Virtual Pulmonary Rehabilitation | Module 3

OVERVIEW

Selecting the right respiratory medication and medication delivery device is a decision best made by you and your healthcare team.

By the end of this module, you will have met the following goals:

Goal 1: Learn to read and understand your prescription label

Goal 2: Learn about the medications currently available for your lung disease

Goal 3: Exercise with us three times, increase your strength training and continue the home walking program

Goal 4: Take action to be consistent with how and when you take your respiratory medications

Medications for COPD

There are many types of medications used to manage and treat COPD. Your healthcare provider will work with you to find the right medication or combination of medications to manage your disease as well as prevent and treat flare-ups.

Bronchodilators work to widen the airways. Beta-2 agonist bronchodilators and anticholinergic bronchodilators can be slow-acting, providing control over your respiratory symptoms, or fast-acting for quick relief.

Long-acting bronchodilators (controller, maintenance or preventer medications)

Beta-2 agonists (LABA)

Foradil, Oxeze (formoterol)
Serevent (salmeterol)
Onbrez (indacaterol)

Anticholinergics (LAMA)

Spiriva (tiotropium)
Seebri (glycopyrronium)
Tudorza (aclidinium)

Short-acting bronchodilators (fast-acting, reliever or rescue medications)

Beta-2 agonists (SABA)

Ventolin (salbutamol)
Bricanyl (terbutaline)

Anticholinergics

Atrovent (ipratropium bromide)

Long-acting bronchodilators improve exercise capacity in COPD patients. The majority of patients with COPD do not require short-acting bronchodilators (‘relievers’) prior to or during exercise as they should be taught during a pulmonary rehabilitation program that they can recover from exercise-induced breathlessness by taking short rest periods and then resuming exercise when their breathlessness is under control. For some individuals, specific workouts in the form of interval training with a work-to-rest balance should be prescribed to manage their exercise induced breathlessness.

Short-acting bronchodilators may be indicated in those people who experience significant chest tightness and/or wheeze during exercise. If this sounds like you, taking short-acting bronchodilators before exercise may enable exercise training:
• At a greater intensity
• For a longer duration
• With less symptoms

Combination short-acting, quick-relief inhalers

Combivent (salbutamol, ipratropium bromide)

Combination long-acting controller bronchodilator medications without inhaled steroid

Anoro (umeclidinium combined with vilanterol)
Ultibro (glycopyrronium combined with indacaterol)

Inhaled medications work to decrease inflammation in the lungs.

Inhaled corticosteroids (ICS) – work to reduce airway inflammation

QVAR (beclomethasone)
Pulmicort (budesonide)
Alvesco (ciclesonide)
Aerospan (flunisolide)
Flovent (fluticasone propionate)
Asmanex (mometasone)

Bronchodilators and corticosteroids work more effectively in combination than individually.

Double-action inhalers can contain corticosteroid with one long-acting controller bronchodilator medication

Breo (fluticasone furoate combined with vilanterol trifenatate)
Advair (fluticasone combined with salmeterol)
Symbicort (budesonide combined with formoterol fumarate)
Zenhale (mometasone furoate and formoterol fumarate dihydrate)

Triple-action inhalers contain corticosteroid with two long-acting controller bronchodilator medications.

Trelegy (fluticasone furoate, umeclimidium, vilanterol)
Breztri (budesonide, glycopyrrolate, formoterol fumarate)
Enerzair (mometasone, glycoppyronium bromide, indacaterol)

