COPD Treatments Compared

People with chronic obstructive pulmonary disease (COPD) often take medications that dilate their lower airways, to make it easier to breathe. These are of two types: beta-agonists and anticholinergics, both used chiefly with inhalers.

The beta-agonists (e.g. Alupent®, Foradil®, Serevent®, Proventil®) are primarily used in asthma, but they’ve also become popular in COPD, where they are prescribed far more often than the anticholinergics. The anticholinergics include Atrovent® (ipratropium) and Spirovira®. For the first time, the benefits offered by these types of bronchodilators have been compared, based on results of 22 published studies.

Anticholinergics more than halved the number of severe worsenings of COPD, and cut the death rate by 75%. Bet-agonists, on the other hand, didn’t change the frequency of severe attacks, and increased the death rate of COPD – almost 2½ times – compared to placebo. Steroid drugs were often given along with beta-agonists (as in asthma treatment), but they didn’t affect the overall result.

COPD is the 4^th leading cause of death in the USA. It’s really two conditions: chronic bronchitis (inflammation and eventual scarring of the lining of the bronchial tubes) and emphysema (destruction of air sacs, or alveoli in the lungs where oxygen is exchanged for carbon dioxide); both conditions result in obstruction of the normal airflow.

The most important treatment begins with quitting smoking, if you’re a smoker. Oxygen helps a lot. But sooner or later the doctor will likely prescribe a bronchodilator to try and improve things. Now she/he has a clear choice – avoid beta-agonists, and use anticholinergics. The problem will be in getting the message out to the health professionals in the face of the ads from the pharmaceutical industry.