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COLD is associated with a number of complications as lung function worsens. Various treatments may be required.
Opioids. Opioids, such as morphine, are generally not used for patients with COLD because of a concern that they may reduce respiratory function. Nonetheless, some studies are reporting that low doses of oral morphine can improve severe breathlessness in patients who cannot find relief from other methods. Such agents can cause nausea, vomiting, and constipation.
Antidepressants and Antianxiety Agents. Antidepressants or antianxiety medications may be helpful.
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Improving Sleep. More than half of patients with COLD often suffer from insomnia. Most of the standard sleep agents may impair lung function. Newer ones, such as zolpidem (Ambien), zaleplon (Sonata), and zopiclone (Imovane), may be less hazardous than older agents. Tricyclic antidepressants may also be helpful without significant effects on breathing. Behavioral methods are the best approach to this problem, however. [SeeWell-Connected Report #27 Insomnia.]
Treating Heart Failure. When patients are in advanced stages of COLD, they may need treatment for fluid accumulation and congestive heart failure. [See Well-Connected, Report #13, Congestive Heart Failure.]
Administering Inhaled Drugs
Most COLD drugs are inhaled using metered dose inhalers, dry powder inhalers, or nebulizers.
Metered-Dose Inhaler. The standard device has been the metered-dose inhaler (MDI). This device, particularly when used with a holding chamber, allows precise doses to be delivered directly to the lungs. MDI-delivered drugs must be used regularly as prescribed and the patient carefully trained in their use in order for them to be effective and safe. Some patients hold the MDI too close to their mouths, or even inside them. Others may exhale too forcefully before inhalation. The holding chamber, or spacer, allows the patient additional time to inhale the medication and so improves delivery. They vary, however, in their ability to deliver medication. For example, in one study the AiroChamber-Plus was more effective than the EasiVent in delivering an inhaled steroid. It should be noted that often MDIs continue to deliver propellant after the drug has been used up. Patients should track their medicine and throw the device away when the last dose has been administered.
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