Medicines for COPD

introduction

Because COPD (Chronic Obstructive Pulmonary Disease) is an inflammatory degenerative disease that causes certain parts of the respiratory system, the bronchi, to swell, two types of medication are used in your treatment. On the one hand find so-called bronchodilators application. This is a group of medications that cause the bronchi to dilate across the body's own pathways, decreasing airway resistance and facilitating breathing. On the other hand, cortisone is also used from a certain extent of the disease, a body-own substance, which has a strong anti-inflammatory effect and thus alleviates the symptoms. However, as cortisone, when used regularly, can have many side effects and make it susceptible to infections, the step-by-step therapy for COPD begins with combinations of the bronchodilator group.

All these drugs are usually given locally, that is, acting directly on the lungs. These are, for example, powders which are atomized and inhaled or liquids which are also inhaled.

Brochodilatoren

Bronchodilators are medicines that dilate the bronchi, which means the larger airways. In certain situations, especially during exercise, the body wants to dilate the airways and thus simplify breathing. After exercise and at rest, the airways are then closed again. For this purpose, the body uses certain messenger substances and signaling pathways. Bronchodilators use these body-own mechanisms by mimicking the dilating messenger and signaling substances or by blocking the constricting substances.

In a COPD patient, the airways are constantly narrowed, on the one hand by mucus, but also by inflammatory swelling. Bronchodilators facilitate breathing, which can greatly improve the symptoms.

Beta-2-Symphathomimetika

Body functions that we can not control consciously, such as the digestion or the speed of the heartbeat, are controlled by the so-called autonomic nervous system, which can be subdivided into two antagonists: the sympathetic and the parasympathetic. While the parasympathetic nervous system is more likely to promote processes that help the body recover, the sympathetic promotes processes that make the body fit to fight or flee: it makes the heart beat faster, tenses muscles, and mobilizes power reserves, throttling for the moment irrelevant functions such as digestion and also raises the bronchi wide.

This principle is exploited drugs from the group of beta-2-sympathomimetics. They act on the bronchi via the same signaling pathway as the messenger substance of the sympathetic nervous system (norepinephrine or adrenaline) and thus lead to a dilation of the bronchi. It is easy to deduce that an overdose of such a drug can lead to side effects such as palpitations, sweating and nervousness.

anticholinergics

Anticholinergics follow a similar principle of action as the beta-2-sympathomimetics described above. They also dilate the bronchi, but not by imitating the sympathetic (see above), but by inhibiting its antagonist, the parasympatheticus. Its messenger substance is namely acetylcholine, which causes a constriction on the bronchi. An anti-cholinergic drug thus inhibits this mechanism and prevents the bronchi from contracting. For example, overdosing may result in a dry mouth, as salivating, which is usually promoted by the parasympathetic nervous system, is then also inhibited.

Because beta-2-sympathomimetics and anticholinergics target a similar but not the same signaling pathway, they can also be used together, thus mutually reinforcing (synergistically).

PDE4 inhibitors

The phosphodiesterase 4 is an enzyme in many cells (especially in immune cells), which cleaves the signaling substance cAMP and thus promotes inflammatory reactions. If this enzyme is inhibited, the signal substance cAMP remains longer and the ignition is not promoted. As with cortisone, this reduces mucus production and mucosal swelling of the bronchi. It has been shown in studies that PDE4 inhibitor in combination with other standard drugs of COPD-stage therapy causes a significant improvement of the symptoms. Furthermore, the drug is very well tolerated and has only rarely side effects.

theophylline

Theophylline is a medicine that can alleviate the symptoms of COPD by several means. First, it inhibits the phosphodiesterases and thus acts via the mechanism described under "PDE-4 inhibitor". But it also blocks a receptor that is found on the cells of the bronchi and thus leads to a dilation of the bronchi. In addition, it promotes the stroke of the cilia in the bronchi, which carry away the mucus. However, since theophylline is very easily overdosed (small "therapeutic range") and studies have shown that the risk of dying of cardiovascular disease is increased, theophylline is only used as a reserve drug in difficult-to-treat COPD cases.

What is the effect of cortisone?

Cortisol is known to many people as the "stress hormone" of the body. Cortisol has several functions, all of which aim to help people function under stress. Among other things, cortisol awakens, suppresses energy-consuming inflammatory reactions and promotes degradation processes, which lead to energy release. Cortisone is the transport form of the hormone cortisol.

With local application of cortisone so there occurring inflammatory reaction via endogenous signaling pathways are suppressed. In the case of COPD, the mucous membrane is inflamed and thus swells due to a constant irritation of the bronchi, usually due to smoking. Cortisone inhibits this inflammation and thus causes a swelling of the mucous membrane and a reduced mucus reduction, which together causes an improvement of the symptoms.

However, since cortisone also promotes local infections by inhibiting the body's defense, which can be particularly difficult in COPD patients, it is only added to the higher levels of COPD-stage therapy.

When do you need oxygen?

From a certain stage of COPD, it can be very difficult for the patient to breathe in enough, so that the blood can be completely saturated with oxygen. The oxygen saturation of the blood can be measured. It is usually 95% -100% in healthy people. If it falls below 90% in a COPD patient, treatment with oxygen may be considered. The decision also depends on the subjective feeling of the patient. Once oxygen therapy is started, it is often the case that the (psychological) need for oxygen is getting bigger and the patient does not get rid of it so easily. An oxygen therapy in COPD can only be considered useful up to an amount of one liter / min. Higher doses are even dangerous over a longer period of time. In a healthy person, the respiratory drive is controlled by the amount of CO2 in the blood. But since COPD patients can not breathe out CO2 well, the body gets used to an increased amount in the blood. The control of inhaling and exhaling is therefore made dependent on the oxygen saturation of the blood. If the amount of oxygen in the blood is greatly increased by an excessive oxygen therapy, the respiratory drive drops massively and dangerous respiratory depression can occur.

Are there any over-the-counter medications?

The drugs mentioned are all prescription. At best, expectorant drugs are available in the pharmacy without a prescription (see expectorant medicines). In the early stages of the disease, you may be able to alleviate the symptoms with home remedies. For example, an inhalation with sage tea or salt water may be used to dissolve the mucus and allow it to cough up better. However, the most effective and cheapest remedy for COPD is definitely to quit smoking as the disease inevitably and incessantly worsens due to continued smoking.

Are there any new medicines that could help soon?

As COPD is getting better understood, there are also many starting points for new drugs. Currently, most focus on the inflammation inhibition in the bronchi, as this is the "sticking point" of the disease. One consideration is whether to administer the PDE4 inhibitors, which were previously only available in tablet form, possibly also by inhalation and thus locally and directly in the lungs effective. In addition, research is being conducted on a drug that may suppress the production of pro-inflammatory messengers via a new pathway (inhibition of p38 MAP kinase).

Another interesting group are the CXCR-2 antagonists, which could prevent accumulation of inflammatory cells in the lungs. However, as medications must always go a long way to approval, it is unclear when and if these drugs will be marketed.

Mucolytic drugs

In pharmacies, various expectorant drugs are sold over the counter, which should also facilitate breathing in COPD. Among other things, there is the so-called ambroxol, which has a very well-proven efficacy. Related to Ambroxol is the bromhexine, which is also available in pharmacies. Since it is partly converted in the body to the more effective Ambroxol, it is recommended to try Ambroxol directly.

Another well-known drug is the ACC (acetylcysteine), which is also used as a decongestant for colds and as an antidote for paracetamol intoxications. Its effectiveness as Schleimlöser, however, is only partially proven. A subjective improvement of stuck mucus is often achieved by inhalation, be it with water, salt water or tea.


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