Why One COPD Medication Instead of Another?

Why Take a Bronchodilator? Bronchodilator inhalers and pills relax the airways, making them wider so that you can breathe more easily. The goal of bronchodilator therapy is to reduce shortness of breath. If you are not short of breath, or if they don't noticeably relieve your shortness of breath, then perhaps you don't need to take a bronchodilator regularly. Discuss this with your doctor.

What Side-Effects are Possible from Bronchodilators? Bronchodilator inhalers and pills are stimulants, like the caffeine in coffee and tea. Thus you may experience nervousness (anxiety), shakiness (tremor), a more rapid pulse, insomnia, or stomach upset (nausea). These will only last for the duration of the effect of the bronchodilator (2 to 4 hours for short-acting inhalers, but 12-24 hours for long-acting inhalers). If you also have heart disease, you may experience palpitations (worrisome cardiac arrhythmias), or angina. If this happens, contact your doctor and discuss it.

Why Take an Inhaled Corticosteroid? These inhalers are designed to reduce airway inflammation and swelling. This beneficial effect takes several days of daily use. These inhalers are often used when some degree of asthma is also present along with COPD. When taken every day, these inhalers may reduce the risk of an exacerbation (temporary worsening) of COPD.

What Side-Effects are Possible from Inhaled Corticosteroids? Many people develop yeast (Candida) infections in their throat (thrush) after using them for several weeks or more. These yeast infections are not serious, but often cause a sore throat, a sore tongue, a white coating at the back of the throat and tongue (which you can see by shining a light at the back of your throat and looking in a mirror). These yeast infections sometimes extend to your vocal cords, causing a change in your voice (hoarseness). Use of a spacer and gargling after taking the inhaler can reduce the risk of thrush. Antifungal lozenges (Nystatin, TM) can be prescribed to kill the Candida yeast.

High daily doses of inhaled corticosteroids (1000 mcg or more) taken for long periods of time may also cause some of the side-effects of prednisone (see that box). Poverty is also a possible side-effect, if you have to pay for these brand-name inhalers out of your own pocketbook.

Why Take Prednisone? Prednisone pills are strong medicine, but very inexpensive since they are generic. They reduce the airway inflammation caused by viral respiratory infections. Prednisone (or its expensive cousin, prednisolone) is often given to treat a COPD exacerbation (worsening).

What are the Side-Effects of Prednisone? Because it is so strong, and distributed to the entire body, prednisone causes some side-effects in most patients. The higher the dose, the more likely side-effects will occur, so most doctors like to stay below 60 mg per day. The longer the time that prednisone is taken, the more likely that serious side-effects will occur, so most doctors like to give only "bursts" of prednisone for 5 to 14 days.

When taken for only a few days, prednisone may cause changes in mood (good or bad) or increased appetite. When taken for months to years, prednisone may cause serious side-effects, such as adrenal suppression (so you must not stop it cold turkey), fluid retention (a moon-shaped face), thinning of the bones (osteoporosis), cataracts, immune system suppression (increased risk of infection), and many other possible side-effects.

Why One Inhaler Versus Another? The primary goal of inhalers is to deliver most of the medication deep into the lungs, where it will be most effective. A secondary goal of inhaler devices is to minimize the amount of drug deposited at the back of the throat.

Small inhalers which you can put in your pocket or purse are generally preferred by patients. These are called metered-dose inhalers (MDIs). Over the last decade, they have evolved to become easier to use, more efficient, and more expensive. In 2007, the FDA eliminated generic albuterol, which used freon as a propellant, so it has been replaced by HFA propellants or by dry powder inhalers (DPIs). The best new inhalers are breath-activated, triggering themselves automatically when you begin to inhale deeply. This makes it more likely that most of the medication will be delivered deep into your lungs. Dry powders and spacers reduce the amount sticking to the back of your throat.