Other medications that may be prescribed

Antibiotics pills (such as azithromycin) may be prescribed in the case of frequent COPD exacerbations with recurrent infection
Corticosteroid pills (such as prednisone) have more side effects than the inhaled corticosteroids in combination medicines. Corticosteroid pills are often used for short periods of time, usually when you have a COPD flare-up. In some cases, however, they may need to be taken on a regular basis if your healthcare provider feels that inhalers alone are not enough. If you need to take corticosteroid pills on a regular basis, your healthcare provider will work to keep you on the lowest dose necessary.
Bronchodilator pills such as theophyllines (Uniphyl or Theo-dur) are slow-onset bronchodilators that work differently than inhaled bronchodilators. These have a higher rate of side effects, and present a greater risk for food and drug interactions. For these reasons they are not commonly used. When they are used, it is usually in combination with other bronchodilators. Make sure your healthcare provider and pharmacist know all the other medicines you are taking. If you are taking these pills, your provider will give you regular blood tests to monitor how much of the medicine is in your body.
In cases of severe COPD associated with chronic bronchitis and frequent exacerbations, a PDE4 inhibitor such as DAXAS [Roflumilast(Dilaresp)] tablets may be prescribed in addition to optimal COPD management.
Those who have been diagnosed with Alpha 1 Antitrypsin Deficiency, also called "genetic emphysema" may be prescribed augmentation therapy such as Prolastin-C, Aralast, or Zemaria, which are administered by injection.

Medications for asthma

There are two main types of asthma medications: controllers and relievers.

Controller medications are usually used on a daily basis to control and prevent asthma symptoms.

Reliever medications are taken as needed to quickly relieve asthma symptoms. Many asthma medications come as sprays or powders in inhaled delivery devices.

Your healthcare provider will work with you to find the right medication or combination of medications to manage your disease as well as prevent and treat flare-ups.

Inhaler devices are the best way to deliver medications directly to the lungs where they are needed, with fewer side effects than medications taken orally.

Inhaled corticosteroids (ICS) make the airways less sensitive to triggers by calming the airways’ overreaction to triggers. They prevent the airway from swelling, prevent mucus overproduction and prevent the muscles around the airway from going into spasm.

Inhaled corticosteroids (ICS)

QVAR (beclomethasone)
Pulmicort (budesonide)
Alvesco (ciclesonide)
Flovent or Aermony Respiclick (fluticasone propionate)
Arnuity (fluticasone furoate)
Asmanex (mometasone furoate)

Bronchodilators are inhaled respiratory medications that act like one of the body’s chemical messengers to widen the airways. Beta-2 agonist bronchodilators and anticholinergic bronchodilators can be slow-acting providing control over your respiratory symptoms, or fast-acting for quick relief.

Long-acting bronchodilators (known as controller, maintenance or preventer medications)

Beta-2 Agonists (LABA)

Foradil, Oxeze – (formoterol)
Serevent – (salmeterol)

Long-acting Anticholinergics (LAMA)

Spiriva – (tiotropium)

Short-acting bronchodilators (known as fast-acting, reliever or rescue medications)

Beta-2 Agonists (SABA)

Airomir, ventolin (salbutamol)
Bricanyl (terbutaline)

Symbicort contains budesonide and formoterol (ICS and LABA). It is the only combination with a LABA that can be used as a fast-acting reliever.

Combination inhaled controller medications work to reduce inflammation with an inhaled corticosteroid (ICS) and widen your airways with a long-acting bronchodilator (LABA)

Advair, Arbesda, Wixela (fluticasone propionate and salmeterol)
Atectura Breezhaler (mometasone furoate and indacaterol)
Breo Ellipta (fluticasone furoate and vilanterol)
Symbicort (budesonide and formoterol)
Zenhale – (mometasone and formoterol)

Reflux medications are recommended for patients with gastroesophageal reflux disease (GERD) and asthma.

Prilosec, Losec (omeprazole)
Nexium (esomeprazole)
Zantac (ranitidine)
Pepcid (famotidine)

Other medications that may be prescribed

The pills and shots (injections) that are used in asthma treatment are safe and effective

Prescription or over-the-counter allergy medications oral (liquid or pill), nasal sprays or injections.
Singulair – (montelukast)

For asthma that remains severe and persistent despite adequate treatment, a class of injected medications called biologics are becoming more widely used. Talk with your healthcare provider about Xolair, Nucala, Dupixent, Cinqair or Fasenra.

