COPD? Don't smoke, take inhalers as directed

Q. I have COPD, chronic obstructive pulmonary disease. My doctor tells me that my main problem is chronic bronchitis, but I also have some mild emphysema. I quit smoking four years ago. I'm on three different inhalers. I don't seem to be getting any better. I wonder if giving up cigarettes was worth it.

A. Most people with COPD have a combination of chronic bronchitis and emphysema. Don't go back to smoking. That is the one thing you can do to prevent your COPD from getting worse.

Other than not smoking, treatment options for COPD are limited. And those that do work only help decrease symptoms, they can't reverse lung damage.

On a more positive note, inhaled medicines can decrease your coughing and shortness of breath. They also help to reduce how often COPD flare-ups or exacerbations occur.

The inhaled drugs most commonly used are:

Long-acting beta agonists, such as salmeterol (Serevent) and formoterol. These drugs help keep airways open.

Anticholinergic agents, such as ipratropium (Atrovent) and tiotropium (Spiriva). These drugs also help keep airways open. Some experts believe they are slightly more effective.

Corticosteroids, such as fluticasone (Flovent), budesonide and many others. Inhaled corticosteroids decrease inflammation in the airways.

Many people with COPD use an inhaler that combines a long-acting beta agonist to open the airways and a corticosteroid. Two examples are Advair and Symbicort.

In this month's issue of the journal Chest, researchers reported results of a study examining the question: "Do people have fewer flare-ups of COPD if they use an inhaled corticosteroid daily?" People with COPD who inhale corticosteroids daily have a higher risk of pneumonia than those who don't use them. The researchers' findings suggest that inhaled corticosteroids for the average person with COPD do not prevent flare-ups.

Don't stop any of your inhalers without discussing it with your doctor. Since your main problem is chronic bronchitis, you may be getting more benefit than you realize.