Any new developments in COPD?

A question from my search-engine slush pile (and it’s a long time since I’ve typed those words, because nothing new is coming through), “anything new on COPD?”.

The simple – indeed, only – answer is a resounding No. Which is the reason I have, at least for now, stopped writing about it – everything I know is now on this blog.

There have been no really new developments in treatments for COPD, or its precursors (not all COPD is smoking-related), for decades. Oh, there has been tweaking of medications, like the development of combination inhalers, but these things are less about benefiting the patient and more about protecting/extending patents.

Combo inhalers, incidentally, are really not the best treatment for everybody – or, even, anybody. For example, I take three bronchodilator inhalers, all of which work in different ways, and for different durations, and so complement each other, plus a high-dose steroid inhaler. The thing is, I do not need the same level of medication every day, or even all day.

First thing in the morning I need all my inhalers, starting with Salbutamol  before I even get out of bed. Then, at 13.00, if I’m out I’ll take them all except Salbutamol (as you know, that’s an at-need reliever – i.e. bronchodilator, so it’s not normally taken with my preventers, which are also bronchodilators, but function more slowly, and for longer, than  Salbutamol). However, if I’m at home, I might well decide not to take the 13.00 dose, especially if I’m doing nothing more strenuous than sitting here typing. The same will apply to the 17.00 dose – it depends on how I feel. At bedtime, I’ll take them all.

There are reasons for this. Firstly, as I’ve said, I don’t need everything all the time (and, of course, the long-acting bronchodilator Phyllocontin Continus is always in my system, taken at 12-hourly intervals). Another reason is that high-dose inhaled steroids create the same systemic problems as oral steroids, and, among much else, I balloon! So I try on to take that every time unless I have to. Lastly, if I take all my inhalers all the time, when I might not actually need them, I would have no fall-back position in the event of a crisis. My way, I always have a medication reserve should I need it.

I would stress that I have 63 years experience of dealing with my respiratory problems – I have had bronchiectasis and asthma since age two, when simultaneous measles and whooping cough trashed my lungs (so hey, unless you want to risk your kids winding up like me, get them vaccinated!), and I know more about my medication, and what liberties I can take with it, than most people. And that probably includes most GPs too. On that basis, unless you know exactly what you are doing, and are seriously in touch with your body (a lot of people aren’t at all aware of what their bodies are doing), you might be better off doing as you’re told by your doctors.

On that note, you might have read that Serevent (one of my inhalers), has quite a few deaths associated with it. This isn’t the fault of the inhaler, but of patients getting inadequate medical advice, and failing to ask the right question. That question, whenever you’re prescribed a new drug, is do I take it as well as what I’m already taking? It really is that simple, and you must always ask, because there’s no guarantee you’ll be told if you don’t.

In the case of Serevent – and I was told this by the doctor who prescribed it, at the Pulmonary Function Laboratory during my 2-day diagnostic trip through it – that if you use a steroid inhaler, you MUST NOT stop taking it if you are prescribed Serevent, because there is a real, if very small, risk of death if you do.