You can find out more about asthma medications on our website.

Medications for bronchiectasis

The goal for managing bronchiectasis is to prevent and/or treat infections and flare-ups (exacerbations). Medications to manage bronchiectasis can be inhaled, oral or intravenous (IV) medications. Your healthcare provider will work with you to find the right medication or combination of medications to manage your disease as well as prevent and treat flare-ups.

Oral/intravenous antibiotics are used to treat exacerbations/infections.

Inhaled antibiotics are used to treat people with chronic infections caused by a type of bacteria called Pseudomonas aeruginosa.

Inhaled tobramycin
Inhaled colistimethate (colistin)
Inhaled amikacin

Mucolytics can be oral, liquid or nebulized. They thin mucus, making it easier to clear from the lungs.

Inhaled hypertonic saline
Inhaled normal saline
Acetylcysteine

Other medications that may be prescribed

Oral azithromycin is an antibiotic that may reduce inflammation in the airways and help prevent or reduce exacerbations.

Inhaled bronchodilators can act like one of the body’s chemical messengers to widen the airways. These are known as bronchodilators. Beta-2 agonist bronchodilators and anticholinergic bronchodilators can be slow-acting providing control over your respiratory symptoms, or fast-acting for quick relief.

Long-acting bronchodilators (known as controller, maintenance or preventer medications)

Beta-2 agonists (LABA)

Foradil, Oxeze (formoterol)
Serevent (salmeterol)
Onbrez (indacaterol)

Anticholinergics (LAMA)

Spiriva (tiotropium)
Seebri (glycopyrronium)
Tudorza (aclidinium)

Short-acting Bronchodilators (known as fast-acting, reliever or rescue medications)

Beta-2 agonists (SABA)

Ventolin (salbutamol)
Bricanyl (terbutaline)

Anticholinergic bronchodilators

Atrovent (ipratropium bromide)

Your healthcare provider may also prescribe these in combination.

EXERCISE

This is the week to increase your strength training.

Your steps to success

Use your pulse oximeter to check your oxygen saturation and heart rate. If they are normal for you, plan to exercise with us.
Have you assessed your symptoms today?
Using pursed lip breathing while exercising helps to reduce breathlessness.
Have you taken your long-acting controller inhalers? Should you take your quick-acting reliever inhaler before exercising?
Is your oxygen set to the correct liter flow for exercise?
Stay connected with friends and family – they are only a phone call away.
If you smoke, try to eliminate one or two cigarettes from your daily routine for a week.

Method for exercise progression

Add 2 repetitions during each strength exercise (ie: if you were doing 10 reps, do 12, if you were doing 12 reps, do 14). The max number of reps is 15.

If you were doing 15 repetitions, increase the amount of weight you are using. Add 0.5 – 1.0 kg for strength exercises. Begin with 8 reps of the new weight.

Read the transcript

Week 3: it takes 21 days to form a habit, and you are well on your way by adding these steps to your daily routine. Let’s exercise!

Gradually increase how long you walk, cycle or swim. Below is a guide to help you increase your walking time.

Home walking program

Week 1
5 minutes, 5 times per day

Weeks 2 & 3
10 minutes, 3 times per day

Weeks 4 & 5
15 minutes, 2 times per day

Week 6
20 minutes, 1 time per day

Week 7
25 minutes, 1 time per day

Week 8
30 minutes, 1 time per day

Relaxation, Meditation and Better Breathing

Reinforcing relaxation and diaphragmatic breathing.

Body Sensing and Breath Sensing with Angie Davis

Youtube supports many free Mindful Meditation and Better Breathing videos to promote effective breathing techniques, as well as mood, motivation, relaxation, stability, clarity and sleep enhancement. The Canadian Lung Association does not endorse the use of any particular or specific website or channel for meditation and relaxation. Sites listed are suggestions only.

