Bronchodilator therapy

  • Despite being an irreversible airflow obstruction disorder, bronchodilators are still used in the treatment of COPD.
  • Different patients of bronchitis need different medications i.e. the treatment needs to be individualized depending on the   severity of the disease. One should always consult a qualified physician to get the right medicine or combination of medicines and to learn how to take them properly. A very mild attack may require only some inhaled bronchodilator (reliever) therapy whereas a severe attack merits hospitalization/nebulization and long term anti- inflammatory (preventer) therapy.
  • Most patients with COPD need 2 kinds of medicines:
    • A quick relief medicine (relievers) helps in bronchodilation (opening the airways) during mild bronchitis attacks. These medicines provide only instant relief and do not prevent recurrent attacks as they have no action on the underlying inflammation (swelling, secretions in the airways). They are to be taken on an SOS (as and when required) basis for symptomatic relief.

Always carry your “reliever” with you when you leave home.

    • A preventive medicine (preventers) is neededevery day to protect the lung in the long run. Preventer drugs do not provide any immediate relief in symptoms but prevent recurrent attacks (by reducing inflammation) when taken regularly by the patient. Most of these “preventers” have to be taken for more than 1 – 3 weeks regularly in the right dose (consult physician) for their effect to start . They do not provide any relief if taken on an SOS basis.

Always remember to take your “preventers” every day and carry them with you when leaving town.

Quick relief medicine Preventive medicine
  • These medicines give instant relief but act for 4 to 6 hours.
  • They relieve cough and breathlessness when there is an attack and do not prevent future attacks.
  • They act by dilating the airways but do not reduce the inflammation.

Examples are :

  • ß2 – agonist like Salbutamol, Terbutaline
  • Anticholinergics – Ipratropium bromide
  • Combinations of above
  • Side effects* include palpitations, tremors of hand, cramps, drying of mouth.
  • Preventers do not give immediate relief, but are to be taken regularly.
  • When they are used for a long time, they control asthma better and prevent any attack from taking place.
  • They act by reducing inflammation and prevent swelling of the airways.

Examples are :

  • Corticosteroids (Fluticasone, Budesonide, Triamcinolone, Beclomethasone)
  • Long acting Theophyllines
  • Sodium Cromoglycate
  • Side effects* include restlessness, vomiting, cramps, fungal infection (mouth). Oral steroids can result in an increase in blood sugar and blood pressure.

 NOTE :

Most of the side effects occur on long term unsupervised self treatment. Patients are advised to take all their drugs under the strict supervision of a doctor. Doctor is the best judge for any change in the medication and hence the patient is advised to consult his/her doctor in case of any side effects.

o    Inhaled steroids are potent anti inflammatory drugs and are the most preferred “preventers”.

  • There are two types of bronchodilator therapies available:
    • Inhalation therapy (e.g. salbutamol / salmeterol, ipratropium)
    • Oral therapy (e.g. salbutamol / salmeterol, theophylline)
  • Inhalation therapy:
    • Inhalation therapy is available with the following drugs :  – Beta2 agonists : both short and long-acting (salbutamol / salmeterol)  –  Anticholinergics (Ipratropium)
  • Inhalation therapy can be administered in the form of :
    • Dry powder inhalation (Rotahaler)
    • Metered dose inhalation (Inhalers)
    • Nebulization
  • Beta2 agonists: generally bring about a rapid relief in symptoms of tightness and breathlessness.
  • Short acting Beta2 agonists available are: salbutamol and albuterol, these are given in a dose of 2 puffs four times daily or as and when required.
  • Long acting Beta2 agonists are salmeterol and formoterol. These can be given in a daily dose of 2 puffs twice daily.
  • Anticholinergic drugs (ipratropium) also help in the dilatation of the airways and reducing the amount of secretions being formed in the airways, but can cause side effects like dryness of mouth and tremors in hand and feet. It may cause retention of urine in elderly patients with co-existent prostate gland enlargement.
  • Oral theophylline also brings about a widening of the airways in COPD patients. Theophylline has the advantages of :
    • Oral administration.
    • Long acting drug (better compliance).
    • Increases the diameter of airways.
    • Increases the efficiency of chest muscles involved in the process of breathing.
    • Increases the efficiency of contraction of heart muscles, thereby improving on the action of blood pumping.
    • Theophylline is available in tablet, capsule and syrup form in the strength of 125mg, 200 mg, 400 mg, 600mg and thus can be given as twice daily or once daily administration depending on the dose.