Typically, symptoms of wheeze and breathlessness improve within minutes with a beta-agonist inhaler, and within minutes with an antimuscarinic inhaler. The effect from both types typically lasts for hours. Some people with mild or intermittent symptoms only need an inhaler as required for when breathlessness or wheeze occurs. Some people need to use an inhaler regularly. The beta-agonist and antimuscarinic inhalers work in different ways. Using two, one of each type, may help some people better than one type alone.
These work in a similar way to the short-acting inhalers but each dose lasts at least 12 hours. Long-acting bronchodilators may be an option if symptoms remain troublesome despite taking a short-acting bronchodilator. Often regular inhaled medication long acting bronchodilators and steroids can be given in combination in a single inhaler.
They recommend that for most people needing combination inhalers, a combination of two long-acting bronchodilators - a beta agonist and an antimuscarinic inhaler - should be offered.
People who should be offered a combination of long-acting beta agonist and antimuscarinic treatment include all patients who have confirmed COPD and who:.
In the past, most patients with COPD needing combination treatment have been given a combination of long-acting bronchodilator and inhaled steroid. The new NICE guideline recommends that this combination should only be considered for patients who have features suggestive of possible asthma. A steroid inhaler may help in addition to a bronchodilator inhaler if you have more severe COPD or regular flare-ups exacerbations of symptoms. Steroids reduce inflammation.
Steroid inhalers are only used in combination with a long-acting beta-agonist inhaler this can be with two separate inhalers or with a single inhaler containing two medicines. The main inhaled steroid medications used for COPD are:. A steroid inhaler may not have much effect on your usual symptoms but may help to prevent flare-ups. So, steroid inhalers are often referred to as preventers. Combination inhalers are available, usually containing a steroid medication and either a short-acting or a long-acting beta-agonist.
Examples of combination inhalers are:. Combination inhalers are useful if people have severe symptoms or frequent flare-ups. Sometimes it is more convenient to use just one inhaler device.
A standard MDI is shown on the right. The MDI has been used for over 40 years and is used to deliver various types and brands of medicines.
It contains a pressurised inactive gas that propels a dose of medicine in each 'puff'. Each dose is released by pressing the top of the inhaler. This type of inhaler is quick to use, small and convenient to carry. It needs good co-ordination to press the canister and breathe in fully at the same time. Sometimes these are known as evohalers. The standard MDI is the most widely used inhaler. However, many people do not use it to its best effect.
Errors include:. However, CFCs damage the Earth's ozone layer, and so are being phased out. The newer CFC-free inhalers work just as well but use a propellant gas that does not damage the ozone layer. These are alternatives to the standard MDI. Some are still pressurised MDIs but don't require you to press a canister on top. When you press on the canister, a chemical propellant pushes a puff of medicine into your lungs.
With an MDI, you have to time your breathing with the release of the medicine. If you have trouble doing this, you can use a device called a spacer. A spacer can help coordinate your inhaled breath with the release of the medicine.
Pros: MDIs are easy to use and can be used with many different types of COPD drugs, including steroids, bronchodilators, and combination medicines. You also get the same dose of medicine each time you use them. Cons: MDIs require you to coordinate between activating the medicine and breathing it in.
You may also need to use a spacer to get the medicine into your lungs. A dry powder inhaler DPI delivers medicine to your lungs when you breathe in through the device. Instead, your inward breath activates the medicine. DPIs come in single-dose and multiple-dose devices. Multiple-dose devices contain up to doses. Cons: On the other hand, you have to breathe in harder than you would with an MDI. This type of inhaler can also be affected by humidity and other environmental factors.
The soft mist inhaler SMI is a newer type of device. It creates a cloud of medicine that you inhale without the help of a propellant. Because the mist contains more particles than MDIs and DPIs and the spray leaves the inhaler more slowly, more of the drug gets into your lungs. Ask your provider 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 provider right away. For all these medicines, some generic brands have just become or will become available in the near future, thus different names might also exist. Institute for Clinical Systems Improvement website.
Updated January Accessed January 23, COPD: clinical diagnosis and management. Murray and Nadel's Textbook of Respiratory Medicine. Philadelphia, PA: Elsevier Saunders; chap If your blood oxygen levels are normal while you're resting but fall when you exercise, you may be able to have ambulatory oxygen therapy rather than long-term oxygen therapy.
If you're taken to hospital because of a bad flare-up, you may have a treatment called non-invasive ventilation NIV. This is where a portable machine connected to a mask that covers your nose or face is used to support your lungs and make breathing easier. Surgery is usually only suitable for a small number of people with severe COPD whose symptoms are not controlled with medicine.
These are major operations done under general anaesthetic , where you're asleep, and involve significant risks. If your doctors feel surgery is an option for you, speak to them about what the procedure involves and what the benefits and risks are. Page last reviewed: 20 September Next review due: 20 September Treatments include: stopping smoking — if you have COPD and you smoke, this is the most important thing you can do inhalers and tablets — to help make breathing easier pulmonary rehabilitation — a specialised programme of exercise and education surgery or a lung transplant — although this is only an option for a very small number of people A doctor will discuss the various treatment options with you.
The main types include: Short-acting bronchodilator inhalers For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. There are 2 types of short-acting bronchodilator inhaler: beta-2 agonist inhalers — such as salbutamol and terbutaline antimuscarinic inhalers — such as ipratropium Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day. Long-acting bronchodilator inhalers If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended.
There are 2 types of long-acting bronchodilator inhaler: beta-2 agonist inhalers — such as salmeterol, formoterol and indacaterol antimuscarinic inhalers — such as tiotropium, glycopyronium and aclidinium Some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic.
Steroid inhalers If you're still becoming breathless when using a long-acting inhaler, or you have frequent flare-ups exacerbations , a GP may suggest including a steroid inhaler as part of your treatment.
Tablets If your symptoms are not controlled with inhalers, a doctor may recommend taking tablets or capsules as well. Theophylline tablets Theophylline is a type of bronchodilator. Possible side effects include: feeling and being sick headaches difficulty sleeping insomnia noticeable pounding, fluttering or irregular heartbeats palpitations Sometimes a similar medicine called aminophylline is also used.
Mucolytics If you have a persistent chesty cough with lots of thick phlegm, the doctor may recommend taking a mucolytic medicine called carbocisteine. Steroid tablets If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.
A 5-day course of treatment is usually recommended, as long-term use of steroid tablets can cause troublesome side effects such as: weight gain mood swings weakened bones osteoporosis Your doctor may give you a supply of steroid tablets to keep at home to take as soon as you experience a bad flare-up.
Pulmonary rehabilitation Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD. A typical programme includes: physical exercise training tailored to your needs and ability — such as walking, cycling and strength exercises education about your condition for you and your family dietary advice psychological and emotional support The programmes are provided by a number of different healthcare professionals, including physiotherapists , nurse specialists and dietitians.
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