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Home > Treating Your COPD

Breathing Easier with the Right
Treatment and the Right Device for You

Nebulizer Myths and Facts A nebulizer is a device that provides medication in a mist. It is an easy way to take your COPD treatment. Read more.
Doctor Discussion Guide for Patients with COPD Talking with your doctor about your COPD treatment can be difficult. Use this guide to prepare for a conversation with your doctor. Make a plan.
About PERFOROMIST PERFOROMIST works all day to help you breathe easier and get back to doing some of the things you enjoy doing.15,21 Learn more.

You have many therapy options for treating COPD. Your doctor may prescribe one COPD medication or a combination of COPD medications to help you breathe easier. There are also several different kinds of devices that can be used to inhale your COPD medication.

This wide range of options means you have choices to make with your doctor concerning which treatment and which device are best for you. While this may seem like a big responsibility, it's great to have options when treating COPD. It allows you to find a treatment you are comfortable taking, and that helps you breathe easier.

COPD Treatment Options

Bronchodilators

Bronchodilators (bronk-oh-dial-ay-tors) are central to managing symptoms in COPD.5 This type of medication opens up the bronchial tubes and is frequently used to treat symptoms like shortness of breath, cough, wheezing, and chest tightness.1,5 Bronchodilators come in either oral (a pill) or inhaled form. The inhaled form works faster because the medicine goes directly into your lungs instead of going through the digestive system and bloodstream first.13

Types of bronchodilators include:

"Rescue" Medication

Rescue medication is usually the first type of medication prescribed for someone with COPD. It is meant to be used only when needed. Rescue medication includes:5

  • Short-acting bronchodilators, which are used for relief of flare-ups (coughing, wheezing, or a sudden shortness of breath) and last a few hours.5 These include short-acting beta2-agonists, or SABA, such as albuterol.14

Maintenance Medication

Maintenance medication is added to a patient's treatment plan when COPD symptoms get worse and can no longer be controlled by rescue medication alone.5 Maintenance medications are meant to be taken every day and help to continuously control symptoms. These medications include:

  • Short-acting anticholinergics (ant-eye-call-in-er-jiks), such as ipratropium, which are usually taken four times daily.15
  • Long-acting bronchodilators, which provide sustained relief (12 or 24 hours) and are taken once or twice daily. These include:
    • Long-acting beta2-agonists, or LABA, such as PERFOROMIST® (formoterol)
    • Long-acting anticholinergics like tiotropium

Combinations

Sometimes medicines are combined for convenience. For instance, your doctor might prescribe for you a SABA/ipratropium combination, so you have two short-acting drugs, one typically taken for rescue and one for maintenance, together in one inhaler, to be taken four times a day.16

Note that your doctor might also prescribe two or more separate medications for you to be used in different situations. For instance, even if you are taking a long-acting bronchodilator for maintenance, you will also need a "rescue" inhaler for sudden episodes of difficulty breathing.1

Beta2-agonists and Anticholinergics

Beta2-agonists open the airways by relaxing the muscles around them.5 Anticholinergics work in a similar way by relaxing the airways (muscle and cholinergic nerves) and helping to keep them open.17

Device Options

Bronchodilators can be delivered by several types of devices. Devices are a means of delivering your medication. The device you and your doctor choose can depend on what you prefer, and what allows you to get the right dose. They include:

  • Nebulizers
  • Handheld inhalers
    • Metered dose inhalers (MDIs)
    • Dry powder inhalers (DPIs)

A nebulizer is a machine that creates a gentle mist you can inhale without having to take deep breaths. It takes longer to use than an MDI or DPI, but you relax and breathe normally while using it. This way most people receive the recommended dose of medication. MDIs and DPIs are types of handheld inhalers that you can carry around with you. While they are convenient and portable, they also require you to coordinate your breathing and actions. The fact is, many people improperly use their inhalers and therefore may not get a full dose.5,18

Your doctor may consider other options to treat COPD.

