Asthma and COPD in Mississippi: Managing Your Breathing Medications the Right Way

Asthma and COPD, what they actually are

Asthma is a condition in which the airways become inflamed and narrow in response to triggers. The narrowing is reversible. Symptoms come and go, often dramatically.

COPD (chronic obstructive pulmonary disease) is progressive airway damage, typically from long term smoking or environmental exposure. The damage is not fully reversible. Symptoms tend to worsen over years.

Some patients have features of both. Treatment overlaps significantly, with important differences.

The medication categories

Rescue medications

Short acting beta agonists (SABAs) like albuterol (ProAir, Ventolin, Proventil) open the airways quickly when you are having symptoms. These are the inhalers you carry with you. If you are using a rescue inhaler more than twice a week for symptoms (not counting use before exercise), your asthma is not controlled and your maintenance therapy needs adjustment.

Maintenance inhalers

Inhaled corticosteroids (fluticasone, budesonide, beclomethasone) reduce airway inflammation. They are the foundation of asthma maintenance therapy. Long acting beta agonists (LABAs) like salmeterol and formoterol open the airways for 12 to 24 hours. They are always combined with an inhaled corticosteroid in asthma; LABAs alone increase asthma mortality and are not appropriate for asthma without an inhaled steroid.

Common combination inhalers include Advair, Symbicort, Breo, Dulera, and Wixela.

Long acting muscarinic antagonists (LAMAs)

Tiotropium (Spiriva), umeclidinium (Incruse), and others. Particularly important in COPD. Often combined with a LABA, with or without an inhaled steroid.

Triple therapy inhalers

Trelegy and Breztri combine an inhaled steroid, a LABA, and a LAMA in one inhaler. Useful for patients with moderate to severe COPD or specific severe asthma situations.

Biologics

For severe asthma not controlled with inhalers, injectable biologics including omalizumab, mepolizumab, benralizumab, and dupilumab target specific inflammatory pathways. These are managed by pulmonologists or allergists.

How to use a metered dose inhaler correctly

• Shake the inhaler well.
• Exhale fully, away from the inhaler.
• Place the mouthpiece between your teeth and seal your lips around it (or use a spacer, which is recommended for almost all patients).
• Press the canister down at the moment you start breathing in slowly and deeply.
• Continue breathing in slowly for 3 to 5 seconds after pressing.
• Hold your breath for 10 seconds.
• Exhale slowly and away from the inhaler.
• If a second puff is prescribed, wait 30 to 60 seconds before repeating.
• Rinse your mouth with water after using any inhaler containing a steroid, to prevent oral thrush.

Dry powder inhalers (Diskus, Ellipta, Flexhaler, Twisthaler) have different technique. They require a fast, deep inhale rather than slow. They cannot be used with a spacer. Soft mist inhalers (Respimat) require yet another technique. Your pharmacist can walk you through whichever device you are using.

Common mistakes

• Not using a spacer with a metered dose inhaler. Spacers improve delivery to the lungs significantly and are recommended for almost all patients.
• Inhaling too quickly with a metered dose inhaler. Slow breathing is correct.
• Inhaling too slowly with a dry powder inhaler. Fast breathing is correct.
• Not holding the breath after inhaling. Letting the medication out immediately reduces deposition.
• Not rinsing the mouth after steroid inhalers, leading to oral thrush or hoarseness.
• Letting the canister run completely empty before refilling, which means dose counts at the end are unreliable.
• Using a maintenance inhaler only when symptoms are bad, instead of every day.
• Using a rescue inhaler so often that it stops working effectively.

What good control looks like

Well controlled asthma means no rescue inhaler use more than twice a week, no nighttime symptoms, no activity limitations, and no exacerbations requiring oral steroids in the past year. If any of those are not true for you, your maintenance regimen probably needs adjustment.

Well controlled COPD means stable symptoms, no exacerbations, and the ability to do daily activities without significant breathing limitation.

Where pharmacy fits

Beyond technique checks, your pharmacist can help align your inhalers across prescribers (you may have a pulmonologist and a primary care physician both prescribing), coordinate refills so you do not run out, help with cost when one inhaler is dramatically more expensive than another in the same category, and flag interactions, particularly between beta blockers and certain breathing medications. Serving Hattiesburg, the Pine Belt, Central Mississippi, and South Mississippi.

When to call a pharmacist

• You have a new inhaler and have not done a technique check.
• You are using your rescue inhaler more than twice a week.
• You have had two or more exacerbations in the past year requiring oral steroids.
• You are pregnant and on inhaler medications.
• Your inhaler is significantly more expensive than you think it should be.
• You cannot afford a refill and need help identifying assistance programs.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.