How can I benefit most from my COPD medications?

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1 Fact Sheet: COPD Medications and Delivery Devices How can I benefit most from my COPD medications? COPD medications can improve your symptoms. By taking the right medication at the right time, you can be more active, cough less, be less short of breath, and have fewer flare-ups. COPD stands for chronic obstructive pulmonary disease. Chronic always there Obstructive there is a block Pulmonary occurs in the lungs Disease an illness The medications ordered for you depend on: your symptoms how mild or advanced your COPD is how well the drugs work for you What medications treat COPD? 1. Medications to manage shortness of breath 2. Medications to prevent and treat flare-ups 3. Other medication: oxygen What Make is sure COPD? you know: what medications you are taking why you are taking them when to take them how to take them how much to take May 2017

2 Here is a quick look at the most common COPD medications and why they are used. Medications to manage shortness of breath: Inhaled Bronchodilators If you have COPD, the main symptom is shortness of breath with activity. You might get short of breath when you exercise, when you do chores, when you feel upset, or for no reason at all. Bronchodilators work by opening up the airways in your lungs. When the airways are more open, it is easier to breathe. Doctors may prescribe more than one bronchodilator to manage shortness of breath because each one works differently. Some bronchodilators act quickly, others act slowly: Quick-acting bronchodilators start to work within minutes. These are often used to help relieve sudden bouts of shortness of breath. Long-acting bronchodilators take a bit longer to act and are used regularly once or twice a day to keep the airways open. There are two main types of inhaled bronchodilators: 1. Beta-2 agonists Side effects: fast heart beat shaky hands (tremors) irritability sleeping problems muscle cramps. Side effects may be less noticeable when you ve been on the medication for a while. Which COPD medications are right for Which COPD medications are right for me? me? The medications you take will depend on your breathing problems. As your COPD progresses and you get more short of breath, more inhalers will be added to help you. 2. Anticholinergics Side effects: dry mouth problems urinating for men who have trouble with the prostate gland Medications to prevent and treat flare-ups: A flare-up is when your COPD symptoms get worse. Flare-ups are often caused by: a trigger, like cold air or stress a chest infection like a cold or influenza (flu) Symptoms of a flare-up are: more shortness of breath than usual cough or more cough than usual a change in the amount, colour or thickness of phlegm Flare-ups can cause more damage to the lungs. It may take longer to recover from a flare-up. That is why it is important to try to prevent and to treat flare-ups early.

3 Combination inhalers to prevent flare-ups These inhalers contain 2 medications: 1. a bronchodilator that relieves shortness of breath and 2. an inhaled corticosteroid that decreases the swelling in your airways. Over time, combination inhalers may help prevent COPD flare-ups. Combination inhalers are preventer medications that need to be taken every day (usually twice a day). They cannot be used for quick relief of shortness of breath. Side effects: shaky hands (tremors) fast heart beat thrush sore throat hoarse voice You can have fewer side effects if you: take the inhaler as prescribed rinse your mouth with water after each dose: gargle and spit the water out use a spacer with your puffer Vaccines to prevent flu and pneumonia Vaccines can help protect you against some strains of flu and pneumonia. A flu shot is given every year, usually in the fall. The pneumonia vaccine is given at least once to people with COPD ask your doctor if you need a repeat shot. Antibiotics to treat infections COPD flare-ups can be caused by viral infections (for example, the flu) or bacterial infections. If you have a bacterial infection, your doctor can prescribe antibiotics. It is important to take all of your antibiotics as ordered by your doctor. When you do not take all of the antibiotics, infections can become harder to treat. Antibiotics do not work for viral infections Corticosteroid pills to treat flare-ups prednisone These pills are sometimes used to treat COPD flare-ups, and should not be taken on a regular basis without the advice of your doctor. Side effects: thinning and bruising of the skin, sore throat, and hoarse voice, weight gain from retaining fluid, emotional changes, problems with blood sugar control, and problems with blood pressure control. Anti-inflammatory pill to prevent flare-ups roflumilast (Daxas) This drug is for patients with severe COPD who have symptoms of cough, excess mucous and frequent flare-ups. It is a once daily pill that is taken in addition to your regular inhalers. Side effects: diarrhea nausea weight loss Other medication: Oxygen Oxygen is considered a medication. Not everyone with COPD benefits from oxygen. People with COPD may be prescribed oxygen if there is a low level of oxygen in the blood For more information about oxygen, see the BreathWorks Fact Sheet What You Need to Know about Oxygen.

