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Your health care provider will determine if you need medication to relieve symptoms of COPD.

Smoking cessation using nicotine replacement therapies

The supervised use of medications is an important adjunct to smoking cessation programs.

Nicotine is the ingredient in cigarettes primarily responsible for the addiction. Withdrawal from nicotine may cause you to have unpleasant side effects, such as anxiety, irritability, difficulty concentrating, anger, fatigue, drowsiness, depression, and sleep disruption. These effects usually occur during the first several weeks after you stop smoking.

Nicotine replacement therapies reduce these withdrawal symptoms. If you require your first cigarette within 30 minutes of waking up, you are most likely highly addicted and would benefit from nicotine replacement therapy.

Several nicotine replacement therapies are available.

Nicotine polacrilex is a chewing gum. Chewing pieces come in 2 strengths (ie, 2 mg, 4 mg). If you smoke 1 pack per day, you should use 4-mg pieces. If you smoke less than 1 pack per day, you should use 2-mg pieces. You should chew hourly and also chew when needed for any initial cravings within the first 2 weeks. You should gradually reduce the amount chewed over the next 3 months.

Transdermal nicotine patches are also available. Patches are well tolerated. The most common side effect is slight skin irritation where the patch is placed. Nicotine replacement therapy patches are sold under the following trade names: Nicoderm, Nicotrol, and Habitrol. Each product has a scheduled decrease in nicotine over 6-10 weeks.

The use of the antidepressant bupropion (Zyban) is effective. It is a nonnicotine aid to smoking cessation. Bupropion may also be effective for those people who have not been able to quit smoking with nicotine replacement therapies.

Inhaled steroids

Some people with COPD who respond well to oral corticosteroids can be maintained on long-term inhaled steroids.

The use of these drugs is widespread, despite little evidence of efficacy in the treatment of COPD. Inhaled corticosteroids do not slow the decline in lung function. They do, however, decrease the frequency of exacerbations and improve disease-specific and health-related quality of life issues for some people with COPD.

Inhaled corticosteroids have fewer side effects than oral steroids, but they are less effective than oral steroids, even at high doses.

Beta2 Agonists - Bronchodilators

Inhaled beta2-agonist bronchodilators relax and open the breathing passages. They work rapidly, typically within minutes.

Beta2 agonists are primarily used to relieve symptoms of COPD. Inhaled beta2 agonists are the treatment of choice for acute exacerbations of COPD.

Two long-acting beta2 agonists (ie, formoterol, salmeterol) are available. They may be useful if you frequently use short-acting beta2-bronchodilators or if you experience symptoms at night.

Anticholinergic agents - Bronchodilators

Maintenance treatment with aerosolized anticholinergic agents (eg, ipratropium bromide) may be more effective than beta2 agonists for people with COPD, particularly in relieving shortness of breath.

Ipratropium bromide opens the breathing passages and has minimal side effects.

It is administered by a metered-dose inhaler, at 2-4 puffs 4 times a day. Beta2 agonists can be added as needed.

Although it is slower to take effect (eg, 30-60 min) than inhaled beta2 agonists, ipratropium bromide lasts longer. Because of this, it is less suitable for use on an as-needed basis.

People undergoing exacerbations of COPD respond well to inhaled beta2-agonists and anticholinergic aerosols (eg, ipratropium bromide). Treatment usually begins with an inhaled beta2-agonist delivered via a spacer or a nebulizer, which creates a mist of the drug. Delivering the drug this way also reduces the side effects. Inhaled ipratropium bromide is also usually added.

Long-acting bronchodilators

Methylxanthines, such as theophylline, are a group of medications chemically related to caffeine. They work in COPD by opening the breathing passages. In addition, methylxanthines reduce inflammation, improve respiratory muscle function, and stimulate the brain respiratory center.

Adding theophylline to the combination of bronchodilators can be beneficial, although the response to theophylline may vary among people with COPD. Their use has decreased over the last decade because of the risks of unwanted side effects. Side effects include anxiety, tremors, insomnia, nausea, cardiac arrhythmia, and seizures.

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