Maintenance medicines continued

Maintenance medications that contain an inhaled corticosteroid (sometimes referred to as steroids) are also known as ‘preventer’ medications and ICS. Corticosteroids are effective in COPD and are different to anabolic steroids. In more severe COPD, these medicines help to reduce the number of flare ups people may experience by reducing inflammation which causes swelling and sputum production in the breathing tubes or airways. They are especially important to use if you also have asthma as they specifically treat the type of inflammation or swelling that commonly occurs in asthma. Preventers must be taken twice a day every day to be effective. It may take up to a few weeks for you to start noticing their effect. So, it is important for you to keep taking them to have an impact on your symptoms.

These inhalers on their own are not used for people with COPD. They are used for asthma and for those people that have both asthma and COPD.

Beclomethasone (QVAR®) A metred dose inhaler that is recommended to be used with a spacer.
Budesonide (Pulmicort®) Comes as a Turbuhaler® or as nebules for use with nebuliser.
Fluticasone (Flixotide®) Comes in both a puffer and an Accuhaler®. If using a puffer, it should be used with a spacer.
Ciclesonide (Alvesco®) A metred dose inhaler that is recommended to be used with a spacer.

Use

  • Inhaled twice a day.
  • Must be used regularly to be effective.

Effects

  • Reduces swelling and the amount of sputum in the breathing tubes or airways.
  • May take up to a few weeks for you to notice its effect.

Side effects A sore mouth and throat caused by a thrush infection or hoarseness of the voice are the most common side effects. To avoid these effects, use a spacer when using a metered dose aerosol (puffer), and rinse your mouth and gargle after each dose).

Sometimes inhaled corticosteroids (preventers) are combined with a long-acting beta2agonist (bronchodilator) in one inhaler. This is often called ICS/LABA combination therapy. These are usually prescribed for those with moderate to severe COPD who have had two or more flare ups over the previous year. Combining medicines like this can help to reduce the number of flare ups which in turn improves lung function and overall health. In addition, combined medicines are easier to use since they are available in one inhaler for two different medicines. They are prescribed twice daily. Combination inhalers include:

  1. budesonide and formoterol (eformoterol) (Symbicort® delivered by Turbuhaler™ or Rapihaler™) – Inhale twice a day.
  2. fluticasone proprionate and salmeterol (Seretide®) delivered via Accuhaler™ or via a puffer and spacer – Inhale twice a day.
  3. fluticasone furoate and vilanterol (Breo® Ellipta®)  Inhaled once a day.
  4. fluticasone propionate/formoterol (Flutiform™).

Use

  • Designed to improve patient adherence with two medicines in one inhaler.
  • Improves quality of life, improves lung function, and prevents flare ups.

Effects and side effects Refer to individual medicines.