4 Know your inhalers! Quick-acting bronchodilators Ventolin Salbutamol Puffer Ventolin Diskus Bricanyl Turbuhaler Airomir Puffer Atrovent* Puffer Long-acting bronchodilators Spiriva Handihaler Serevent Diskus Oxeze** Turbuhaler Onbrez Breezhaler Seebri Breezhaler Combination Inhalers Advair Puffer Advair Diskus Symbicort Turbuhaler If you are short of breath and need help right away, take a quick-acting inhaler. Long-acting and combination inhalers need to be taken on a regular basis to help improve shortness of breath and prevent flare-ups. *Atrovent is not as quick acting as the others and is often taken on a regular basis. **Oxeze can act as a quick-acting and long-acting bronchodilator.

5 How do I take my inhalers? The best way to take many COPD medications is to inhale them directly into your lungs. At first it can be tricky to learn how to use your inhalers. Practice will ensure the medication gets into your lungs. Ask your doctor, pharmacist or Certified Respiratory Educator to watch you use your inhaler to make sure you are doing it right. Ask them how to care for and clean your inhalers and devices. Medications can be inhaled through different devices: Puffers (also called inhalers, pressurized metered-dose inhalers, MDIs, or pmdis) Dry powder inhalers (DPIs) Always check the instructions included with your inhaler for directions on priming and proper use. Puffers Puffers have a pressurised canister that sprays a precise dose of medication. Make sure you write down each time you take a dose of your puffer. Unless a puffer has a counter, it is hard to tell when a puffer is empty by feeling its weight or by shaking it. It might seem like the inhaler still has something inside, but what is left is not medication, just propellant (an ingredient added to your puffer to help the medication come out). Spacers (also called a holding chamber or spacing chamber) are clear plastic tubes that fit on the end of your puffer. Spacers make it easier to take your puffer. Instead of spraying the puffer right into your mouth, you spray it into the spacer. It holds the medication from your puffer. This gives you time to slowly breathe in the medication from the spacer. How to use a puffer with spacer 1. Remove the caps from the puffer and spacer. 2. Shake the puffer. 3. Put puffer mouthpiece into the spacer. 4. Seal lips around the spacer mouthpiece. 5. Breathe normally and tilt chin slightly. 6. Press down the puffer canister once this will spray medication into the spacer. 7. Breathe in slowly and deeply. 8. Take spacer out of your mouth. 9. Hold breath for 5 10 seconds. 10. Breathe out. 11. If you need a second puff, wait 30 seconds and repeat steps Replace caps. 13. Rinse out your mouth with water, spit

6 What Do I need is COPD? a spacer? YES! Puffers are easier to use, and more effective if used with a spacer. A spacer holds the medication for a few seconds after the puffer is activated. It can also help to decrease the side effects of inhaled steroids, such as thrush, hoarse voice and sore throat. Dry Powder Inhalers (DPIs) DPIs are plastic inhalers with dry powdered medication inside. Types of DPIs are: Handihaler Diskus Turbuhaler The Diskus and Turbuhaler come pre-loaded with many doses of the drug. You need to load the HandiHaler with a drug capsule for each dose. How to use a Handihaler How to use a puffer 1. Remove the cap from the puffer. 2. Shake the puffer. 3. Breathe normally and slowly. 4. Breathe out and tilt head slightly 5. Seal lips around the mouthpiece. 6. Breathe in slowly and depress canister once. 7. Continue to inhale in a slow, deep breath. 8. Hold breath for 5 10 seconds. 9. Breathe out. 10. If you need a second puff, wait 30 seconds and repeat steps Replace cap. 12. Rinse out your mouth with water, spit the water out, and wash your hands. 1. Open the cap. 2. Open the mouthpiece. 3. Place capsule in centre chamber. To open the capsules: Peel back foil on flat side of blister strip, exposing one capsule at a time because the capsules are sensitive to heat and light. 4. Close mouthpiece until you hear it click. 5. Hold inhaler upright, press green button once and then release. 6. Blow out all the air from your lungs. 7. Tilt chin up slightly. 8. Seal lips around the mouthpiece. 9. Breathe in slowly and deeply. 10. Take Handihaler out of mouth. 11. Hold breath for 5-10 seconds. 12. Breathe out. 13. Repeat steps Throw empty capsule into the garbage. 15. Close cap. 16. Wash hands immediately.