Why Use a Nebulizer Instead of a Pocket Inhaler? The primary advantage of a nebulizer is that you only breathe quietly. Some doctors also believe that nebulizers are more effective for some patients. Nebulizers to deliver a mist of medication have been around for more than 100 years. The air pressure needed to nebulize the liquid medication was first generated by a hand-bulb, then a tank of oxygen, then an electric pump (compressor), and most recently by ultrasound. Usually, about 3cc (about a teaspoon) of the medication solution is placed into the nebulizer. Then you breathe quietly from the nebulizer mouthpiece for a few minutes.

The Disadvantages of Nebulizers:

1. you have to pour the medication into the nebulizer;
2. it takes longer to deliver the medication;
3. the device is more expensive;
4. compressors are noisy and must be plugged into the wall;
5. the nebulizers should be cleaned routinely.

On the other hand, the primary disadvantage of most pocket inhalers is that technique is important -- you have to figure out how to trigger the inhaler at the beginning of a slow and very deep inhalation and then hold your breath for several seconds. Sometimes you are not confident that the pocket inhaler actually delivered the medication into your lungs, because you can't see the mist or powder.

Related Topics:

• 10 FAQs About Living With COPD
• Exercises for Chronic Obstructive Pulmonary Disease

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Latent Tuberculosis: Dad's Diagnosis

Editor's Note: WebMD Staffer Leona Perry has been taking the story of tuberculosis patient Andrew Speaker a little more personally than the rest of us here at WebMD. Her sister Renee was diagnosed with tuberculosis in late 2004 and it put their family into a difficult medical situation. Leona told her story and Renee shared her tale; Here's what happened to their dad.

When we all found out my sister Renee had TB, my parents immediately made an appointment with their local health department to be tested.

After a couple of days, Mom's test site looked normal. But Dad's was red and raised. He had to go in for a chest x-ray and more testing.

The x-ray revealed a dark, scary spot on his lung, but sputum tests came back negative for active TB. The doctors diagnosed him with Latent TB, and told him that the spot was probably a sign that sometime earlier in his life he had the active form of the disease and just didn't know it.

He told us he suspected that he may have contracted it as a child from others in his family that may not have known they had TB.

My dad's grandmother died of tuberculosis, back when it was called consumption. He remembers his dad, my Papaw Leo, telling him how his mother had been in a Sanatorium for a long time when he was a child. She apparently passed away there.

My great Aunt Naomi, Papaw's sister, was just a kid herself but had to take over all of her mother's duties around the house, including caring for her siblings and her dad.

Because my dad's TB was the latent form, the doctors said Renee couldn't have gotten the disease from him. She will probably never know exactly where she came in contact with it.

They say that everything happens for a reason. I wouldn't wish TB on my sister or anyone else, but what if my dad's Latent TB had become active when he was older and couldn't fight off the disease or handle the long course of treatment? He already has Type 2 Diabetes. It's probably a blessing that he was tested and found out when he did.

Dad was put on antibiotics for six months to kill the TB bacteria. He is now TB free.

I have to say that I'm glad medicine has advanced to the point that tuberculosis isn't the killer it once was. If you catch the disease early and get the right treatment you can beat it and even keep any complications at bay.

Our family was blessed. I wish the best to any family this disease touches.

Previous: Tuberculosis and My Sister: Leona's Story, Tuberculosis: The Cough That Never Ends, Tuberculosis Diagnosed: Start Spreading the News, Tuberculosis Treatment: The Road to Recovery

More Information About Tuberculosis:

• Tuberculosis Treatment
• Tuberculosis Symptoms

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Tuberculosis Treatment: The Road to Recovery

Editor's Note: WebMD Staffer Leona Perry has been taking the story of tuberculosis patient Andrew Speaker a little more personally than the rest of us here at WebMD. Her sister Renee was diagnosed with tuberculosis in late 2004 and it put their family into a difficult medical situation. Leona told her story; now it's Renee's turn.

I felt run down all the time, and like I said before, my cough was really bad at night, so I wasn't sleeping very well. Brad had given up sleeping with me because he couldn't get any sleep either. I lost a lot of weight, too. I went from 125 lbs down to around 115. That part I really didn't mind too much.

The nurses at the Health Dept were great and made it as pleasant an experience as they could. Mary, my main nurse, answered every question we had.

