Chronic Obstructive Lung Disease Medications

(Page 2)

Long-Acting Beta2-Agonists. Long-acting forms, salmeterol (Serevent) or formoterol (Foradil), are proving to be particularly effective for COLD. Major analyses suggest they reduce exacerbations by 20% to 25%. They may help inhibit bacteria from building up on the airways and may offer real improvements in lung function. Unlike short-acting forms, these beta2-agonists may even have anti-inflammatory properties.

Inhalers that combine a long-acting beta2-agonist and a corticosteroid (Advair, Seretide, Symbicort) are even more effective than either agent -- reducing exacerbations by 30%. A new study found that Advair significantly cuts inflammation of the bronchi in smokers and ex-smokers with COLD. This drug combination also improved lung function.

Side Effects. Side effects of both long-and short-acting beta2-agonists include anxiety, tremor, restlessness, and headaches. Patients may experience fast and irregular heartbeats. A physician should be notified immediately if such side effects occur, particularly in people with existing heart conditions. Such patients face an increased risk for sudden death from cardiac related causes. This risk is higher with oral or nebulized agents, but there have also been reports of heart attacks and angina in some patients using inhaled beta2-agonists.

Loss of Effectiveness and Overdose. There has been some concern that short-acting beta2-agonists become less effective when taken regularly over time, increasing the risk for overuse. The degree to which this affects the airways is uncertain. In some studies, the duration of action has declined, but the peak effect appears to be preserved, making these drugs still useful for acute attacks. Regular use of long-acting beta2-agonists may reduce the effect of short-acting forms.

It's a major concern that patients who perceive beta2-agonists as being less effective may over-use them. Overdose can be serious and in rare cases even life-threatening, particularly in patients with heart disease.

Theophylline and Other Methylxanthines

Methylxanthines a number of actions in the lungs that should help COLD patients. They include opening airways, improving exchange of gases, reducing shortness of breath, improving mucus clearance, and stimulating the process of breathing. These agents are recommended by expert groups for patients with severe exacerbations or incomplete responses to bronchodilators.

Unfortunately, a major 2003 analysis indicated these agents do not produce any significant improvement in lung functions, symptoms, or overall outcomes after treatment for acute exacerbations. Some experts, then, believe that these modest benefits do not outweigh the risk for the toxic effects commonly associated with these agents.