Ask the Pharmacist
by Ron & Marla Chapleau

March 7, 2016


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Q)  I have just been told that I have COPD. What exactly does that mean and how is it treated?

A)  COPD is the acronym for Chronic Obstructive Pulmonary Disease, in other words it is a lung condition that results in a blocked airflow from the lungs.

This obstruction leads to difficulty breathing, coughing, wheezing and increased sputum production (phlegm). Often people initially complain of shortness of breath and limitations in activities.

The most common cause of COPD is smoking but can also be caused by second hand smoke and long-term exposure to occupational dust and/or chemicals. Smokers that also have asthma have an even higher risk of developing it. Most are 35-40 years old when symptoms first begin.

COPD is graded to assess severity of breathlessness with Grade 1 being the mildest form (only get breathless with strenuous exercise) and on up to a Grade 5 which is the most severe (breathless while engaging in everyday activities such as dressing and too breathless to leave the house).

People with COPD are more at risk of developing other respiratory illnesses such as colds, flu and pneumonia. To reduce this risk and to prevent further lung damage, it is strongly suggested to get vaccinated yearly for the flu virus and keep up to date on both pneumonia vaccines (including the new one Prevnar 13 which should be an automatic for anyone with even the mildest form of COPD).

COPD patients have an increased chance of developing heart disease, lung cancer, high blood pressure and depression. People have been told countless times that smoking increases the risk for these conditions already, but smoking with a chronic lung condition such as COPD increases that risk even further. It should come as no surprise that the first and most important step in the treatment of COPD is to stop smoking.

As far as drugs go, inhalers are a great way to treat COPD as they are inhaled right into the lungs where you need them to work thereby reducing the risk of side effects compared to oral medications. Bronchodilators (beta-agonists and anticholinergics) are most often the first option; they open up the airways very quickly and alleviate coughing and/or shortness of breath within minutes. Short-acting beta-agonists (SABD) such as salbutamol (Ventolin) are usually tried first and can be used on an as needed basis for mild cases.

 If symptoms persist or your COPD is moderate to severe, you may be prescribed a long-acting anticholinergic (LAMA) such as tiotropium (Spiriva) or glycopyrronium (Seebri) and continue using the SABD as needed. To get even more broncho-dilating action, a long-acting beta-agonists (LABA) such as indacaterol (Onbrez) can be added.

There are combination products that combine LABA’s/LAMA’s which helps minimize how many inhalations you need to take daily. Some examples of these combination inhalers are Anoro Ellipta or Ultibro Breezhaler.

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For some, the COPD symptoms will still persist and in these cases an inhaled corticosteroid should be introduced to help reduce airway inflammation. You could add a steroid inhaler on its own such as fluticasone (Flovent) or switch the LABA/LAMA combination to a LABA/steroid combination such as Symbicort, Advair or Breo Ellipta and use a LAMA on its own. The key would be to ensure you are on a LABA and LAMA and an inhaled steroid.

In extreme cases, you might have to take a short course of a steroid tablet (prednisone) to prevent further worsening. The use of long-term prednisone is limited if at all possible due to its increased risk of weight gain, diabetes, osteoporosis, cataracts and other infections.

Sometimes, people are prescribed theophylline oral tablets to help improve their breathing but these can cause nausea, an increase in heart rate, tremor and headache. This medication was used more in the past before the days of the inhaled medications.

To help improve the quality of life for some people with very debilitating symptoms, oxygen can be prescribed to help deliver supplemental oxygen directly to your lungs. Oxygen is available in lightweight, portable units that can be taken around on errands if need be.


For more information on this or any other topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and Port Elgin Pharmasaive.

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Monday, March 07, 2016