I have so many patients that are diagnosed with COPD that have infections that do not clear up even after 2 to 3 courses of antibiotic treatment. They describe symptoms of shortness of breath, chronic cough, and constricted breathing. My first question to them is, "are you taking your controller everyday" if they have been prescribed one. With COPD, if your prescriber gives you a controller or preventative inhaler, it is important that it be used on a daily basis to prevent flare-ups and not on an as needed basis.
Controller inhalers contain either a bronchodilator or an inhaled corticosteroid or a combination of both . They only manage COPD and don't treat flare ups. Early in the disease, patients may need only a short-acting bronchodilator (ProAir HFA, Ventolin HFA, and Proventil HFA, (all contain albuterol); Xopenex (levalbuterol) and Atrovent HFA (Ipratropium Bromide) as needed for shortness of breath. Bronchodilators relax the muscles around your aiway. This can help relieve coughing and shortness of breath and make breathing easier.
As the disease progresses, a long-acting bronchodilator (Spiriva (tiotropium), Foradil and Perforomist both contain formotorol; Brovanna (arformoterol)) may be needed in addition to the short-acting (rescue) inhaler. At stage 3 or 4 , prescribers often add an inhaled steroid (Flovent (fluticasone), and Pulmicort (budesonide) are examples). These inhaled corticosteroids can reduce airway inflammation and help prevent flare ups. Side effects may include bruising, oral infections if you don't rinse out your mouth with every use. Combination inhalers combine a bronchodilator with an inhaled steroid. Some examples include Advair (salmeterol/fluticasone) and Symbicort (formoterol/budesonide).
Too many times, my patients will tell me that they only use the rescue inhaler and not the controller for several reasons. Expense of the controller is a big part of the problem. These inhalers (Advair, Symbicort...) are expensive and no generic alternatives are available. Secondly, patients may not understand that they need to take this everyday because they do not "feel" a difference when they take it. The immediate effects of the rescue are not evident with the controller because its job is to keep the patient from needing to use the rescue inhaler. If you have COPD and are using your rescue inhaler more than you should be, then you need to ask why and be evaluated by a physician. Are you taking your every day medication? Is your disease progressing and do you now need a combo inhaler? I review technique with them to make sure they are using the inhaler correctly and getting the most out of their medication.
I also ask them if they are smoking.
Stopping smoking is the sole intervention shown to decrease disease progression. Smoking cessation before 40 years of age, prevents 90% of smoking- related deaths!! For women, stopping before 30 years old prevents more than 97% of smoking-related deaths. Prevention is very important and therefore Vaccination is critical.
I am an immunizing pharmacist and can vaccinate any person 18 years of age and older. Pharmacists are trying to vaccinate people 12 years and older as well and it is a topic on the senate floor as we speak. Too many times, doctors offices are overwhelmed with flu vaccine requests, and either receive their flu stock later in the season, or cannot give you an appointment in a timely manner. When I see in my patient's profile that they are taking inhalers, I ask them if they have received their flu shot and pneumonia shot. Getting vaccinated with the Flu vaccine yearly is critical to flu prevention and a standard of care . And the earlier you are vaccinated, the better. We start vaccinating patients in September. It is not too early and it will last throughout the entire flu season. It takes several weeks to develop full immunity, so get vaccinated, and do it as early as possible. Why wait in a doctors office, pay a co-pay, and be exposed to sick patients, when your pharmacist can vaccinate you on a walk in basis.
Medicare part B covers Flu and Pneumonia Vaccines at zero cost!! Many other insurances also pay for flu and pneumonia vaccinations, because they know that the cost of treating someone with these diseases is staggering. So many COPD patients end up hospitalized with Pneumonia or Influenza that could have been prevented or at the very least, their symptoms could have been controlled and lessened, had they received those vaccines. Your pharmacist can always run a claim to see if both are covered. It is a myth that you can get the flu from the flu vaccine . It is an inactivated vaccine, meaning it is dead. It cannot give you the flu. The only type of flu vaccine that is live is the nasal version which is not given to populations with COPD, asthma etc.. We don't even keep it in stock at our pharmacy.
Weight loss and exercise can improve lung function. Obesity severely impacts respiratory function , and weight loss can reduce shortness of breath. Long term oxygen therapy is not to be used on an as needed basis. patients on long term oxygen therapy ( LTOT) need to us oxygen at least 15 hours daily. Note that it's effects are not immediate. Most patients begin to benefit after a year or more of treatment. LTOT has benefits of increased quality of life and fewer exacerbations and hospitalizations.
Researchers constantly look for new treatments and targets for COPD. Stem cells could play a role in identifying new treatments. Studies that use stem cells to grow new lung tissue are currently in the early stages. Anxiety and depression are serious concerns for COPD patients. As pharmacists, we need to be vigilant in addressing those concerns. COPD is a daily, wearing struggle for patients and their families. A diagnosis of COPD is not the end of the world. For all stages of disease, effective therapy is available which can control symptoms, reduce your risk of complications, and improve your ability to lead an active life.
Vanessa Andricola, Pharm D.