Oral and inhaled medications are used for patients with stable chronic obstructive pulmonary disease (COPD) to reduce dyspnea, improve exercise tolerance, and prevent complications. Most of the medications used in COPD treatment are directed at the following 4 potentially reversible mechanisms of airflow limitation:
- Bronchial smooth muscle contraction
- Bronchial mucosal congestion and edema
- Airway inflammation
- Increased airway secretions
Bronchodilators act to decrease muscle tone in small and large airways in the lungs, thereby increasing ventilation. The category includes subcutaneous medications, beta-adrenergics, methylxanthines, and anticholinergics.
Additionally, opioids have been shown in multiple studies to relieve dyspnea, particularly near the end of life. Dosage is very patient specific. Currow et al used a low, once-daily dose of sustained-release morphine for chronic refractory dyspnea.
Flovent inhibits bronchoconstriction producing direct smooth muscle relaxation. It may decrease the number and activity of inflammatory cells, in turn decreasing airway hyperresponsiveness. Effectiveness in COPD is not established. Inhaled corticosteroids have a lesser role in the management of chronic bronchitis. Several studies demonstrate no benefit, although approximately half of patients who respond to oral steroids may benefit from inhaled agents.