Talking With Your Doctor About Nonsteroid Options for COPD

How to Describe Your COPD Symptoms

Your doctor needs to know about your symptoms to prescribe the right nonsteroid treatment or other medicine. Even though you live with COPD, it may be hard to describe how you feel. A symptom diary or tracker can help.

On paper or in an app, keep a daily log of your symptoms. Include:

• Coughing
• Phlegm (mucus) when you cough
• Wheezing
• Shortness of breath during daily activities
• Feeling tired
• Flare-ups (when your symptoms get worse)
• Lung infections, such as pneumonia
• Visits to urgent care or the hospital 

Track when your symptoms start and what makes them better or worse. Share your symptom tracker with your doctor at each visit, and explain how your symptoms affect your daily life.

Tell your doctor how you feel now compared to before you had COPD. Can you do all the things you want to do? "Is it just that you get short of breath walking up a single stair or a couple of flights of stairs?" says Michael Stephen, MD, a pulmonary doctor at Penn Medicine in Cherry Hill, New Jersey. "Or were you running marathons and now you can only run a half-marathon, and you're frustrated?"

How to Talk About Nonsteroid Options

Your doctor should discuss all the COPD treatments with you. If they don't bring up nonsteroid options, ask.

Doctors follow treatment guidelines called the Global Initiative for Chronic Obstructive Lung Disease (GOLD). "The guidelines suggest you start out with nonsteroidal bronchodilators," says Norman Edelman, MD, a professor of medicine and pulmonologist at Stony Brook Medicine in Stony Brook, New York.

"One is a long-acting beta-agonist, which is what we commonly call a bronchodilator. The other is a long-acting anti-muscarinic," he says. These medicines relax muscles in your lungs and keep your airways open to help you breathe better. "In general, most physicians start with a puffer – an inhaler or nebulizer that provides both [medicines] for COPD."

You may also have too much mucus in your airways. In that case, your doctor could prescribe nonsteroid treatments like anti-inflammatory medicine to clear up mucus.

What Questions Should You Ask Your Doctor?

Learn about any new medicine you get. "When a doctor prescribes an inhaler for COPD, ask the doctor, 'What's in it? Does it have two drugs or three drugs?'" Edelman says. If one of the medicines is a steroid, ask if you really need it. Steroid medicines can cause side effects.

What Questions Will Your Doctor Ask You?

Your doctor needs to know about your symptoms to prescribe the right nonsteroid medicine. Be ready to answer questions like these:

• How long have you had COPD symptoms?
• How often do you get flare-ups? 
• Do you feel short of breath when you walk up stairs? Are you short of breath when you walk on a flat surface?
• Has your shortness of breath gotten worse?
• What other symptoms do you have? A cough? Mucus? Chest pain?
• What medicines do you already take?

Lung function tests help your doctor know which medicines you need. These tests measure:

• How much air your lungs can hold
• How much air you can breathe out
• How fast you blow air out of your lungs
• How much air is left in your lungs after you breathe out

A check of your lung function also shows whether your treatment is working. "Every COPD patient should have at least one of these tests. Very often that's checked once a year," Stephen says.

How to Talk About Challenges

Medicines help control symptoms, reduce flare-ups, slow the disease, and keep you active. But there are some challenges to COPD treatment.

You need to take the medicine every day to manage COPD. It may be hard to stick with the dosing schedule. It's easier to stay on track when you're involved in planning treatment and you understand how the medicine works.

Nonsteroid treatments are generally safe, but side effects can happen, especially as you get older. These may include:

• Fast or abnormal heart rate
• Shakiness
• Nervousness
• High blood pressure
• Trouble peeing
• Dry mouth

Call your doctor if you have any problems while on COPD treatment. Some side effects are manageable. If the side effects are too much, your doctor might switch you to a different drug.

What to Do After Your Appointment

Your doctor will make sure the nonsteroid medicine has helped. "If you're starting a new drug, you want to come back for a symptom check in a month or two," Stephen says.

During this visit, your doctor will see if you've met your treatment goals. If you don't have flare-ups, your symptoms are under control, and you feel good, you'll see your doctor again in about a year.

Medicine is just one part of COPD treatment. You can also control symptoms in other ways. "Exercise, pulmonary rehab, nutrition, and keeping at a [healthy] weight are a huge part of getting COPD patients the most out of life," Stephen says. "You need to take control of your own health and well-being."