Theophylline

Theophylline relaxes muscles around the breathing passages so the breathing tubes can open and you can breathe easier. This medication is also believed to suppress response of the airways to stimuli. Due to its potential for side effects, bronchodilators are usually preferred.5,19

Corticosteroids

Inhaled corticosteroids may reduce the frequency of flare-ups (coughing, wheezing or a sudden shortness of breath). These drugs are recommended for a limited amount of time, as long-term use has been associated with side effects.5

Combination Therapies

Your doctor may recommend a COPD therapy that includes two medications pre-packaged together in one device. For example, an anticholinergic drug and a short-acting beta2-agonist can be taken together in the same device, either with a nebulizer or a metered dose inhaler. A combination of two drugs that work differently and have different durations of action (how long they work) may improve your breathing.5

Oxygen

Oxygen may help people with severe COPD. If you require additional oxygen, your physician will prescribe it and monitor oxygen levels in your blood.

Antibiotics

Antibiotics are only given for infections, such as pneumonia, which may accompany COPD. Antibiotics don't treat COPD.5

Surgery

There are some surgical procedures that can help people with COPD.5

Pulmonary Rehabilitation

Broad-based programs for improving all aspects of life with COPD have been very successful. Pulmonary rehabilitation programs include medical management, exercise, education and nutritional counseling.5

It's important that your symptoms are controlled as well as possible so you can focus on living life to the fullest and not worrying about your breathing. Let your doctor know if you feel you need more relief from your COPD symptoms. Having a conversation with your doctor is the best way to determine whether or not a COPD treatment is working for you, and whether or not you are ready to consider other options. For help making a plan to talk to your doctor about treatment options, click here.

Next topic: Nebulizer Myths and Facts

References

  1. PERFOROMIST Prescribing Information. Napa, CA: Dey Pharma, L.P. 2010.
  2. Gross NJ, Nelson HS, Lapidus RJ, et al; Formoterol Study Group. Efficacy and safety of formoterol fumarate delivered by nebulization to COPD patients. Respir Med. 2008;102(2):189-197.
  3. Mannino DM et al. MMWR Surveill Summ. 2002;51:1-13.
  4. National Institutes of Health/U.S. Department of Health & Human Services. National Heart Lung and Blood Institute Diseases and Conditions Index. What is COPD? Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html. Accessed July 13, 2011.
  5. Rodriguez-Roisin R, Anzueto A, Bourbeau J, et al; GOLD Executive Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2009). Global Initiative for Chronic Obstructive Lung Disease website: http://www.goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html. Accessed March 8, 2010.
  6. National Heart Lung and Blood Institute: National Institutes of Health. When you are diagnosed with COPD. Available at: http://www.nhlbi.nih.gov/health/public/lung/copd/breathing-better/taking-action.htm. Accessed July 13, 2011.
  7. American Lung Association. Living with COPD: a life change. Available at: http://www.lungusa.org/lung-disease/copd/living-with-copd/life-change.html. Accessed July 13, 2011.
  8. CDC FastStats: Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema. Available at: http://www.cdc.gov/nchs/fastats/copd.htm. Accessed April 11, 2011.
  9. CDC Vital and Health Statistics. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2009. Hyattsville, Maryland. 8/2010.
  10. U.S. Department of Health and Human Services. Caregiver tip sheet. Available at: http://www.strokecamp.com/content/resourcesCAR/CaregiverTipSheet.pdf. Accessed on July 13, 2011.
  11. Data on file. Evaluation of concepts for Perforomist. Dey #0257 Final research report (market research). LinguiSearch. March 23, 2011.
  12. Nelson HS, Gross NJ, Levine B, et al. Formoterol Study Group. Cardiac safety profile of nebulized formoterol in adults with COPD: a 12-week, multicenter, ranodmized, double-blind, double-dummy, placebo- and active-controlled trial [published correction appears in Clin Ther. 2009;31(4):920].
  13. Proventil HFA Prescribing Information. Kenilworth, NJ: Schering-Plough. 1998.
  14. Atrovent HFA Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. 2010.
  15. Combivent Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. September 2010.
  16. Spiriva HandiHaler Prescribing Information. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. and New York, NY: Pfizer Inc. 2010.
  17. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol treatment: evidence-based guidelines. Chest. 2005;127(1):335-371.
  18. Theophylline extended-release tablets prescribing information. Kansas City, MO: Nostrum Laboratories, Inc. May 2009.
  19. Pari Trek S Compact Compressor Nebulizer System. Instructions for use. Revised 2006.
  20. Geller DE. Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir Care. 2005;50:1313-1321.
  21. Advair HFA Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2011.
  22. Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. In press.
  23. Van der Palen J, Klein JJ, Kerkhoff AH, van Herwaarden CL, Seydel ER. Evaluation of the long-term effectiveness of three instruction modes for inhaling medicines. Pt Ed Couns. 1997;32:S87-S95.
  24. Data on file. Survey conducted by KRC Research: COPD Patient and Caregiver Studies, March 2009. Dey Pharma, LP.
  25. Advair Diskus Prescribing Information. Research Triangle Park, NC: GlaxoSmithKline. 2011.
  26. Pulmicort Flexhaler Prescribing Information. Södertälje, Sweden: AstraZeneca. 2010.
  27. Mayo Clinic. Asthma inhalers: which one’s right for you? Available at: http://www.mayoclinic.com/health/asthma-inhalers/HQ01081/METHOD=print. Accessed August 22, 2011.
  28. Symbicort Prescribing Information. Dunkerque, France: AstraZeneca. 2010.
  29. Centers for Medicare & Medicaid Services. Department of Health and Human Services, USA. Medicare and Home Health Care. Available at: www.medicare.gov.
  30. Centers for Medicare & Medicaid Services. Medicaid Program—General Information: Overview. Available at: www.cms.gov/MedicaidGenInfo/. Accessed June 23, 2011.