Brad took me out to the park on the weekends to walk around, since I couldn't go shopping. I could tell that my lungs were being affected because I couldn't walk a half mile before I was completely out of breath and panting.

After 3 weeks of treatment I was declared to be safe in society again and was able to go back to work. I was very lucky that the company I work for had a sick day policy of 30 days at that time, or I would have had to go on short-term disability.

I then had to go back twice a week to give samples, and I was also taking several types of antibiotics that I was only allowed to take with the nurses at the Health Dept watching me. They evidently have a lot of people who actually refuse to take the medicine, so it is not a take-home option.

When I asked how I could have gotten the disease, I was told that the foreigners coming into our country are bringing this disease in from the Third World countries. Many of them are not getting treatment, so it's becoming more prevalent again.

I finally finished all of my medication at the end of August 2005, and then I was sent for another set of x-rays to make sure the disease was no longer in my lungs.

The sad part is that I did actually infect one of my friends/coworkers, Kenny. He did not have the active type so he was put on the preventative medication for nine months. This is an elective medication, but if you don't take it, the disease could become active.

FYI...if you see someone walking through the mall with a mask on, leave immediately. They could be one of those people who is supposed to be quarantined at home and thinks as long as they have their mask on they are not harming anyone else.

Previous: Tuberculosis: The Cough That Never Ends, Tuberculosis Diagnosed: Start Spreading the News

More Information About Tuberculosis:

• Tuberculosis Treatment
• Tuberculosis Symptoms

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Tuberculosis Confirmed: Start Spreading the News

Editor's Note: WebMD Staffer Leona Perry has been taking the story of tuberculosis patient Andrew Speaker a little more personally than the rest of us here at WebMD. Her sister Renee was diagnosed with tuberculosis in late 2004 and it put their family into a difficult medical situation. Leona told her story; now it's Renee's turn.

Once I was diagnosed, I had to start spreading the news.

My boyfriend, everyone at work, and anyone I had come in contact with since I had the cough had to be tested. The people I was in contact with everyday, if they came back negative on the first test, were required by law to return in three months to be tested again. The Health Dept did this because if you had just been exposed to the disease, you could test negative the first time, and positive later.

I had been sent for a lung x-ray the same day the doctor had given me the skin test. Those were sent to the Health Dept, where they verified that I did indeed have something growing in my lungs.

I had to go to the Health Dept everyday and cough up as much stuff out of my lungs as I could so they could test it to see if it was indeed TB. I was told that the lab would not have results for at least a month, because they had to take my samples that I gave them and grow the TB in a dish. Apparently, it takes at least that long for the culture to grow into something they could see with the microscope. They go ahead and treat you as if you have the disease though because if gone untreated you can die.

Previous: Tuberculosis: The Cough That Never Ends
Next: Tuberculosis Diagnosed: The Road to Recovery

More Information About Tuberculosis(TB):

• Andrew Speaker Treated in Denver
• Facts about Tuberculosis

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Tuberculosis: The Cough That Never Ends

Photo by Leona Perry

Editor's Note: WebMD Staffer Leona Perry has been taking the story of tuberculosis patient Andrew Speaker a little more personally than the rest of us here at WebMD. Her sister Renee was diagnosed with tuberculosis in late 2004 and it put their family into a difficult medical situation. Leona told her story; now it's Renee's turn.

I had this cough that started around Halloween of 2004. It started out like a little tickle in my throat, and I would cough rarely. Then, I started to cough on a regular basis, and I assumed I had some type of a cold.

I went to the doctor and was told they could hear wheezing in my lungs, and they thought it could be something bronchial. I was given some medicine and took that for a week. The cough seemed to go away.

About a week later, the cough started up again and it was really bad at night. I went back to the doctor, and they ran all kinds of tests. I was a little anemic, but, other than that, they couldn't find anything wrong with me. The doctor thought maybe it was a type of allergy, and put me on Claritin. She also gave me a cough medicine with a narcotic in it to take at night to help me sleep. Because of the excessive coughing, neither I, nor my boyfriend Brad were getting any sleep.

