Since COPD has an inflammatory component, your doctor may prescribe a steroid-containing medication. The type of steroid contained in these preparations is not the type that builds muscle. Your body normally makes its own anti-inflammatory steroids; however, extra doses may benefit selected patients.

Steroids also can be given in several forms. The inhaled form delivers the medication right where you want it, straight to the lungs. If your breathing does not respond to the inhaled form, your doctor may choose to place you on a pill form. An intravenous form is also available. Steroids have many side effects, and this is why your doctor will try to get you off steroids as soon as possible. There is much less concern with side effects when using inhaled steroids, and this is the preferred form.

A Special Note on Inhaled Medications
Metered dose inhalers, or hand-held inhalers, are a convenient and safe way to deliver medication to the lungs. Because they are delivered locally and directly to lungs, smaller doses of medication can be used. The beneficial effects of the medication can occur, while the side effects are minimized. But… if the inhalers are not used correctly, the medication will not get to the right place. At best, using perfect technique, only 10% to 20% gets to the right place, so you see why it is important to use good technique. There are now several MDI’s on the marked requiring different techniques.

Using Your Inhaler Correctly

Using the older form (gas-containing type) of MDI correctly:

• Begin by controlling your breathing. Use pursed lip breathing to help you slow down your rate of breathing and to help you coordinate the remainder of the steps.

• Remove the cap from the mouthpiece of the inhaler.

• Shake the inhaler for 5-10 seconds.

• Place the mouthpiece in one of the three acceptable positions: In your open mouth with your tongue and teeth out of the way. Resting on your lower lip with your mouth wide open. Or 1-1.5 inches in front of your wide open mouth.

• Begin to inhale as you press the inhaler. This is a very important step and will take practice to perfect.

• Inhale slowly for 5-6 seconds if you can manage. This helps the medication to get deeply into the lungs. Contrary to what most people think, inhaling quickly makes most of the medication deposit on the back of the throat and not in your lungs. Slow is the way to go.

• At the end of the inhalation, hold your breath for about 10 seconds.

• Exhale through pursed lips.

• If more than one puff is prescribed, wait a few minutes before taking your second puff and repeat the steps above.

• After your last puff, rinse your mouth and throat with mouthwash or water to prevent dryness. Do not swallow the water or mouthwash. This is essential if you are using inhaled steroids.

Rinse the mouthpiece thoroughly with warm water at least once a day. Let it dry before assembling and storing it. If you are carrying your inhaler in your pocket book, put it in a ziplock bag to keep it lint free.

Other Facts about Inhalers

Do not use your inhaler more often than ordered, or it may not be as effective when you really need it. Inhaled medicines obtained over the counter should not be used unless ordered by your doctor. Some of these medications can interact with your prescribed medicines in an adverse way. It is a good idea to mark the date you first start using a new inhaler so you can keep track of when it is getting empty. For example, if you use two puffs four times a day of your inhaler, and it holds 200 inhalations, you will need to replace it in 25 days.

Newer MDI’s use powders and come with complete instructions. Ask your pharmacist, doctor, nurse, respiratory therapist, or other medical aid in interpretation of the instructions if you have any problems.

Spacer Devices
A spacer device is a tube that allows you to spray the medication into it before you inhale. It may also be useful in training first-time users of the gas-containing forms of metered dose inhalers (MDI) and for people who are having trouble using their inhalers correctly. There are several commercially available spacer devices.

You may benefit from a spacer if you

• have trouble pressing your inhaler as you breathe in,
• get yeast infections from inhaled steroids(thrush).
• cough when you use the inhaler, or
• feel more comfortable using a spacer

The basic steps for using a spacer are:

• Control your breathing with pursed lip breathing.

• Shake the inhaler and take off the caps from the mouthpieces of the inhaler and the spacer.

• Place the inhaler into the spacer driver.

• Place your lips around the mouthpiece of the spacer.

• Depress the spray into the spacer.

• Inhale slowly.

• Hold your breath for 5-10 seconds.

As you can see, the steps are similar to using an inhaler without a spacer. A spacer eliminates the need to breathe in as you press the inhaler. It is still important to inhale slowly and hold your breath. Each type of spacer comes with instructions. If you have any problems, do not hesitate to ask for help.

Cleaning of MDI’s and Spacers

There are many types of MDI’s and spacers available. The proper cleaning of these types of dispensers is very important to prevent infection. Discuss the proper cleansing of your specific unit(s) with your caregiver or pharmacist.