Please see full Prescribing Information and Medication Guide, including Boxed Warning.

Indication

PERFOROMIST (formoterol fumarate) Inhalation Solution is used for the long-term treatment of chronic obstructive pulmonary disease (COPD) including chronic inflammation of the lungs (bronchitis) and emphysema. It is only to be used with a nebulizer and is taken twice daily (morning and evening).

WARNING: ASTHMA-RELATED DEATH

PERFOROMIST Inhalation Solution belongs to a class of drugs called long-acting beta2-agonists (LABA). People with asthma who take LABA such as PERFOROMIST Inhalation Solution have an increased risk of death from asthma problems. Do not use PERFOROMIST Inhalation Solution if you have asthma without using a long-term asthma control medicine.

IMPORTANT SAFETY INFORMATION

Warnings and Precautions
PERFOROMIST Inhalation Solution should not be used instead of rescue inhaler or nebulized medicine for the treatment of acute symptoms. Extra doses of PERFOROMIST Inhalation Solution should not be used for that purpose since overuse can cause serious heart problems, including death. Acute or sudden symptoms should be treated with an inhaled short-acting beta2-agonist. Seek immediate medical attention if:

  • your symptoms quickly worsen despite recommended doses of PERFOROMIST Inhalation Solution
  • PERFOROMIST Inhalation Solution treatment becomes less effective
  • you need more inhalations of a short-acting beta2-agonist (rescue inhaler or nebulized medicine) than usual.

Do not use PERFOROMIST Inhalation Solution with other LABA medicines for any reason.

How to Use PERFOROMIST Inhalation Solution
Use PERFOROMIST Inhalation Solution exactly as directed by your health care professional. Do not stop using PERFOROMIST Inhalation Solution or other medicines to control or treat your COPD unless told to do so by your health care professional because your symptoms might get worse. Your health care professional will change your medicines as needed.

Co-existing Conditions
The use of PERFOROMIST Inhalation Solution with certain health conditions or with certain medications can cause serious side effects. Tell your health care professional about all of your health conditions, including if you:

  • have heart problems
  • have high blood pressure
  • have diabetes
  • have seizures
  • have thyroid problems
  • have liver problems
  • are pregnant or planning to become pregnant. It is not known if PERFOROMIST Inhalation Solution can harm an unborn baby.
  • are breastfeeding. It is not known if PERFOROMIST Inhalation Solution passes into breast milk and if it can harm your baby.

Drug Interactions
Tell your health care professional about all the medicines you take including prescription and over-the-counter medicines, vitamins and herbal supplements. PERFOROMIST Inhalation Solution and certain other medicines may interact with each other and cause serious side effects.

Side Effects
The most common side effects reported in patients taking PERFOROMIST Inhalation Solution were diarrhea, nausea, nasopharyngitis, dry mouth, dizziness, and insomnia. Serious side effects may include sudden shortness of breath, serious allergic reactions, chest pain, increased or decreased blood pressure, a fast and irregular heartbeat, low blood potassium, high blood sugar, and high blood acid.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.