7 How to use a Diskus 1. Open the Diskus. 2. Slide the lever until you hear a click. 3. Blow out all the air from your lungs. 4. Tilt chin up slightly. 5. Seal lips around the mouthpiece. 6. Breathe in quickly and deeply. 7. Take Diskus out of mouth. 8. Hold breath for 5-10 seconds. 9. Breathe out. 10. Close the Diskus. 11. Repeat steps 1-9 if a second dose is needed. 12. Rinse your mouth with water, spit out, and wash your hands. How to use a Turbuhaler 1. Unscrew and remove the cap. 2. Hold the inhaler in an upright position and turn the coloured base as far as possible in one direction, then turn back until a click is heard. 3. Blow out all the air from your lungs. 4. Tilt chin up slightly. 5. Seal lips around the mouthpiece. 6. Breathe in quickly and deeply. 7. Take Turbuhaler out of mouth. 8. Hold breath for 5-10 seconds. 9. Breathe out. 10. Repeat steps 2-8 if a second dose is needed. 11. Replace the cap. 12. Rinse your mouth with water, spit out, and wash your hands. How to use a Breezhaler 1. Remove the cap. 2. Hold the base of the inhaler and tilt the mouthpiece to open it up. 3. Place the capsule into the chamber. To open the capsules: Peel back foil on flat side of blister strip, exposing one capsule at a time because the capsules are sensitive to heat and light 4. Close the mouthpiece until you hear it click. 5. Hold inhaler upright, press both blue buttons together once and release. 6. Blow out all the air from your lungs. 7. Tilt chin up slightly. 8. Seal lips around the mouthpiece. 9. Breathe in rapidly. 10. Take device out of mouth. 11. Hold breath for 5-10 seconds. 12. Breathe out. 13. Repeat steps Throw empty capsule into the garbage 15. Close cap. 16. Wash hands immediately. Nebuliser with mask or mouthpiece Very rarely someone with COPD may not be able to use an inhaler. A nebuliser is a device that delivers medication as a vapour or mist that you inhale. If you have a nebuliser, talk to your COPD educator about proper use.

8 Nine tips to get the most out of your COPD medication 1. Attend a pulmonary rehabilitation program or COPD clinic to learn more about your COPD medications and how to take them. Ask a COPD Educator about local programs or search online at 2. Work with your doctor to decide upon the best way to manage your COPD symptoms. Help your doctor develop your treatment plan by discussing: your symptoms, lifestyle, activities, concerns, and the medications you take and how well they work. 3. Use only one pharmacy for all your medications to help prevent the chance of drug interactions. 4. Keep a list of all your medications so your health care providers can check for possible drug interactions. 5. Work with your doctor to develop a written action plan to help you manage COPD flare-ups. 6. The best way to take many COPD medications is to inhale them directly into your lungs. It is the most effective way to get the most benefit with the fewest side effects. Ask your pharmacist or COPD Educator for more information. 7. Use your medications correctly, as prescribed by your doctor. All medications can cause unwanted side effects. If you have concerns about side effects, talk to your doctor, pharmacist or certified respiratory educator. 8. Make sure you can tell the difference between your inhalers and that you know how to use them properly. You may use several different inhalers. 9. Medications are important but they are only one part of living with COPD. In order to get the most out of life, you will also need to stop smoking, exercise regularly, eat a healthy diet and get plenty of rest. Confused? Don t understand these instructions? Call The Lung Association at and speak with one of our Certified Respiratory Educators.