In general, non pharmacological interventions (smoking cessation, pulmonary rehabilitation) are just as important as drug treatments for COPD.
Medications help some, but not all, patients with COPD. Trial regular treatment for at least one month, or longer for inhaled steroids, and assess response . No content in this box Discontinue if not beneficial. Ensure that patient education and inhaler technique is adequate.
Using your inhaler - how to videos
Assess treatment response:
Trial in the following order
Short acting bronchodilators:
These may improve symptoms and exercise tolerance, and reduce the number of exacerbations.
Duolin HFA , the combined salbutamol / ipratropium inhaler, replaces Combivent from February 2011. The majority of patients can be continued on beta agonist alone for their reliever. If side effects of high use of beta agonists are an issue (tremor, palpitations, hypertension), consider addition of ipratropium inhaler. However, such a patient, if severe enough, might also benefit from long-acting bronchodilators. Recent evidence suggests there may be dangers of LABA use alone in asthma but not in COPD . Conjunct use of steroid inhaler is recommended with LABA in Asthma.
Long acting bronchodilators:
Note: There is possibly an increased risk of pneumonia while on high dose inhaled steroids.
Only 25% of COPD patients will obtain significant benefit from inhaled corticosteroids.
Theophylline preparations may be of benefit for some selected patients, but are not commonly used.
Palliative medications for end stage disease, ie, morphine elixir.
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