COPD: Sorting out misconceptions and medication mismanagement

“It’s like breathing through a straw.”

“Most days, I feel like a fish out of water gasping for air.”

“It takes me three times longer to accomplish everything due to shortness of breath and lack of stamina.”

Dr. William Abraham Board-Certified, Internal Medicine TMC One

Dr. William Abraham
Board-Certified, Internal Medicine

That’s how some patients with chronic obstructive pulmonary disease, or COPD, describe life with their condition. It’s one of the most common lung diseases and it makes it difficult to breathe. According to the COPD Foundation, more than 24 million Americans, including more than 343,000 Arizonans, have been diagnosed with it. There are two main forms of COPD: chronic bronchitis, which involves a long-term cough with mucus, and emphysema, which involves damage to the lungs over time. Most people with COPD have a combination of both conditions.

Smoking is the main cause of COPD, but in rare cases, nonsmokers can develop emphysema. Other risk factors for COPD include exposure to certain gases or fumes in the workplace, exposure to heavy amounts of secondhand smoke and pollution, or frequent use of cooking fire without proper ventilation.

Symptoms include a cough, with or without mucus, fatigue, many respiratory infections, shortness of breath that gets worse with mild activity, wheezing and trouble catching one’s breath. There is no cure for COPD, but there are many things you can do to relieve symptoms and keep the disease from getting worse.

Medicines used to treat COPD include inhalers (bronchodilators) to help open the airways, inhaled or oral steroids to reduce lung inflammation, and anti-inflammatory drugs to reduce swelling in the airways. But there are a lot of common misuses with these medications.

Dr. William Abraham is a board-certified internal medicine physician with TMC One who has more than 30 years of experience. He sorted out some of the misinformation about popular medications in hopes of getting you to breathe easier.

Rescue inhalers: When are you puffing “too much”?

Short-acting bronchodilators or “rescue inhalers” are commonly used when a patient becomes short of breath. These are usually albuterol, under the brand names of ProAir HFA, Proventil HFA and Ventolin HFA. The liquid form may also be put in a nebulizer. They are designed to bring quick relief and work by relieving spasms in the airways or bronchial tubes. For inhalers, doctors usually prescribe two puffs every four to six hours as needed for shortness of breath or wheezing. While these medications provide instant relief, it’s important to keep in mind that they can also affect the heart and cause an irregular or a racing heartbeat. Using a rescue inhaler as it’s prescribed tends to only help the lungs although it’s not uncommon for some patients to notice their heart beat just a bit faster.

With COPD patients, the problem develops when they are short of breath and their condition is quickly becoming so severe that they start using their rescue inhaler significantly more than is prescribed – sometimes every 5 to 10 minutes! These medications can become quite dangerous and induce potentially fatal, irregular heart rhythms.

Bottom line: Never use a rescue inhaler more than every four hours.

▪ Maintenance inhalers: Do they really need to be used every day?

Many patients with COPD also have long-acting bronchodilator and corticosteroid combination inhalers prescribed for them. The common brand names for these are Advair, Symbicort and Dulera. Unlike rescue inhalers, which provide instant relief, these medications become effective only when used over a long period of time. For example, the corticosteroid component must be taken for seven days in order to become completely effective! When used correctly, these inhalers can prevent severe wheezing and shortness-of-breath attacks or episodes when there is a lot more mucus produced than usual.

As a result, patients can absolutely feel the effects of these long-acting bronchodilator and corticosteroid combination inhalers. Since they find themselves needing their rescue inhaler less often, doctors say these maintenance inhalers have a good compliance rate.

Problems develop, however, when patients use their long-acting, combination inhalers once a day instead of the recommended twice a day in an attempt to save money. Keep in mind, the bronchodilator component is only effective for 12 hours. If you’re using one of these maintenance inhalers only once a day, that means that for half your day, your lung function will be significantly decreased while the medication is no longer active. Or, patients may only start using their long-acting, combination inhaler when they begin to feel sick and their breathing starts to suffer. By then, it’s too late in the game to be able to experience any real benefit.

Bottom line: All of these maintenance inhalers should be used every 12 hours every day in order to receive the maximum benefits of these medications.

▪ I was recently diagnosed with COPD. Realistically, what’s my quality of life going to be and is there anything I can do to slow down the progression of the disease?

Oftentimes, newly diagnosed COPD patients believe that they will gradually lose more and more lung function over the years. These patients also often think that how quickly they’ll decline is predetermined by aging and severity of the disease. A common misconception is that, eventually, their lung function will become so poor that simple breathing will become impossible. Realistically, however, there are many factors that determine how quickly someone’s lung function will deteriorate.

There are things COPD patients can do to preserve their lung function for as long as possible. Perhaps the most important: quit smoking. Studies show that patients with COPD who continue to actively smoke will have their lung function decline about twice as fast as patients who quit smoking. Regardless if you are diagnosed with mild, moderate or severe COPD, it is never too late to quit smoking. Even if your lung function is tempered by the disease, making it the best it can be will translate to a stronger ability to be active, and therefore, have a better quality of life.

Bottom line: Even if you have been diagnosed with COPD, it is never too late to quit smoking.

Dr. Abraham is available for same-day appointments including annual physicals
if you are finding it difficult to get in to your regular provider.
His office is located at 1396 N. Wilmot Road in Tucson, 85712.
Call (520) 324-2160 to make an appointment.

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Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461
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