COPD: Is Spiriva, Advair or Xopenex right for you?

The following question was emailed to me, and I've decided the answer would be of interest to many of my readers.

Your Question:

Hey - I'm a student therapist right now but I was talking to my manager about her mother and she has emphysema. She's on home oxygen and her doctor prescribed xopenex BID via HHN, advair BID, and spiriva QD. I'm wondering if this is a little excessive considering xopenex and salmeterol are both beta-adrenergic bronchodilators and considering xopenex is a short acting bronchodilator while salmeterol lasts much longer why is the doctor prescribing the xopenex? She doesn't have asthma so I don't believe she has a need for a fast acting bronchodilator. Also since shes taking salmeterol (in advair) twice a day, is the spiriva really needed as well?

My Answer:

Great question. I think your doctor is right on track with the Advair and spiriva. Advair has both a long acting bronchodilator and corticosteroid component to prevent bronchospams and control inflammation. Spiriva, believe it or not, has been proven to improve lung function, something every emphysema patient could benefit from.

Xopenex should definitely be ordered, but only on an as needed (prn) bases to treat acute episodes of shortness of breath due to bronchospasm. In my opinion, there is no added benefit from pre-set frequency of Xopenex unless the patient is often short of breath despite all the other medicines.

Here's an exception to that last statement: some COPD patients have trouble deciding when they need to use their rescue medicine. For these patients, a set frequency may be indicated. For the most part, however, Xopenex should only be used if it is needed.

One of the neat things about Spiriva only being needed once a day, and Advair twice a day, is this improved patient compliance with these meds. With improved compliance, the rescue medicine (Xopenex and Albuterol) should be needed less often.

Note: All asthma and COPD patients should have either a xopenex or Albuterol inhaler handy at all times, and perhaps, if indicated, the capability to take breathing treatments.