4. Phosphodiesterase-4 Inhibitors
Phosphodiesterase-4 inhibitors, also known as PDE4 inhibitors, also reduce inflammation and swelling in the lungs – much like all of the medications we have discussed. However, their mechanism of action is different than all of the other medications.
PDE4 is an enzyme that is present in our bodies when we have an inflammatory response. Therefore, it is present in people with COPD in high amounts, because their lungs are chronically inflamed. PDE4 inhibitors block this enzyme, which helps to reduce inflammation.
The only PDE4 inhibitor that is currently available is an oral medication called roflumilast (Daliresp). It is taken daily and is used in conjunction with a bronchodilator. Studies indicate that people prescribed Daliresp have fewer COPD exacerbations.
It is important to note that PDE4 inhibitors are NOT rescue medications – they are maintenance medications and must be taken at regular intervals in order to be effective.
Side effects include:
- Diarrhea, nausea, and vomiting
- A headache
- Back pain
- Decreased appetite
- Flu-like symptoms
Side effects typically decrease when taking the medication regularly.
Theophylline is another oral medication used to treat lung conditions such as COPD and asthma. It belongs to a drug class called methylxanthines.
Theophylline also works by opening the airways of the lungs. It works a bit differently than some of the other medications that we have discussed. It relaxes the muscles of the lungs. It also acts by “decreasing the response to substances that cause your airways to constrict.” The combination of these two actions makes it easier for people with COPD to breathe.
Although this medication may be highly effective, it is not without risks. For someone with COPD who may be on other medications for comorbid conditions, this medication can interact with many different medications.
Although this list is not extensive, here are some medications, listed by condition, that interact with theophylline. Many of these medications may increase serum theophylline levels in the body, which means that taking these medications in conjunction with theophylline can heighten the risk of side effects:
- Antibiotics: ciprofloxacin, clarithromycin, erythromycin
- Anxiety medications: diazepam, flurazepam, lorazepam, midazolam
- Blood clot medications: pentoxifylline, ticlopidine
- Depression medications: fluvoxamine
- Gout medications: allopurinol
- Heart rhythm medications: mexiletine, propafenone, verapamil, propranolol
- Birth control: estrogen
Certain seizure medications can cause a reduction in serum theophylline levels of the body, which can be dangerous if you have a seizure condition – this can mean that if you take phenobarbital or phenytoin with theophylline, you could have seizures.
The most common side effects of theophylline include a headache and insomnia. Generally, these side effects go away within a couple of weeks.
Be sure to check with your pharmacist to ensure that your current medications do not interact with theophylline if you are prescribed it.
6. Oxygen Therapy for COPD
Oxygen therapy is an excellent option for people with COPD who have a hard time maintaining their oxygen saturation. In fact, it is typically an option only for these people, as insurance coverage is tricky for oxygen therapy.
Some people need oxygen therapy for everyday life activities, while others need oxygen therapy only while they're asleep. If you need oxygen therapy, your physician will need to write a prescription that is specific to your needs.
For those that need oxygen, it can improve quality of life and can even extend life.