Goodful | 10-Minute Meditation to Start Your Day

The Daily Calm | 10-Minute Mindfulness Meditation

Better Breathing Coach | Janice Brown

TAKE ACTION

Know your medications

Keep track of your medications with this downloadable form.

Correctly using your inhalers

Take your inhaler with the Learning Video to make sure you are using your inhaler correctly and getting the most out of your device. Follow along for seven days to improve medication delivery to your lungs.

www.lung.ca/lung-health/how-use-your-inhaler

Assessing your confidence

Assess your confidence in taking your medications by answering these statements Yes, No or Sometimes:

I take my long-acting controller medications regularly, as prescribed.
I shake my fast-acting reliever medication 5 to 6 times before taking the first puff, hold my breath for 5 to 10 seconds with each puff, and wait 30 to 60 seconds if I am prescribed more than one puff.
I rinse my mouth after taking my inhaler.

If you answered No or Sometimes, get more information on the proper use of your inhaler by visiting www.lung.ca/lung-health/how-use-your-inhaler

Assess your confidence using an MDI Spacer by answering these statements Yes, No or Somewhat:

I know how to use my MDI spacer / Aerochamber
I know that if I inhale too quickly, my spacer whistles to warn me to slow down.

If you answered No or Somewhat, get more information on how to use your spacer.
www.lung.ca/lung-health/get-help/how-use-your-inhaler/mdi-spacer-adult

Cleaning Your Spacer

To clean your spacer, follow the instructions that come with it. In most cases, they will advise you to:

Take the spacer apart.
Gently move the parts back and forth in warm water using a mild soap. Never use high-pressure or boiling hot water, rubbing alcohol or disinfectant.
Rinse the parts well in clean water.
Do not dry inside of the spacer with a towel as it will cause static. Instead, let the parts air dry (for example, leave them out overnight).
Put the spacer back together.

If you are using your spacer every day, you should replace it about every 12 months.

My COPD Action PlanUsing your Action Plan

Assess how you will manage flare-up/exacerbation symptoms

I am confident that I will recognize when my symptoms are flaring up and will take action to use My Action Plan for regular medications when I am well, and the medications needed to help prevent an exacerbation.
If I am not confident, I will take My Action Plan to my provider or pharmacist and will talk with a certified respiratory educator.

Download your COPD Action Plan.

Download your Adult Asthma Action Plan.

Download your Pulmonary Fibrosis Action Plan.

Modules

Introduction · Module 1 · Module 2 · Module 3 · Module 4
Module 5 · Module 6 · Module 7 · Module 8 · Conclusion

‹ Back to program homepage

Speak to a certified respiratory educator

Call our Health Information Line at 1-866-717-2673 to speak to a certified respiratory educator. You can also email info@lung.ca.

Before you begin the BREATHE Better – Stay STRONG Virtual Pulmonary Rehabilitation Program, please read and agree to the medical disclaimer.

Medical Advice Disclaimer, Disclaimer of Warranty and Limitation of Liability

Please read this document carefully. The Canadian Lung Association (CLA) strongly recommends that you consult your physician or other qualified healthcare provider before choosing to take part in BREATHE Better-Stay STRONG. You acknowledge that CLA offers no medical assessment, diagnosis, or treatment, and that CLA makes no determination as to whether or not you are physically fit to participate in this program. This program is intended for Canadians living with chronic lung disease, be it obstructive or restrictive in nature. This program is not supervised and therefore not intended for Canadians who are awaiting lung transplant, lung volume reduction surgery or those who have pulmonary hypertension. Certain pre-existing non-respiratory conditions may also exclude you from participating in the exercise portion of this program.

