If you suffer from chronic lung disease, such as COPD, you more than likely have a nice collection of inhalers and medications you take on a regular basis. Different colors, different dosages, different types of inhalers… How well do you know these “friends” you spend so much time with? Let’s start at the beginning, controlling your symptoms. Maintenance Medications.
Maintenance medications are used to help keep your symptoms under control. You might also hear these referred to as “Controller Medications”. The key to successful management lies here. Maintenance medications should be taken regularly, when scheduled, and will be taken on a regular, daily basis. Depending upon which ones you take, you could be scheduled to take them in the morning, evening, or both. If you suffer from asthma, the most important controller medication you will take is an inhaled corticosteroid. If you suffer from COPD, the most important controller medication you will take is a long acting bronchodilator (airway opener). Your rescue breather is referred to as a short-term bronchodilator, your controller medications are referred to as long-term bronchodilators. Remember, the number one rule for everyone… KEEP YOUR RESCUE BREATHER WITH YOU ALWAYS. You never know what triggers you might be exposed to and what could cause your airways to tighten up.
Now that we understand what bronchodilators are, let’s list a few for familiarity sake. You have undoubtedly heard of a few of these.
Short acting Beta Agonists (rescue medications) may include Albuterol (also known an Ventolin or Proventil), Fenoterol, and Terbutaline. Key to quick or fast acting meds: they work within minutes and last for up to 4-6 hours.
Short acting Anticholinergics (not used for rescue, but rather a maintenance med that is used more frequently during the day) may include Ipratropium Bromide (aka Atrovent, Apovent, Aerovent).
Long acting Beta Agonists (maintenance or controller medications) may include Formoterol 12+ hours, Salmeterol 12+ hours, Serevent 12+ hours, Symbicort 12+ hours, Foradil 12 hours, Indicaterol 24 hours, and Tiotropium Bromide (Spiriva) 24 hours.
Long acting Anticholinergics may include Tiotropium Bromide, aka Spireva.
Some medications are called combination medications. These are medications that have a beta agonist and anticholinergic in one. The may include Fenoterol/Ipratropium, aka Berodual, Albuterol/Ipratropium, aka DuoNeb, Combivent.
The next division of medications are anti-inflammatory medications. These do not give immediate relief and are not a rescue breather. They are a maintenance medication to be used regularly to control symptoms. Many of these are inhaled corticosteroids. Steroids act directly on the site of contact to reduce inflammation and manage your airways. Inhaled corticosteroids have fewer side effects than systemic steroids, and are a good medication to use under some conditions. The list of inhaled corticosteroids may include Beclomethasone dipropionate, Triamcinolone acetonide, Flunisolide, Fluticasone propionate, Budenoside, Fluticasone propionate/Salmeterol, Mometasone, QVAR, Axmacort, AeroBid and AeroBid-M, Flovent and Flovent rotadisk, Pulmicort, and Advair.
When you take a variety of medications it is important to know which order to take them in. Inhalers are no exception. If you take a combination of inhalers, remember this rule. Take the bronchodilator first, then the corticosteroid or combination medication. This accomplishes two things. First, if you take a look at the type of medications you have and the nature of those meds, you will understand that if you take a bronchodilator prior to other medications you airways will be more “open” for delivery of the secondary medications. Second, if you take your corticosteroid after your inhaler you are done with your inhalers and ready to rinse your mouth out. This is an important thing to remember. Rinsing your mouth reduces the possibility of developing thrush, an overgrowth of yeast in your mouth. This can be very uncomfortable, taste bad, and sometimes get to the point of pain. It creates a white film in your mouth and on your tongue. It can be very difficult to recover from and take a long time to get over. It is best to be proactive and do what you can do to avoid it. So, bronchodilator first, wait up to 15 minutes for optimal opening of your airways, then steroidal medication, then rinse your mouth with lukewarm water and spit it out. Don’t swallow it and deliver that medication directly into your digestive system, as the same situation may arise somewhere along your intestines if you do. Inhale. Rinse. Spit.
Last, but certainly not least, make a list of all your meds and their scheduled times. Include in that what type of medications they are, so when you have one of those “forgetful” moments you can easily solve it by simply reviewing your list. Provide your pharmacist and physicians (yes, all of them) with this list so your healthcare can be as streamlined as possible, and you are right on top of your game. Happy breathing!