TREATMENTS FOR COPD
PLEASE GET YOUR VACCINATION AGAINST INFLUENZA - IN THE AUTUMN.
I will explain the terms and treatments recognised by NICE(the National Institute for Clinical Excellence), and the medications that I take and then it is up to you if you wish to review your medications with your GP or consultant.Treatments will depend on whether you have mild, moderate or severe COPD ( or emphysema). Oxygen (link!) may be regarded as a treatment but I have dealt with that separately on another page. You may find that you have side effects from certain medicines and those you must discuss with your GP.
Lung damage from smoking is irreversible, which means that no treatment will, as yet, replace all that damaged tissue. Before you throw your hands in the air and say “well that’s it then, there’s no point in stopping smoking and I might as well throw myself off the nearest cliff.” there certainly is something you can do.
Firstly you need to slow down the progression of the disease. Every year all healthy people lose a little lung power or put in medical terms a loss in FEV1. [Forced Expiratory Volume]. Patients with COPD who no longer smoke lose the same amount as people who have never smoked BUT if they continue to smoke (and 40% or so do) the rate of loss is TWICEas fast as patients who stop smoking. That means, putting it bluntly, that if you have severe COPD and continue to smoke, you will probably die, for example, within 6 years instead of 12. This statement is not meant to be a forecast, but just figures to illustrate my point! The first real and only effective treatment for COPD is therefore to STOP SMOKING – see link.
You must also have an annual vaccination for influenza and it is recommended that you consider a vaccination for the most common types of pneumonia.
And what about breathlessness?
There are certainly treatments to make breathing easier. There are also breathing techniques you can be taught on an Expert Patients Course or in Pulmonary Rehabilitation, and there is oxygen. But on this page I am going to deal with BRONCHODILATORS first.
What are bronchodilators?
Basically these are medicines delivered by inhalers which are pictured below. There are a number of types and some are called Turbohalers or Aurohalers powder and are and others deliver a spray. Both powders and sprays are drawn into your lungs, which require some effort on your part. You will be taught how to use them and it is important to learn and practise the techniques. If you are still having breathing difficulties you may be given a NEBULISERwhich delivers greater quantities of the drugs by pushing it into your lungs. However, there is some debate about its use. Besides being an expensive treatment, it may be no more effective than taking multi-bursts from your inhaler. However, if you have been hospitalised a few times or have suffered a number of exacerbations it might be appropriate for you.
DO NOT USE YOUR RESCUE INHALER ( BRICANYL, VENTOLIN etc) IMMEDIATELY AFTER EXERCISING. USE IT BEFORE OR WHEN YOU STOP FOR A WHILE. OTHERWISE YOU WILL NOT INHALE DEEPLY ENOUGH FOR THE LUNGS TO BENEFIT FROM THE MEDICINE. ALWAYS TRY TO HOLD YOUR BREATH FOR A FEW SECONDS TO ALLOW THE MEDICATION TO SETTLE IN THE LUNGS. IT IS NOT NECESSARY TO INHALE MORE THAN TWICE FROM ONE DOSE. SOME ELDERLY FOLK MIGHT FIND IT DIFFICULT TO USE AN INHALER - PLEASE SEE YOUR GP PRACTICE NURSE. ALSO IF YOU ARE HARD OF HEARING YOU MAY NOT HEAR THE CLICK OF THE POWDER INHALERS.
What type of medicines or drugs are delivered by inhalers?
The following is a description of the drugs I take and why. This does not however mean they might be suitable for you!!! Remember that I have severe COPD and you may never need all these.
I take SPIRIVA(otherwise known as Tiotropium) – this has recently been developed and established to be the drug of choice especially for those patients with moderate to severe COPD. It causes a slight but measurable improvement in your FEV1, health status and breathing. You breathe it in deeply (in powder form) from a special container into which you insert a capsule. You press a button which pierces the capsule and then breathe in deeply and hold your breath a little. And the beauty of it is that you only have to do this once a day. The drug is known as a long acting bronchodilator and is also called an ANTICHOLINERGIC. Some patients take IPRATROPIUM instead and the difference is ipratropium only lasts between 3 and 6 hours and is prescribed to be inhaled four times a day.
I also take short acting bronchodilators known as Beta2-agnonists! Don’t worry about these medical terms! These affect your lungs differently that’s all and help your breathing. Some patients may get buy with just these with the milder form of the disease and not have to take Spiriva (see above). I used to take just Ventolin or Salbutamolwhen I felt breathless – this came as spray and you can see many asthma patients take it from a blue tube. However just to confuse you I now take Bricanylwhich is a combination drug which I find more effective. However, it is more expensive and some GPs may be reluctant to offer it depending upon the severity of the disease and your reaction to Ventolin or similar.It comes in powder form and when I breathe in deeply less of it ends up on the back of my throat. And for the enthusiasts amongst you this combination drug contains terbutaline sulphate (doesn’t mean anything to me either!). Any way, whichever of these short acting Beta2-agonists you use, you take them when you feel more breathless up to a limit set by your GP. They are also known as RELIEVERS or RESCUE MEDICINES. Not everybody gets on with say Bricanylso they just take Ventolin instead or vice versa. Always discuss any side effects with your GP. It is important whichever inhaler you use to breathe it in as deeply as possible and to hold your breath ideally for 5 seconds or so.If you have difficulties you may be offered a SPACER which is a small chamber to hold the spray and you will have more time to breathe it in. With a powder inhaler there are aids for people with arthritis to make the inhaler easier to use.
Most patients with medium to severe COPDtake some form of inhaled steroids. No, don’t scream – they are not the same as those taken by some dumb athletes or body builders!! Your GP may refer to these inhaled steroids as CORTICOSTEROIDS. NICE(remember - see above) recommended in 2004 that all patients should take them if their FEV1 is less than 50%. It also recommends that these inhaled steroids be taken with long acting bronchodilators. But some patients have side effects with these combination drugs so report any side effects that are still present after a week or two. I use SYMBICORT(delivered by fine powder), twice a day, which contains budesonide (the steroid) and formoterol (a long acting Beta 2 agonist).
This picture shows the drugs I take.
Well if you’ve followed all this you’ve done very well.Otherwise just pass on the page to your GP or rely on their judgement! In summary I take SPIRIVA, BRICANYL AND SYMBICORT.But a friend of mine who has Severe COPD (emphysema) doesn’tbecause she had some side effects using the last two so she just uses the corticosteroid FLIXOTIDE,[fluticasone propionate], SPIRIVA and VENTOLIN. It’s up to you to discuss these medicines and YOUR side effects with your GP. If you have a lot of sticky phlegm you may be offered mucolytics to reduce it.
What about surgery?
Well this is a tricky subject. If you are a young patient with severe COPDand not long to live - say for example in your 40s then you might be offered a lung transplant. But I don't think I will. In any case you will only be offered it if you have only a few months to live, and the rest of your body is in reasonable shape! If you are over 65, I'm afraid it is very rarely an option.
You might be eligible for what is called "volume reduction surgery".If your disease is confined to only part of your lungs, then surgery might remove this diseased part so allowing the remaining lungs perform better. I am not eligible because my disease is spread evenly throughout my lungs. Talk it over with your consultant not your GP.
OTHERWISE
Some patients who are retainers of CO2 (carbon dioxide) may be offered Non-Invasive Ventilation machines to use at night. I have one and will be shortly adding a page about these machines.
THERE ARE RESEARCH TRIALS THAT INVOLVE MILD SURGERY - SEE PROFESSIONAL SECTION.