Treating Your Condition: Smoking Cessation

Table 2: Drugs used to treat COPD

Drug

Action

Side effects

Comments

Bronchodilators

Anticholinergic agents: ipratropium (Atrovent), tiotropium (Spiriva). Inhaled medication used as a first-line treatment for most people with COPD.

Blocks acetylcholine, a chemical that causes muscle contractions.

Dryness in the back of the throat is the most common side effect.

The safest, most effective medication for COPD.

Beta-2 agonists: albuterol (Proventil, Ventolin), salmeterol (Serevent), formoterol (Foradil). Inhaled medication (rarely taken in pill form) used when anticholinergic drugs can't be taken or in combination when the anticholinergic drug is not effective alone. Long-acting versions are used as maintenance therapy on a daily basis; short-acting drugs treat acute exacerbations.

Relaxes muscles around the airways; reduces the work of breathing; improves lung function.

Anxiety, restlessness, headaches; when overused, can cause irregular heartbeat. May interact with other common medications.

Speeds the heart rate and should be used with caution by people with heart disease.

Theophylline: theophylline (oral), aminophylline (intravenous infusion). Second-line treatment, used when an anticholinergic and a beta-2 agonist do not provide relief.

Relaxes muscles around the airways; may improve contraction of the diaphragm and reduce inflammation.

Nausea, vomiting, headache, insomnia, irregular heartbeat; greater risk of overdose than with the alternative medications; may interact with other common medications.

Prescribed less often than other bronchodilators because of side effects and risk of overdose.

Corticosteroids

Inhaled forms include fluticasone (Flovent), beclomethasone (Beclovent), budesonide (Pulmicort), and triamcinolone (Azmacort); these are used for maintenance therapy. Pills, such as prednisone, are sometimes used for acute exacerbations.

Suppresses inflammation.

Inhaled: thrush, throat irritation, hoarseness, increased risk of bruising.

Pills: increased risk of infections, glaucoma, osteoporosis, and other long-term complications.

Serious side effects are most common with long-term use, so these drugs are mainly prescribed for short periods.

Alpha-1-antitrypsin

Alpha-1-antitrypsin replacement therapy. Intravenous medication for people with alpha-1-antitrypsin deficiency.

Supplements alpha-1-antitrypsin in the body, helping slow down the destruction of lung tissue caused by a deficiency of it.

Headaches, muscle and joint pain, lower back pain. For patients with severe COPD or heart failure, worsening of shortness of breath may occur.

For patients with the deficiency disorder who have moderate to severe disease. Benefits are less clear for patients with normal lung function or with mild disease.

Antibiotics

Penicillin, tetracyclines, sulfa, cephalosporins, macrolides, fluoroquinolones. Taken as pills by people with respiratory infection or acute exacerbation.

Kills bacteria.

Stomach upset and diarrhea are the most common side effects.

Antibiotics treat only bacterial infections.

A patient's experience: Climbing higher

She was on vacation in Barcelona four years ago when Lois, 78, first realized that something was wrong. "I couldn't climb the hills," she recalls. "I got tired and out of breath whenever I tried."

There were other signs. She didn't have the stamina for her customary whirlwind afternoons of shopping. She would get winded and exhausted while walking around a shopping mall.

She went to the doctor, who diagnosed COPD. The diagnosis came as a surprise. Although she was once a heavy smoker, she'd quit nearly 40 years earlier and hadn't touched a cigarette since.

Her doctor prescribed two bronchodilators for her to take daily and told her to work out on a treadmill for 20 minutes a day, five days a week. Never much for exercise, Lois isn't thrilled with the treadmill, but she follows her doctor's orders. Her biggest incentive is that her workouts help her feel more energetic and less winded during her daily errands and activities.

Medication and regular exercise haven't restored Lois's life to normal. Her biggest disappointment is that she hasn't gotten back enough endurance for her favorite activity: marathon shopping. "I can't run around the mall like I used to," she says.

But she is encouraged by the improvement she sees in her capacity for short bursts of fairly strenuous activity. With the help of the medication and exercise, she has built up her stamina and lung capacity to the point that she can once again climb stairs. At the local college where she takes a course, there's a stairway with 21 steps. "I do 11 steps, then stop, then do the other 10," she says. "I know how to pace myself."