Antibiotics

Antibiotics are usually used in treatment of acute exacerbations. Your doctor will select the type of antibiotic most suitable for you, for the suspected infection, and one which will be the most effective for the known local organisms.

III. Oxygen

If your lung function is impaired severely, there may come a time when your body cannot absorb enough oxygen from the air. This is when extra oxygen can be of benefit. Some patients only require extra oxygen while walking or exercising. Some patients require extra oxygen only at night. Others will benefit from around-the-clock use of extra oxygen.

The most common form of oxygen is delivered by nasal cannula (a small tube that carries oxygen from a tank to your nose). You may have large tanks in your house for long-term use or small lightweight portable tanks for when you are on the go. Liquid oxygen is available in small light-weight containers which one refills from a larger tank maintained at the home. There are also machines that concentrate oxygen from the air. These are stationary devices designed to use in the home. Portable units are available but are very expensive and currently not covered by Third Party Payors.

To decide if you will benefit from extra oxygen, your doctor should perform some special testing. Usually your doctor will want to measure the level of oxygen in your blood- a test called arterial blood gas (ABG). Another instrument, a pulse oximeter, can measure the oxygen in your blood without the discomfort of needles. This may be done at rest, while you walk, or even overnight while you sleep. Please note: Long term oxygen therapy prolongs life in COPD patients who have low blood oxygen levels (hypoxemia).

Oxygen should be considered in the same manner as any other medication. It requires a prescription which should be followed very carefully. It is also important to note that oxygen is not addictive.

There are safety precautions that your supplier will go over in detail. The use of oxygen is generally quite safe when one uses common sense. Oxygen does not burn, but it does support combustion. Do not smoke while using oxygen!

IV. Lung Reduction Surgery

For certain types of COPD and in carefully selected patients, a special type of lung surgery may offer improvement in lung function. This surgery removes damaged areas of the lung so that any remaining normal lung can function better.

In certain patients with COPD, parts of the lung enlarge greatly and form large “balloons” (bullae) in the lung. This most commonly takes place in the upper lung areas. The large “balloons” contain part of the lung that does not work well and can “crush” the rest of the remaining lung. By pressing on the rest of the lung, the lung cannot function as well as it could if it was allowed to expand normally. The surgery removes the large “balloon” parts of the lung and allows the rest of the lung to expand again.

While early data suggest that there is benefit in a select group of patients, it is still a major surgical procedure and should not be undertaken lightly. Prospective patients need to undergo very careful testing prior to consideration for this type of surgery. Your pulmonary physician, along with a thoracic surgeon, will be best able to decide if you will benefit from this surgical procedure.

Furthermore, this should not be considered a single procedure. This surgery differs from other surgeries in that you will need to take part in an aggressive pre- and post-operative rehabilitation program. The surgery is only part of the whole procedure, and this needs to be a carefully orchestrated package for it to have the maximal effect.

V. Transplant Surgery
While lung transplantation is currently being performed for some patients with late stage COPD, this is a highly invasive, complex procedure which carries substantial risk. There are strict criteria for lung transplant recipients, and there is a long waiting list. For these reasons, as well as the possible complications of any organ transplant surgery, this option is viable only in a very small, select group of patients.

Self Management - Things to Remember

• Contrary to earlier concepts, COPD can be treated successfully.

• Throw away the thoughts that your disease is self-inflicted and move on to a better lifestyle.

• There are a multitude of things that can be done to improve your symptoms.

• You can be your own best doctor by understanding your disease and how best your individual case can be treated.

• It is never too late to stop smoking. When you stop smoking, the rate of decline of your lung function readjusts to that of a normal decline associated with aging.

• Exercise is a major portion of the successful treatment of COPD.

• Nutrition is extremely important. You do not want to “burn” your breathing muscles for energy.

• You must absolutely stop smoking if you have not already done so.

• Stopping smoking improves life expectancy.

• Your anxieties can be treated. Mild tranquilizers, used with caution, can be quite effective.

• You can learn to return to doing most of the things you may have given up.

• Never be afraid to ask questions.

• Never stop educating yourself about your disease. A well-informed patient is the one who does the best.

• No two COPD patients are prescribed the same overall management. Each case is unique. Each person may respond differently to the same treatment. Therefore, your doctor may need to “try” different approaches to your case.

• A formal rehabilitation program is the best way to start exercising, but remember never stop.

• To avoid hospitalization, report a change in your symptoms early.