Commonly prescribed COPD medications at our office

As you know, we have a large number of patients with COPD.  COPD is inflammatory in nature and marked by narrowing of the bronchial tubes. For patients with stable COPD, the medications will depend on the severity of COPD. A good summary report about COPD can be is available at GOLD guidelines.

For Mild COPD we generally use albuterol as needed.

For moderate COPD: we use Spiriva, and offer pulmonary rehab.

For severe COPD: we use Advair or Symbicort, or Dulera along with Spiriva; or we can use nebulized Pulmiocort+Perforomist or Pulmicort+Brovana

For patients who have an acute exacerbation of COPD- marked by increasing cough, sputum, wheezing, and shortness of breath- we treat with oral short course of prednisone and antibiotic such as azithromycin, or doxycycline, or levaquin if we suspect bacterial infection.

Patients who have severe COPD, and have had acute exacerbations with chronic bronchitis, a new medication called DALIRESP (ROFLUMILAST) is recently approved by the FDA. It is a preventive medicdation that reduces the risk of acute exacerbation of COPD. It is once a day pill. It cannot be given to patients with significant liver disease or to patients who have significant weight loss. It works as a phosphodiesterase-4 (PDE-4) inhibitor. It leads to increased cyclic AMP that lead to reduced inflammation and muscle relaxation.

We generally use nebulized albuterol, or Pulmicort, Perforomist, Brovana only in patients with severe COPD or those who have limitations in hand-breathing coordination, cognitive issues, arthritis, etc. where they are less likely to inhale the Advair or Symbicort easily.

Confirming that the patients are taking their COPD medications regularly at each office visit is very useful. It is also a good idea to check their inhaler technique. Using spacer for meter dose inhalers is a good idea.