Harvard Women's Health Watch

Short of breath? Here's what you can do

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Both asthma and chronic obstructive pulmonary disease (COPD) can be managed successfully with the right medications.

Shortness of breath, persistent coughing, and wheezing are well-known symptoms of both asthma and chronic obstructive pulmonary disease (COPD). Yet the two disorders have separate causes. COPD, which includes emphysema and chronic bronchitis, is primarily due to changes in lung tissues brought on by smoking and abetted by aging. Asthma is essentially an allergic reaction that causes muscle spasm and mucus secretions that close the airways.

But having one doesn't exclude having the other. As many as 15% of older people who have COPD may also have asthma, and women are more likely than men to have both. Moreover, those who have both conditions tend to be sicker.

"Studies show that patients with both asthma and COPD have more symptoms, have more flare-ups, use more medication, and are hospitalized more often than patients with COPD alone," says Dr. Craig Hersh, assistant professor of medicine at Harvard Medical School.

People with either condition are cautioned to avoid things that trigger flares, like dust, air pollution, extreme cold, and, of course, tobacco smoke. Bronchodilators—inhaled medications that open the airways—are prescribed for both asthma and COPD. However, some drugs work better for treating asthma while others work better for COPD, so it's important to get the right diagnosis, Dr. Hersh says.

Medications for asthma

Asthma is essentially an allergic response that causes swelling of the large airways (bronchi), which lead from the trachea to the lungs, and the small airways (bronchioles), which branch out inside the lungs. It is treated primarily with inhaled medications.

Corticosteroids like fluticasone propionate (Flovent) or budesonide (Pulmicort), which help control lung inflammation, are used daily to prevent flare-ups. They are commonly called "controller" medicines.

Long-acting beta-agonists like formoterol (Foradil) or salmeterol (Serevent) can be added if asthma is more severe, either separately or combined with a corticosteroid in drugs like Advair (fluticasone and salmeterol) or Symbicort (budesonide and formoterol). They also are "controllers."

Beta-agonists like albuterol (ProAir, Proventil, Ventolin) relax the bronchioles. Used only when symptoms occur, they're called "quick relievers."

Options for severe asthma that hasn't responded to other treatments include

  • inhaled drugs like cromolyn or theophylline, which are effective but may have serious side effects in older patients

  • pills to block inflammation, such as montelukast (Singulair), zafirlukast (Accolate), or zileuton (Zyflo CR)

  • injections of omalizumab (Xolair), which shuts down allergic reactions.

Get the most from your meds

  • Don't skimp. Inhaled drugs can be expensive, but it's important to take them regularly. Check with your doctor and health plan about the most affordable options.

  • Learn to use inhalers properly. There are several different types of inhalers and spacers, and all are used somewhat differently. Take your first puffs in your clinician's office under observation to make sure you're getting the full benefit of the medication.

  • Rinse your mouth with water after using corticosteroid inhalers. Washing away excess medication reduces the likelihood of developing a common side effect—thrush, an oral yeast infection.

  • Consider a nebulizer. If you find inhalers difficult to use, ask about getting a medication that is delivered by a nebulizer, which creates a vapor that you inhale through a mask or mouthpiece.

Treating COPD

COPD develops when lung tissues lose elasticity, which prevents them from expelling air and mucus efficiently. Keeping airways open helps increase oxygen and prevent infection.

As a first treatment for mild COPD symptoms, your doctor might prescribe a short-acting bronchodilator, such as

  • an anticholinergic, like ipratropium (Atrovent HFA), which relaxes the bronchi

  • a beta-agonist, like albuterol

  • a combination of a beta-agonist and an anticholinergic, like Combivent (albuterol and ipratropium), to open the airways.

  • If your symptoms worsen you may be given

  • a longer-acting inhaled bronchodilator, like tiotropium (Spiriva) or aclidinium (Tudorza)

  • an inhaled corticosteroid or a combination of a longer-acting beta-
    agonist and corticosteroid, like Advair, Symbicort, or Breo (fluticasone and vilanterol)

  • a newer oral anti-inflammatory drug, roflumilast (Daxas, Daliresp), to reduce the number of flare-ups if you have them frequently.

If you have COPD, be sure to get a flu shot and pneumonia vaccines. Call your doctor when you have a respiratory infection, which can trigger a COPD flare; you may need an antibiotic or antiviral medication.