This is a quick nutshell overview there’ll be other videos with more details but these are medications for asthma and copd most patients that have asthma and copd can take the same these same medications but there are some that for example asthma patients don’t take such as anti-cholinergic drugs it’s just not efficacious for c for asthma as it would be for copd
Copd goes a little bit deeper with the impaired gas exchange and damage to the alveoli much more thickening and secretions in the in the deep in the bronchial tree and so therefore they uh need many times anticholinergic medications to help that so there’s anti-inflammatory medications are the first one here and those include your corticosteroids as well as other
Types of anti-inflammatory agents we which we will get into more detail but here’s a couple examples here dalla resp is only used for copd and it’s used for those that uh you know they’re on a lot of inhalers and they’re not really getting good relief and that’s a pill form and zolair is used for asthma and this is more of a immune modulator medication it does
Not cause actually does not cause issues with your immune system decreasing because it’s dealing only with the allergic response in your body then there’s bronchodilators to open up the bronchials which is used for both there’s the leukotriene receptor antagonists such as singulair that’s used in very commonly in asthma and allergies we have monoclonal antibodies
And the phosphodiesterase which is not used very often copd patients these are the anticholinergic drugs dry dry it up and then we have combination drugs so we see asthma patients on combination of bronchodilators and anti-inflammatory such as your um your steroid inhalers also yeah which is this one right here the glucocorticoids long acting beta agonists and
Then there’s also beta adrenergic to open up the airways and an anti-cholinergic those are used for copd patients these can be used for both right here is an overview of respiratory inhalers well not just inhalers but respiratory medications for asthma and copd i’m just going to go over this really quickly here so we have short acting beta agonists right here and
Then you have long-acting beta agonists remember beta-2 agonists they remember you have alpha and beta cells so these work on the beta cells to promote opening of the airways or dilation of the airways so you have to go back to what your parasympathetic and sympathetic nervous system are doing so kind of if you need to review that go back and review that what it
Does is open up the bronchioles the short acting works within 15 minutes this is your albuterol i think most of you probably heard of albuterol these are the brand names so i determine which one they get depending on what their insurance company wants them to get or let’s say they don’t have insurance and i’m going to find out from the insurance company which one
Is the cheapest but these are all the same they open the bronchioles then we have the long acting they’re really not given alone anymore uh if you’re gonna see it it’s more for copd given alone but studies out there have shown that uh it causes mortality if you’re taking a long-term beta agonist uh if you’re over using it i should say so it’s not used in asthma as
Much what they do though if look at the next line you have your cortical steroids remember that reduces inflammation again which one am i going to pick it depends on what the insurance wants so every patient that has moderate to severe asthma is going to be on a cortical steroid but everybody that has asthma has one of these on hand because if they have a trigger
That triggers and they need something to open up their bronchioles right away so they could have one of these on hand and they’ll always have this on hand but what happens is many patients say well i’m taking one of these medications let’s say that they’re taking um qvar because that’s a common one cuvar and you take qvr once a day most of these you will take
Once a day some you take twice usually once these patients don’t notice any difference because it’s working slowly to reduce inflammation you’re not getting that instant open up your airway relief like you do with the beta agonist so what they’ve done now well it’s not now this has been around for years is they take the short acting plus the long acting equals
Combination medication so if we look here these are all your combination medications of a cortical steroid here plus a lung acting beta 2 agonist if you take it how it’s prescribed then it will be safe but with any medication with these we want to be on the lowest dose possible so these patients a lot of times are going to be in your advair or there’s briolip
Dust dullara symbicort these are used very commonly with copd and asthma patients we will go over guidelines in another slide set there’s also muscarinic anti-tagginess these are used for copd only because of the mechanism of action these are your atrovent and cursed elliptis by riva spyriva respond to doors these have been out for quite a while they do the same
Thing again it depends on the insurance and what’s going to pay but let’s say someone’s resistant that’s when we go to these biologic medications and these are used uh for asthma patients that have severe asthma that are not responding to these treatments i’m not going to go into bronchial thermoplasty or yeah i’m not going to go into that one the dala resp is
Used for copd which we will go over in another slide but this just gives you an overview of how many are out there and when you are a prescriber you have a few that are kind of in your arsenal i call it that you prescribe most often but again you get used to what insurance companies cover what if like i have state medicaid patients and it usually changes every
Three to six months sometimes quicker for example q vars on their formulary and so is pro air so that’s what they want me to prescribe so that’s what i’m going to prescribe uh it’s usually playing the game of saying all right i’m going to give you an ad bear in the ins and the pharmacy says no it’s not cover and they sent something back to me saying it’s not
Covered then i have to pick a different one all right let’s try some doulera and then they say it’s not covered and we go on and on so i try to get the pharmacy to say you need to give me a list of medications that’s covered which is beneficial for the patient so we’re not wasting time going back and forth and further treatment of their asthma or copd
Transcribed from video
Asthma and COPD Medication Overview By Dr. Jennie Peters