THERE ARE POTENTIAL RISKS INHERENT in your participation in BREATHE Better-Stay STRONG, including, without limitation, worsening of your existing symptoms, an increased load on the heart, episodes of light headedness, fainting, dizziness, pain, chest discomfort, shortness of breath and bone and muscular injury. If you experience faintness, dizziness, pain, or unmanageable shortness of breath at any time while participating in exercise program, you should stop immediately.

CLA and BREATHE Better-Stay STRONG cannot respond to medical emergencies. If you think you have a medical emergency, call 911 immediately.

CLA assumes no liability or responsibility for the use of any information provided by BREATHE Better-Stay STRONG, or for your reliance on this information in place of specific medical advice from a qualified health care provider. As is, the health information content provided in this program is current, reviewed and approved by qualified healthcare professionals. To the maximum extent permitted by applicable law, CLA disclaims all liability for any errors or other inaccuracies in the information provided. In no event shall CLA be liable for damages of any kind, including but not limited to direct, indirect, special, consequential, or other monetary damages in connection with your use of or reliance upon information provided by BREATHE Better-Stay STRONG.

By following this program, you acknowledge that you have read, understand and agree to abide by the above Medical Advice Disclaimer, and Disclaimer of Warranty and Limitation of Liability.

Module 3

Medications for Your Chronic Lung Disease

OVERVIEW

Taking your medications

Obstructive lung disease

Using an inhaler

Medications for COPD

Long-acting bronchodilators (controller, maintenance or preventer medications)

Short-acting bronchodilators (fast-acting, reliever or rescue medications)

Inhaled medications work to decrease inflammation in the lungs.

Other medications that may be prescribed

Medications for asthma

Inhaled corticosteroids (ICS)

Long-acting bronchodilators (known as controller, maintenance or preventer medications)

Short-acting bronchodilators (known as fast-acting, reliever or rescue medications)

Other medications that may be prescribed

Medications for bronchiectasis

Other medications that may be prescribed

Long-acting bronchodilators (known as controller, maintenance or preventer medications)

Short-acting Bronchodilators (known as fast-acting, reliever or rescue medications)

Medications for cystic fibrosis

Other medications that may be prescribed

Restrictive lung disease

EXERCISE

Your steps to success

Method for exercise progression

Home walking program

Relaxation, Meditation and Better Breathing

TAKE ACTION

Know your medications

Correctly using your inhalers

Assessing your confidence

My COPD Action PlanUsing your Action Plan

FEEDBACK

Tell us what you think

Modules

Speak to a certified respiratory educator

Module 3

Medications for Your Chronic Lung Disease

OVERVIEW

Taking your medications

Obstructive lung disease

Using an inhaler

Medications for COPD

Long-acting bronchodilators (controller, maintenance or preventer medications)

Short-acting bronchodilators (fast-acting, reliever or rescue medications)

Inhaled medications work to decrease inflammation in the lungs.

Other medications that may be prescribed

Medications for asthma

Inhaled corticosteroids (ICS)

Long-acting bronchodilators (known as controller, maintenance or preventer medications)

Short-acting bronchodilators (known as fast-acting, reliever or rescue medications)

Other medications that may be prescribed

Medications for bronchiectasis

Other medications that may be prescribed

Long-acting bronchodilators (known as controller, maintenance or preventer medications)

Short-acting Bronchodilators (known as fast-acting, reliever or rescue medications)

Medications for cystic fibrosis

Other medications that may be prescribed

Restrictive lung disease

EXERCISE

Your steps to success

Method for exercise progression

Home walking program

Relaxation, Meditation and Better Breathing

TAKE ACTION

Know your medications

Correctly using your inhalers

Assessing your confidence

My COPD Action PlanUsing your Action Plan

FEEDBACK

Tell us what you think

Modules

Speak to a certified respiratory educator

BREATHE Better – Stay STRONG Virtual Pulmonary Rehabilitation Program Medical Disclaimer

Medical Advice Disclaimer, Disclaimer of Warranty and Limitation of Liability