ABCs of Inhalers

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There are more options than ever before for treatment of asthma and chronic obstructive pulmonary disease (COPD). So many new inhalers have arrived on the pharmacy shelves in the last few years it may be hard to keep up with what is available.

There are basically 3 classes of inhaled medications that are used in the treatment of asthma and COPD.

A: Anticholinergics

B: Beta-agonists or Bronchodilators

C: Corticosteroids

Anticholinergic medications are generally used for COPD but can help in asthma also, especially if other medications do not provide sufficient control. Anticholinergics work by relaxing the nerves that control the airways. This helps open up the airway so the air moves better, and also helps dry up mucus secretions. People with COPD often have excessive mucus which leads to a wet, productive cough and can create an environment where bacteria grows and leads to lung infections like pneumonia. Anticholinergics can be short acting (Atrovent) or long acting (Spiriva, Tudorza, Incruse, Seebri).

Beta agonists work by binding to beta-2 receptors on the smooth muscle tissue in the airways. This causes the airway muscles to relax and open up, allowing for improved airflow. These are used for asthma or COPD. Beta agonists can be short acting (ProAir, Ventolin, Proventil, and Xopenex) or long acting (Serevent, Arcapta, Striverdi). For asthma patients, long acting beta agonists should be used in combination with an inhaled corticosteroid.

Corticosteroids are cortisone type drugs that reduce inflammation in the lungs and airways. These are most effective in the treatment of asthma, which is a condition characterized by chronic inflammation. They may be used in COPD also, especially advanced COPD, if other drugs fail to control symptoms. Reducing the inflammation in asthmatic airways decreases the response to triggers like pollen, dust, cold air and other irritants. Inhaled corticosteroids are typically dosed once or twice a day. Examples include Flovent, QVAR, Asmanex, Pulmicort, Alvesco, and Arnuity.

For patients who need to take more than one inhaled medication, there are many combination inhalers available also.

Advair, Symbicort, Dulera and Breo are examples of products that contain a corticosteroid and a bronchodilator.

Anoro, Stiolto, Utibron, and Bevespi are examples of inhalers that contain both an anticholinergic and a beta agonist.

Trelegy is an inhaler that contains all 3 classes of medications.

For more information on asthma and COPD click here

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