COPD Medication Information for Physicians

The following information is a helpful guide when prescribing or evaluating a COPD medication regime:

• Pharmacotherapy for COPD is used to decrease symptoms and/or complications.
• Short acting bronchodilators, including anticholinergics and beta-agonists and long-acting beta-agonists are the cornerstone of COPD therapy. Methylxanthines, such as theophylline, may also provide additional benefit. They are given either on an as-needed basis for relief of persistent or worsening symptoms, or on a regular basis to prevent or reduce symptoms. The side effects of bronchodilator therapy are pharmacologically predictable and dose dependent.
• There is now good evidence that inhaled corticosteroids (ICS) are efficacious in a sub-population of patients with severe-very severe COPD, with a history of frequent exacerbations. Well-controlled studies have demonstrated a 25% reduction in exacerbations in this group. While not recommended, it would not be unreasonable to initiate this therapy in individuals with moderate disease with frequent exacerbations.
• Continuous oxygen has been shown to improve quality of life and, with the exception of smoking cessation, is the only intervention shown to prolong life. Some individuals may need oxygen, only with sleep or exercise.
• Inhaled bronchodilators (particularly inhaled ß2-agonists and/or anticholinergics), theophylline, and systemic, preferably oral, glucocorticosteroids are effective treatments for acute exacerbations of COPD.
• Patients experiencing an exacerbation, with increased sputum volume, dark colored sputum and/or fever will usually benefit from the use of a broad spectrum antibiotic. The three most common organisms cultured in mild to moderate disease are Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, and Streptococcus pneumoniae. Most patients, especially those with mild to moderate COPD, respond to treatment with one of the less expensive first-line antibiotics: amoxicillin (Amoxil, Trimox, Wymox), trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra), erythromycin, and doxycycline. A less than optimum response to these first line drugs, especially in patients with more severe underlying disease may require a switch to Augmentin or to second or third generation ecphalosporins.