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Q&A with Australian Health Practitioners
What medications are used to treat chronic obstructive pulmonary disease (COPD)?
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Dr Mark Hurwitz
Respiratory & Sleep Medicine Physician
Director Respiratory and Sleep Medicine The Canberra Hospital Clinical Associate Professor The Australian National University Medical School View Profile
There are a number of medications that are used. In the first instance, our major issue is symptom control, or symptom relief. So that's particularly, shortness of breath, so in the first instance one would generally use a short acting beta-agonist. And then, if they responded to that one would continue with that, but if they needed further management, then one would use a long acting beta-agonist or a long acting anti- cholinergic. So, one would go to that passage. Clearly then, if the condition continued to deteriorate and they had, at least, moderate COPD with an FEV1 of less than 50% predicted, then one would consider the use of an inhaled steroid, and one would generally use that in a combination product with the long acting beta-agonist.
There certainly is good evidence that the use of long acting anticholinergics and the use of combination products do have value, not only in reducing the exacerbations, but also the progress of the disease. And this is clearly of value. I think the one thing that we always need to stress to people, is that unfortunately, you can not cure the condition, but we certainly can help them to manage it appropriately, which will improve their quality of life by improving their ability, improving the amount of things that they can do on a daily basis, and how much easier it is for them. And also, if we can reduce the number of exacerbations that they have experienced, then this will hopefully, also slow down the progression of the disease.
On the one hand, I think the big change in our management has been that we are more aggressive in symptom relief, and from that, I think we have learned that we are having some effect on the chronic aspect of the disease. And we certainly are improving people's quality of life. And one of the big issues with the children that are associated with COPD is that people start to do less, and by doing less they tend to stay at home more, and for longer, and this certainly reduces their quality of life. It can also cause depression as any chronic disease can do. And if you can keep people active, and maintain their quality of life, well then clearly we'll reduce depression which obviously is a significant advantage.
The other benefit that we don't think about is that if we can keep people active and maintain their muscle mass, then by maintaining muscle mass that's also good for bone health. And we know that people with COPD are particularly prone to osteoporosis. And some of this may well relate to the fact that they're not doing much. They're not maintaining their bone health. And this would clearly be in addition to the use of corticosteroids both orally and by the inhaled route. So that if we can maintain the exercise regimens and maintain their state of fitness, we clearly are improving their situation quite significantly.
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