In this article I’ll explain some of the medications used for asthma and COPD (chronic obstructive lung disease).
Both illnesses are considered obstructive lung diseases.
This means narrowing of the small airways that interferes with the easy flow of air into and out of the lungs.
In asthma, the obstruction is reversible.
Asthma often has a strong genetic component. It’s associated with allergies and airway hyperreactivity. The obstruction in COPD is less likely to be reversible and is associated with smoking and air pollution. But there can also be a genetic component. Some inherited diseases, such as alpha-1 antitrypsin deficiency also cause COPD.
There is also an overlap syndrome where patients can have components of both asthma and COPD. Some lung diseases have symptoms that mimic these conditions
Examples include lung cancer and interstitial lung disease. Wheezing after acute infections such as COVID-19, RSV and influenza can be a sign of underlying asthma.
Classes of medicines used to treat these illnesses include:
• SABA — short-acting beta agonists such as the commonly used medicine albuterol. These drugs relax airway muscles to allow more air to flow in and out. They usually start working quickly but wear off quickly.
• LABA — long-acting beta agonists such as formoterol. These last longer than the short acting beta agonists. Some take longer start working.
• LAMA — long-acting muscarinic antagonists, such as Ipratropium. These act via a different biochemical mechanism to open the airways.
• ICS —inhaled corticosteroids such as budesonide. Similar to prednisone, which is a steroid medicine taken by mouth; ICS deliver steroids directly to the lungs so less is absorbed by other parts of the body. This reduces side effects and adverse reactions.
When deciding which medicines to prescribe for a patient with COPD, their medical provider will need to assess the severity of the patient’s symptoms.
Minimally symptomatic patients may need only a LAMA. As symptoms worsen, COPD patients may require both a LAMA plus a LABA. And the patients with the most severe symptoms may require triple therapy with a LAMA, LABA and an ICS. That’s why it’s important for patients with COPD to become established with a primary care provider who can assess illness severity to prescribe the best controller medicines. This reduces the chance that a COPD patient will wind up in the urgent care, emergency room, hospitalized or — worst of all — die prematurely.
For years, the mainstay of mid intermittent asthma treatment was a SABA such as albuterol as needed. But new guidelines suggest a better approach may be a LABA-ICS (such as formoterol-budesonide) combination as needed. This same medicine can be used as a single maintenance therapy.
Albuterol every 20 minutes to one hour remains the main therapy for acute exacerbations of asthma. LABA-ICS can also be used up to six times per day for quick relief. Patients may also need a short course of steroids by mouth.
These are the main medicines used to treat asthma. For patients with severe disease there are additional medicines such as omalizumab and benralizumab.
Non-medication ways to help control COPD and asthma include quitting smoking (unfortunately switching to vaping still damages your lungs), avoiding triggers and vaccinations that reduce your chances of contracting a respiratory infection (influenza, COVID-19, pneumonia vaccine and RSV for those older than 60).
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.