Medication and Devices for Chronic Obstructive Pulmonary Disease (COPD)

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1 Medication and Devices for Chronic Obstructive Pulmonary Disease (COPD) Patients with COPD take a wide variety of medicines to manage their symptoms these include: Inhaled Short Acting Bronchodilators Short-acting bronchodilators are called "quick-acting," or "reliever," medicines. These bronchodilators relieve symptoms very quickly by opening the airways. The reliever medicines are best for treating sudden symptoms. The action of inhaled bronchodilators starts within minutes after inhalation and peaks around 10 to 15 minutes; one dose will last for up to 6 hours. Short acting bronchodilators can also used 15 to 20 minutes before any activity to help prevent breathlessness. Short Acting Bronchodilators include o Salbutamol (Ventolin) o Terbutaline (Bricanyl) Inhaled Long Acting Bronchodilators These drugs act in a similar way to the short acting bronchodilators to relax the muscles around your airways but they work for longer. This means they only need to be used once or twice a day. These drugs are prescribed to give you relief throughout the day and should be used regularly. Some work as quickly as the short acting drugs and so should not be used if you need immediate relief from your breathlessness. Long Acting Bronchodilators include o Tiotropium (Spiriva / Respimat) used once a day Both short and long acting bronchodilators can be taken on the same day. 1

2 Inhaled Corticosteroids These drugs reduce the inflammation in your airways but will not improve your lung function. Inhaled corticosteroids are usually used when people are having two or more chest infections a year that need to be treated with antibiotics and oral corticosteroids. You will still need to take your inhalers when given steroid tablets. Since patients often need to take both long acting bronchodilators and inhaled corticosteroids, inhalers are available which contain both of these drugs in one inhaler. Steroid inhalers cannot be used for rapid relief of breathlessness and should be taken after your inhaled bronchodilator. You may be receiving one of these: o Fostair Whenever you use any inhaler containing an inhaled corticosteroid you should use it via a spacer if possible and always rinse, gargle and spit with water or mouthwash after using the inhaler. This helps to reduce the chance of you suffering form oral thrush which can be a side effect of using inhaled corticosteroids. There is more information below on how to use and care for your spacer. Theophyllines These are tablets that you can take to help open up your airways and include: o Neulin o Slo-phyllin o Uniphyllin o Phyllcontin If you are on one of these drugs you will need to have blood tests to monitor the level of drug in your blood; your nurse / GP will discuss how often you are likely to be tested. This is because the level has to be just right to make sure the drug is working but also to avoid you getting any side effects. 2

3 Oral Corticosteroids These are used to help treat chest exacerbations (a worsening in symptoms); like inhaled corticosteroids they reduce the inflammation in your airways. The oral corticosteroid you may receive is called Prednisolone. Oral corticosteroids are associated with side effects and so are used for the shortest period of time possible or at the lowest effective dose. When they are used to treat an exacerbation although the dose is fairly high they are only used for 7 to 14 days and are then stopped. Whilst they are not generally prescribed to be taken every day if your doctor has decided that this is necessary then they will be kept at the lowest dose possible. One of the side effects oral corticosteroids can cause is osteoporosis and so you may also be prescribed calcium and vitamin D tablets to help protect your bones. This usually happens if you are on corticosteroids long term or if you need a number of courses due to lots of exacerbations. These tablets will not strengthen your muscles. You should also carry a steroid card which will inform NHS staff of your usage. You should take your corticosteroid tablets in the morning, ideally just after breakfast and if you are taking the enteric coated tablets you should avoid taking indigestion remedies at the same time. A common side effect from using steroid tablets is indigestion and can increase your appetite. Antibiotic treatment in COPD Antibiotics are used to clear chest infections; although not all antibiotics will clear chest infections it is important if you are producing sputum, to give a sputum sample to your surgery nurse / /GP for testing. Excessive use of antibiotics can cause resistant bacteria (germs). Not all exacerbations are treated with antibiotics and you should seek advice from your GP if the treatment causes severe diarrhoea. It is important that you complete your course of antibiotics so you gain the full benefit. Mucolytics These are drugs that are prescribed to help you cough up your sputum more easily. They make the sputum less sticky and so it is easier to cough up, they include: o Carbocisteine (Mucodyne) o Mecysteine (Visclair) These drugs do not work for everyone. You should have been tried on them for a month to see if they helped you or not. If they didn t work then your doctor should have stopped prescribing them, however if they are helpful 3

4 your doctor may continue to prescribe them and you should continue to take them. Spacer Devices Spacer devices are prescribed to make it easier for you if you use a metered dose inhaler (MDI) They reduce the need to co-ordinate pressing down the inhaler and breathing in, examples include o Volumatic o Aerochamber They reduce the need to co-ordinate pressing down the inhaler and breathing in. Using a spacer will increase the amount of drug deposited in the lungs. 4

5 The following information explains how to use your spacer and metered dose inhaler: Shake your inhaler Attach the inhaler to the spacer Put the mouthpiece of the spacer in your mouth Press the inhaler down to put one dose into the spacer Breathe in and slowly as you usually would four or five times. Try not to hold your breath when you are doing this If you are going to have a second dose take the inhaler out of the spacer, shake it again and repeat the steps above The spacer should be cleaned once a month. You should wash it in a bowl of soapy water, rinsed with fresh water and then allow it to air dry on the draining board overnight. Do not dry with a towel. The mouthpiece should then be rinsed with clean water clean before use. You should not rub the spacer with a cloth to dry it, as this will cause static inside the spacer, and the next time you use it the drug you put in will stick to the insides of the spacer rather than going into you lungs. You should replace your spacer every 6 to 12 months because over time the pieces do not fit together quite as tightly as they did when the spacer was new. Oxygen If the level of oxygen in your blood is too low when you are resting, or if the level drops when you are active, you might need oxygen treatment. This is used to increase the amount of oxygen that flows into your lungs and bloodstream. There are two types of oxygen treatment that are suitable for people with COPD: Long term oxygen therapy: if the level of oxygen in your blood falls below a certain amount when you are resting, you might need to use an oxygen machine for hours each day. The tubes from the machine are long so you can move around your home, and portable oxygen tanks are available if you are away from home. Ambulatory oxygen: if your oxygen levels drop when you are active, you might be given ambulatory oxygen. This is a small, portable oxygen cylinder, which can help reduce breathlessness when you are out and about or exercising. You should be given a full assessment by your health care professional before using either of these types of oxygen treatment. 5

6 Rescue Packs Have a discussion with your GP or nurse and suggest if you can have a rescue pack. This is a course of antibiotics and steroids that can be stored at home for when you start with a chest infection and you can self-manage yourself at home. If you bring up phlegm and it has changed colour, increased volume and is thicker than usual. Then make sure that you have some sample pots readily available then you can hand in your sample to your surgery, and it can be tested so your GP knows that you are on the correct antibiotics. Please let you GP know when you have started a course of antibiotics and steroids. 6