Medications & You

Knowing which medication NOT TO TAKE is often as important as knowing which TO TAKE when you have chronic lung disease.

There are many different medications on the market today that help you breathe easier. Your doctor may already prescribe some of these for you. If so, the list of medications included may help you understand why you are taking them, how they work, and possible side effects.

You should always tell your doctor if you are taking other medications, especially those listed below that should only be used under the direction of your doctor. This is particularly true of narcotics, sleeping pills, and tranquilizers.

Over the counter cold and sinus medications:

Before you take over-the counter medications you should discuss potential problems with your pharmacist or doctor. Read the labels carefully. Products containing cough suppressants can be counter-productive to a respiratory patient since they prevent coughing which clears the lungs!

Asthma:

Individuals with Asthma or asthma symptoms from flu or pneumonia might find that aspirin causes shortness of breath and wheezing. If this occurs, discuss a substitute with your doctor.

Flu and Pneumonia Vaccines:

Anyone with COPD is considered high risk. Discuss these immunizations with your doctor.

Flu vaccine: Given yearly.

Pneumonia Vaccine: Given every 5-10 years, depending on your age and symptoms. Check with your doctor for the new pneumovax 23 vaccine.

General Medication Guidelines

  • Take medications as prescribed.
  • Take PRN medications only when needed.
  • Missed doses- never double dose.
  • Storage: original container, away from heat, light, moisture and children.
  • Don’t use over the counter medications without consulting your pharmacist or doctor.
  • Keep a written record of medications you’re taking, including herbal, vitamins and over the counter.
  • Don’t take medication prescribed for someone else!

Notify your doctor if medications are not working, or you develop questionable, side effects.

Always ask questions if something seems wrong to you.

** If taking a variety of inhaled medications, always take the quick acting one before the slow acting one. Albuterol is the true rescue drug, with onset of action 1-5 minutes after inhalation. A good rule of thumb is to take the bronchodilators first and the steroids last. Remember to rinse your mouth out after the steroids. **

Pulmonary Medications

1. Theophylline– Theo-Dur, Slo-Bid, Theo-24

How they work- Bronchodilator that opens narrowed airways to allow better airflow.

How to take them- by mouth in a pill, capsule or liquid form.

Side effects- Upset stomach, nausea, vomiting. Nervousness, restlessness, hyperactivity.

* Take with food if upset stomach is a problem. Blood levels are needed periodically*

2. Inhaled Bronchodilators– Albuterol, Proventil, Ventolin, Xopenex, Foradil, Serevent, Sriverdi.

How they work- Bronchodilators that open narrowed airways to allow better airflow. Specific time to bronchodilatation depends on the specific drug chosen. (physician to discuss with you when he prescribes the drug)

How to take them- Inhaled directly into the airways by use of a metered dose inhaler, nebulizer or diskus.

Spacer is always used with inhaler to enhance medicine deposition in the airways and to decrease side effects.

Possible Side effects- Increase heart rate, nervousness, restlessness, dryness of mouth and throat.

3. Anticholinergics– Incruse, Tudorza, Atrovent inhaler or Spiriva handihaler.

How they work- Dilates the airways by prevention of airway contraction and maintenance of open airways.

How to take them- Atrovent is inhaled directly into the airways by use of a metered dose inhaler with spacer or nebulizer. Spiriva is used with handihaler device.

Spacer is always used with Atrovent to enhance medicine deposition in the airways to decrease side effects.

Possible side effects- Cough, hoarseness, sore mouth and/or throat, decreased with use of spacer.

4.Oral Steroids– Prednisone

How they work- Steroids help to reduce inflammation of airways.

How to take them- May be taken in a pill or liquid form. DON’T STOP ABRUPTLY.

Possible side effects- Cough, hoarseness, sore mouth and/or throat, stomach upset. (long-term side effects if taken over a prolonged period of time)

5. Inhaled steroids– Azmanax, Arnuity, Pulmicort, Qvar and Flovent.

How they work- helps to reduce inflammation of airways. They work slowly: preventative or maintenance drug.

How to take them- Inhaled directly into the airways via metered dose inhaler with spacer or appropriate delivery devices.

Possible side effects- Cough, hoarseness, sore mouth and/or throat, lessened or prevented by use of proper delivery device.

