Chronic Obstructive Pulmonary Disease (COPD) (cont.)
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A health care professional will determine if a patient needs 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 a person 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 a person stops 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 two strengths (ie, 2 mg, 4 mg). If a person smokes one pack per day, they should use 4-mg pieces. If a person smokes less than one pack per day, they should use 2-mg pieces. Individuals should chew hourly and also chew when needed for any initial cravings within the first 2 weeks. Patients should gradually reduce the amount chewed over the next 3 months.
Transdermal nicotine patches are also available, and are well tolerated. The most common side effect is slight skin irritation where the patch is placed. Examples of brand name nicotine replacement therapy patches are Nicoderm, Nicoderm C-Q, Nicoderm C-Q Clear, Nicotine System Kit, and Habitrol. Each product has a scheduled decrease in nicotine over 6 to 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.
A newer class of drugs, involves simulating the nicotine receptors but less so than nicotine, for example, varenicline (Chantix). Studies have indicated that this drug may be more effective than bupropion. As with all drugs, this drug may have many adverse side effects. However, cigarette smoking still remains much worse, especially if COPD is present
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.
Several long-acting beta2 agonists (ie, formoterol, salmeterol [Advair Discus, Advair HFA, Serevent Diskus], indacaterol [Arcapta Neohaler]) are available. They may be useful if the patient frequently uses short-acting beta2-bronchodilators or if they experience symptoms at night.
Anticholinergic Agents - Bronchodilators
Maintenance treatment with aerosolized anticholinergic agents (for example, ipratropium [Combivent, DuoNeb, Atravent HFA, Atrovent Nasal]) 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.
Anticholinergics also dilate airways but through a different receptor than the beta2 agoinists. It is administered by a nebulizer, powder, or metered-dose inhaler. The frequency depends on the agent being used. Beta2 agonists can be added as needed.
People undergoing exacerbations of COPD respond well to inhaled beta2-agonists and anticholinergic aerosols.
Methylxanthines, such as theophylline (Elixophyllin, Theo-24, TheoCap, Theochron, Theo-Time, Uniphyl), 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 arrhythmias, and seizures.
Medically Reviewed by a Doctor on 3/23/2015
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