COPD, or chronic obstructive pulmonary disease, is a lung disease characterized by chronic obstruction of lung airflow. Dilating the airways with inhaled or oral medications helps to improve symptoms and improve overall oxygenation. The main treatments include inhaled short- and long-acting beta-2 agonists, inhaled short- and long-acting anti-cholinergics, or oral theophylline.
Albuterol
Albuterol is an inhaled short-acting beta-2 agonist that dilates the airways. Side effects include tachycardia or elevated heart rate, tremor, and lowered potassium.
Xopenex
Xopenex is an inhaled short-acting beta-2 agonist. It is a chemically purified form of albuterol that only includes one of the two types of albuterol. It is thought to have less tachycardia and tremor, and, therefore, a better side effect profile; however, this is debatable. The cost is higher than albuterol for the patient.
Ipratropium Bromide
Ipratropium bromide is an inhaled anti-cholinergic medication that is the preferred treatment for bronchodilation in the COPD patient. It is typically given every 6 hours. There are less side effects than with the short-acting beta-2 agonists.
Formoterol and Salmeterol
Formoterol and salmeterol are long-acting beta-2 agonists that are used for bronchodilation. For short-term use they may be as effective or more effective than ipratropium. Side effects tend to be dose-related, according to Dr. T. Welte of Respiratory Medicine at the Hannover Medical School in Germany.
Tiotropium
Tiotropium is a long-acting anticholinergic that may produce equivalent or superior bronchodilation to ipratropium. There is less research into tiotropium and it currently costs more than ipratropium.
Theophylline
Theophylline is a third-line agent for COPD patients who fail to get adequate symptom control with anticholinergics and beta-2 agonists. It is an older generation medication that has more side effects and is difficult to dose to keep below toxic levels. It does work very well when it is used.
References
- "Lippincott's Illustrated Reviews: Pharmacology (3rd ed)"; Dr. Richard Howland, Dr. Mary Mycek; 2006
- "Current Medical Diagnosis and Treatment"; Dr. Steven McPhee, Dr. Maxine Papadakis; 2007
- "International Journal of Clinical Practice": Optimising treatment for COPD--new strategies for combination therapy
