Treatment for Chronic Obstructive Lung Disease

(Page 2)

Newer beta2-agonists, including levalbuterol (Xopenex), have more specific actions than the older medications. Most are inhaled and are effective for 3 - 6 hours.

Long-Acting Beta2-Agonists. Long-acting beta2-agonists salmeterol (Serevent) and formoterol (Foradil) are proving to be particularly effective as long-term maintenance therapy for COPD. They reduce exacerbations by 20 - 25%, may help prevent bacteria from building up on the airways and may offer real improvements in lung function. A nebulized formulation of formoterol is also available for the treatment of COPD.

Some inhalers combine a long-acting beta2-agonist and a corticosteroid (such as Advair, Seretide, and Symbicort). However, recent research is questioning whether adding inhaled corticosteroids to inhaled long-acting beta agonists has any significant benefit. The combination does not have a major impact on the number of severe COPD exacerbations or mortality.

---

---

Side Effects. Side effects of both long- and short-acting beta2-agonists include anxiety, tremor, restlessness, and headaches. Patients may experience fast and irregular heartbeats. A physician should be notified immediately if such side effects occur, particularly in people with existing heart conditions. Such patients face an increased risk of sudden death from heart-related causes. This risk is higher with medications taken by mouth or through nebulizers, but there have also been reports of heart attacks and chest pain (angina) in some patients using inhaled beta2-agonists.

Loss of Effectiveness and Overdose. There has been some concern that short-acting beta2-agonists may become less effective when taken regularly over time, increasing the risk of overuse. The degree to which this affects the airways is uncertain. In some studies, these drugs became less effective with longer use. However, the peak effect appears to remain, making these drugs still useful for attacks. Regular use of long-acting beta2-agonists may reduce the effectiveness of short-acting forms.