Chronic Obstructive Pulmonary Disease (COPD) (cont.)

When airway inflammation (which causes swelling) contributes to airflow obstruction, antiinflammatory medications (more specifically, corticosteroids) may be beneficial. Examples of corticosteroids include prednisone and prednisolone (Pediapred Oral Liquid, Medrol). Twenty to thirty percent of patients with COPD show improvement in lung function when given corticosteroids by mouth.

Unfortunately, high doses of oral corticosteroids over prolonged periods can have serious side effects including:

• osteoporosis,
• bone fractures,
• diabetes mellitus,
• high blood pressure,
• thinning of the skin and easy bruising,
• insomnia,
• emotional changes, and
• weight gain.

Therefore, many doctors use oral corticosteroids as the treatment of last resort. When oral corticosteroids are used, they are prescribed at the lowest possible doses for the shortest period of time to minimize side effects. When it is necessary to use long term oral steroids, medications are often prescribed to help reduce the development of the above side effects.

Corticosteroids also can be inhaled. Inhaled corticosteroids have many fewer side effects than long term oral corticosteroids.

Examples of inhaled corticosteroids include:

• beclomethasone dipropionate (Beclovent, Qvar, and Vanceril),
• triamcinolone acetonide (Azmacort),
• fluticasone (Flovent),
• budesonide (Pulmicort),
• mometasone furoate (Asmanex), and
• flunisolide (Aerobid).

Inhaled corticosteroids have been useful in treating patients with asthma, but in patients with COPD, it is not clear whether inhaled corticosteroids have the same benefit as oral corticosteroids. Nevertheless, doctors are less concerned about using inhaled corticosteroids because of their safety. The side effects of inhaled corticosteroids include hoarseness, loss of voice, and oral yeast infections.

To decrease the deposition of medications on the throat and increase the amount reaching the airways, spacers can be helpful. Spacers are tube-like chambers attached to the outlet of the MDI canister. Spacer devices can hold the released medications long enough for patients to inhale them slowly and deeply into the lungs. A spacing device placed between the mouth and the MDI can improve medication delivery and reduce the side effects on the mouth and throat.Rinsing out the mouth after use of a steroid inhaler also can decrease these side effects. It is less clear whether spacing devices help with deposition or side effects of other inhaled medications.

Advair, a powered inhaler device, contains both salmeterol (a long acting beta-agonist) and fluticasone (an inhaled steroid). This medication has shown to be effective in COPD patients with chronic bronchitis. Its major side effects include the possible development of thrush (oral candidiasis) and hoarseness. Another combination medication available in an MID device is budesonide and formoterol (Symbicort).

Source: MedicineNet.com
http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/article.htm