

References

Anderson B, Brown H, Bruhl E, et al. Institute for Clinical Systems Improvement website. Health Care Guideline: Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD). 10th edition. www.icsi.org/wp-content/uploads/2019/01/COPD.pdf. Updated January 2016. Accessed February 28, 2018.

Han MK, Lazarus SC. COPD: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 44.

Rabe KF, Watz H. Chronic obstructive pulmonary disease. Lancet. 2017;389(10082):1931-1940. PMID: 28513453 www.ncbi.nlm.nih.gov/pubmed/28513453.

Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease 2017 report: GOLD Executive Summary. Respirology. 2017;22(3):575-601. PMID: 28150362 www.ncbi.nlm.nih.gov/pubmed/28150362.

  • COPD inhaler

    COPD inhaler

    Animation

  •  

    COPD inhaler - Animation

    Inhalers of one kind or another are often the mainstay of asthma therapy. I'm Dr. Alan Greene and let's talk about how to actually use an inhaler. When someone is first handed an inhaler, their first instinct is often to put their mouth around the opening and to squeeze. But it turns out when you do it that way, you'll often end up with a lot of the medicine inside your mouth, on your tongue, on the roof of your mouth, inside the cheeks. You get less medicine down into the lungs where it is needed. It tastes bad. And if it happens to be one of the preventative kinds of medications, it could actually lead to thrush or yeast in the mouth. Something else that's worth noting. An even better way to use an inhaler is with a spacer. We especially recommend this for kids, but it's better for adults, too. And the way the spacer works, you don't have to be coordinated. You don't have to time it perfectly. You can put the spacer into your mouth and you squirt the medicine into the spacer and just breathe in and out normally for a while so the medicine keeps coming in. Now what ever you use, whether it's a straight inhaler or the spacer, there's a recent change that's worth being aware of. For a long time, asthma inhalers were propelled by CFCs (chlorofluorocarbons) that caused some problems with global warming and ozone depletion. Those have now been replaced or are being replaced with something called HFA instead. And that's great for the environment, but it is a little bit clumpier. So it's important the little place where the medicine comes out of, you may need to clean off on an albuterol kind of inhaler, whether you are using a spacer or using directly into your mouth.

  • COPD inhaler

    Animation

  •  

    COPD inhaler - Animation

    Inhalers of one kind or another are often the mainstay of asthma therapy. I'm Dr. Alan Greene and let's talk about how to actually use an inhaler. When someone is first handed an inhaler, their first instinct is often to put their mouth around the opening and to squeeze. But it turns out when you do it that way, you'll often end up with a lot of the medicine inside your mouth, on your tongue, on the roof of your mouth, inside the cheeks. You get less medicine down into the lungs where it is needed. It tastes bad. And if it happens to be one of the preventative kinds of medications, it could actually lead to thrush or yeast in the mouth. Something else that's worth noting. An even better way to use an inhaler is with a spacer. We especially recommend this for kids, but it's better for adults, too. And the way the spacer works, you don't have to be coordinated. You don't have to time it perfectly. You can put the spacer into your mouth and you squirt the medicine into the spacer and just breathe in and out normally for a while so the medicine keeps coming in. Now what ever you use, whether it's a straight inhaler or the spacer, there's a recent change that's worth being aware of. For a long time, asthma inhalers were propelled by CFCs (chlorofluorocarbons) that caused some problems with global warming and ozone depletion. Those have now been replaced or are being replaced with something called HFA instead. And that's great for the environment, but it is a little bit clumpier. So it's important the little place where the medicine comes out of, you may need to clean off on an albuterol kind of inhaler, whether you are using a spacer or using directly into your mouth.

    Self Care

     
     

    Review Date: 2/18/2018

    Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. 02-25-19: Editorial update.

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