Treatment Options for COPD Are Limited But Can Be Effective

Howard LeWine, M.D.

Q: I have COPD. My doctor tells me that my main problem is chronic bronchitis, but I also have some mild emphysema. I quit smoking 4 years ago. I'm on three different inhalers. I don't seem to be getting any better. I wonder if giving up cigarettes was worth it. What do you think?

A: Most people with chronic obstructive pulmonary disease (COPD) have a combination of chronic bronchitis and emphysema.

And like you, they often share your frustration. But don't go back to smoking. That is the one thing you can do to prevent your COPD from getting worse.

Other than not smoking, treatment options for COPD are limited. And those that do work only help decrease symptoms. They can't reverse the lung damage that's already occurred.

On a more positive note, inhaled medicines can decrease your coughing and shortness of breath. Also they help to reduce how often COPD flare-ups occur. Doctors call these COPD exacerbations.

The inhaled drugs most commonly used are:

--Long-acting beta agonists, such as salmeterol (Serevent) and formoterol. These drugs help keep airways open.

--Anti-cholinergic agents, such as ipratropium (Atrovent) and tiotropium (Spiriva). These drugs also help keep airways open. Some experts believe they are slightly more effective than long-acting beta agonists for COPD.

--Corticosteroids, such fluticasone (Flovent), budesonide and many others. Inhaled corticosteroids decrease inflammation in the airways.

Many people with COPD use an inhaler that combines a long-acting beta agonist to open the airways and a corticosteroid. Two examples are Advair and Symbicort.

There is some controversy about which inhalers are the most effective in reducing symptoms and number of flare-ups of COPD. In this month's issue of the journal Chest, researchers reported results of a study examining the question: "Do people have fewer flare-ups of COPD if they use an inhaled corticosteroid daily?"

The question is important because people with COPD who inhale corticosteroids daily have a higher risk of pneumonia than those who don't use them. The researchers' findings suggest that inhaled corticosteroids for the average person with COPD do not prevent flare-ups.

However, don't stop any of your inhalers without discussing it with your doctor. Since you main problem is chronic bronchitis, you may be getting more benefit than you realize.

Howard LeWine, M.D. is a practicing internist at Brigham and Women's Hospital in Boston and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.

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