By the time the doctor actually tested me for tuberculosis, it was the middle of February 2005. When the doctor told me they were going to do the TB skin test, she acted like she was pretty certain it would come back negative, but it was kind of a last ditch effort to find out where this cough was coming from.

They did the skin test, and I went home.

When the skin test started welting up the very next day, my boss and I were looking the disease up on the Internet. The first thing that's mentioned is death, so yeah, I was scared. Then we did some more research and realized that it was contagious but treatable.

You go back after the second day to have the skin checked, and when I went back, there really was no mistaking that I was positive for TB. The skin had welted up about a quarter of an inch off my arm in a quarter-sized circle. I was immediately masked and sent to the TB clinic at the Durham County Health Dept. I was quarantined for three weeks.

I was only allowed to be outside. I was told that the disease would dissipate in the air, but if I went into buildings there was nowhere for the disease to travel, so I had to wear a mask when I went to the Health Dept.

Coming Next: Diagnosis: Start Spreading the News

More Information About Tuberculosis(TB):

• Tuberculosis (TB): 17 Questions and Answers
• Tuberculosis (TB) Prevention

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Tuberculosis and My Sister: Leona's Story

Editors' Note: WebMD Staffer Leona Perry has been taking the story of tuberculosis patient Andrew Speaker a little more personally than the rest of us here at WebMD. Her sister unexpectedly was diagnosed with tuberculosis in late 2004 and it put their family into a difficult medical situation. Here's her story:

My husband and I always take our kids to visit our families in South Carolina every Christmas.

In December 2004, we all ended up at my mom's on Christmas afternoon. My sister, Bonnie, drove down from Charlotte, N.C., and my sister Renee, and her boyfriend, Brad, had just come in from Durham.

Renee was coughing. "I've got this cold I just can't seem to kick," she said. I'd had pneumonia before, so I suggested she might get that checked out. She sounded pretty bad.

A couple of weeks later my mom called. "Leona, I have some bad news..." I hate it when my mom starts a conversation with those words. I'm always geared up to find out who has passed away. But, what she told me next was almost worse. Renee had gone back to the doctor and had some tests run. She had TB (tuberculosis).

I didn't know much about TB, but I did know that it could be deadly. Way back in the day, they called it "Consumption" and a lot of people didn't live through it. I had a mild panic attack about my sister BEFORE my mom handed out even more bad news...Renee had been highly contagious when she was coughing all over us at Christmas. (Sorry, Renee!)

Everyone in the family who had had any contact with my sister during the past month was going to have to be tested for TB. I had to call my local health department and let them know my kids had been exposed. They told us to contact our pediatrician immediately to set up appointments to have the tests done.

I sat the kids down and explained what was happening. They were worried about their aunt, but they also wanted to know what type of test they were going to have to take. I told them it would be a Tuberculin Skin Test, and went immediately to my handy-dandy WebMD to find a good explanation of what it was going to entail. My son, who was seven years old at the time, still didn't like the idea that they were going to stick a needle under his skin and put something in there.

As a mom, I wasn't half as worried about the little bit of pain my kids were going to have to endure for the test as I was that they might actually have TB. All sorts of nightmares were running through my mind: "Colton is so little. Can his body take this disease?" "What if one of the girls has it? Will they be able to kick it?" "Even if they kick it, what kind of permanent damage would it do?" Scary, scary thoughts.

I also had to call all the parents of my kids' friends. If my kids came up positive on the test, they'd then have to have their kids tested. See how this begins to snowball?

We were all on pins and needles the next few days while we waited to see if the tell-tale bumps would appear inside the circles the nurse in our pedi's office had drawn around the exposed area.

No bumps. Yay!

But, we still had to go have the pediatrician confirm that there REALLY were no bumps so she could alert the Health Department that we were all clear.

Finally, the fear was over on our end. But Renee's journey was just beginning.

Renee's story begins with a nagging cough. Read about her scary story here.

We'd love to hear what you think. Add your comments below..

More information on TB:

• Tuberculosis Symptoms
• Tuberculosis Treatment

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