6.Combination medications– Combines medications from different drug classes.

Combivent- Atrovent and Albuterol- metered dose inhaler or nebulizer (Duoneb)

Symbicort-Foradil and Pulmicort-metered dose inhaler

Advair- Serevent and Flovent- diskus.

Breo-Fluticason and Vilanterol

Dulero-Foradil and Asmanax

Anora-Umedlidinium and Vilanterol

Stiolto-Tiotroprium bromide and Olodaterol

7. Leukotriene Modifiers– Accolate, Singulair, Zyflo.

How they work- A new class of Asthma medicines that work by preventing swelling in the airways. It also prevents constriction in the airways.

How to take them- They can be taken in pill or liquid form. Accolate should be taken on an empty stomach.

Possible side effects- Headache, dizziness and nausea.

Correct Use of Metered Dose Inhalers

Use of Metered Dose Inhaler, (MDI), is an easy and convenient way for someone with lung disease to take his or her medications. By inhaling the medicine directly into your lungs, you decrease the side effects on the rest of your body. Anything inhaled into your lungs will go to work quicker, than if it is taken in pill form.

There are several important points to learn in order to use your inhaler correctly:

1. The use of a spacer device attached to a MDI is the best way to use your inhaled medication. A spacer or holding chamber is a device that attaches to the MDI. It holds the medication in chamber for approximately 10-15 seconds; long enough for you to inhale it in a slow, deep breath.

2. The spacer increases the amount of medication that goes directly into your lungs. Even with correct technique and inhalation, you CANNOT get as much medication into your lungs without the spacer! So, please use your spacer!

3. A spacer comes in many forms, but their goal is the same-to allow you to get your medicine into your lungs where it can help your breathing! Ask your pharmacist or doctor for help in purchasing a spacer, and make sure you are given instructions on proper use of your device!

4. When using a spacer with your MDI, you will probably not taste or feel the medicine going into your throat and lungs. That is a good thing- anything you taste will stay on your tongue to be exhaled out into the air or swallowed- not inhaled into your lungs! This is especially helpful with steroid inhalers because the spacer will help prevent yeast infections in your mouth.

How to use your spacer:

1 Attach the inhaler to the spacer, as shown in the direction or explained to you by the doctor or your rehab staff.

2 Shake well. Exhale.

3 Press down on the MDI. This will put one puff into the holding chamber.

4 Inhale SLOWLY and DEEPLY.

5 Hold your breath for 5-10 seconds. (the longer the better).

6 Exhale peacefully.

7 Wait a full minute before your next puff. Repeat steps 2-6.

How to know how much medicine is left in your inhaler.

1. The best way for you to know how much medicine is in your inhaler is to COUNT your puffs! This is not as difficult or time consuming as you may think!

2. If you are using your MDI on a regular schedule, it is easier than you might think to keep track of your puffs. Each canister states how many actuations (puffs) there are in that particular MDI. Example: Atrovent has 200 actuations per inhaler. If you are taking 2 puffs 4 times a day- (8 puffs), you divide 200 by 8, which equals 25. This means your inhaler will last 25 days. Go to your calendar and mark that date or put a piece of tape on your inhaler with that date. NO GUESS WORK!!!!!!

3. If you have an Albuterol inhaler or any other one that your take “as needed” just put a piece of tape around it and mark it every time you use a puff. This is the best way to ensure you are getting medicine- not just propellant!

4. The method of checking your inhaler in a bowl of water is inaccurate- unless the canister if full, it is all guesswork. Remember, the propellant and drug are both in your MDI- they both have weight- that is one reason this method is inaccurate.

Cleaning your spacer.

1 Each day you should remove the mouthpiece from your spacer and rinse it in warm running water. If you mouthpiece is attached, just run it under the water with the spacer.

2 Once a week, wash your spacer in warm water with dishwashing liquid in it. Rinse well and air dry.

3 Every 2 weeks soak your spacer in a solution of 3 parts water and 1 part vinegar. Follow this with a good rinsing and let air-dry.

4. Use of inhaled mediations can help you control the symptoms of your lung disease. But, if you don’t use them correctly, with a spacer, you decrease that control by decreasing the amount of medicine you can get to you lungs!

Using a spacer with your MDI will help you maintain a better lifestyle and control!!