10 Improvements Over Past 20 Years

Recently, my boss came to me and said, “Happy Anniversary!” She bought me lunch. It was a worthy celebration of my 20 years as a respiratory therapist.

So, in honor of this event, I thought it would be neat to reflect back over those 20 years. What is new for COPD? What's new as far as wisdom, innovations, and medicine?

Here's a list of the top 10 advancements in COPD over the past 20 years.

1. CPAP/ BiPAP/ VPAP. These are machines that can make breathing easier. They are usually used at night. They keep your airways open and oxygen levels up while you sleep. These machines have significantly advanced over the past 20 years. They are very compact and quiet now. The masks have also vastly improved. This makes them much more tolerable. I find that most people tolerate them quite well. And this is important, as studies show these machines may improve both the quality and length of life for those living with COPD.
2. Albuterol/ Xopenex. Albuterol is the gold standard breathing medicine since the early 1980s. Two albuterol inhalers (Ventolin and Proventil) were approved by the FDA in 1981. Xopenex is the new kid on the block, as it was approved by the FDA in 1999. Xopenex is the more expensive one. But, studies show it may be stronger and last longer than albuterol. The debate is still ongoing if this is true. Still, it’s nice to have options. Some people prefer one over the other in their quest to breathe easier.
3. Ipratropium Bromide (Atrovent). It’s a muscarinic (anticholinergic) that’s been around since the late 1980s. Like albuterol, it opens airways. It's always been prescribed for COPD. But, more recent studies show it works just as well or better than albuterol in opening COPD airways. It's sometimes ordered by itself. But, most often it’s combined with albuterol in medicines like Combivent and Duoneb. So, for this reason, you’ll see it listed as a top-line treatment for COPD
4. Tiotropium Bromide (Spiriva). It is a muscarinic medicine like Atrovent. But, the neat thing is it an inhaler that only needs to be taken once a day. Many COPDers find this preferable to four times a day Atrovent.
5. Serevent. This is a long-acting bronchodilator inhaler. It’s been around since the 1990s. It helps keep airways open for 12 hours. So, it only needs to be inhaled twice daily. While it can be used alone, it's often combined with an inhaled corticosteroid in a newer (not so new anymore) medicine called Advair.
6. Advair/ Symbicort/ Dulera. Advair was approved by the FDA in 2000. It’s a combination inhaler with both an inhaled corticosteroid and long-acting bronchodilator. You basically take 2 medicines at the same time. Even better, you only take it twice a day. Symbicort and Dulera are similar medicines. They were approved by the FDA in 2006 and 2010 respectively. So, these are three nice options here. Those who can’t tolerate one may tolerate one of the others. Oh, and I almost forgot about AirDuo, the first generic Advair to hit the market. So there are four options here.
7. Breo. Make that five. Originally referred to as Super-Advair. It was approved by the FDA as another alternative to Advair/ Symbicort/ Dulera. Its chemical composition is similar to Advair.  But, it only needs to be taken once a day. Nice!
8. Brovana/ Pulmicort. There are many inhalers that help you breathe easier with COPD. But, as the disease progresses, it sometimes becomes difficult to inhale the medicine. This makes inhalers less ideal for some people with COPD. Brovana is a medicine similar to Serevent. But it's a solution you take with a nebulizer. This makes sure the medicine is well distributed through your lungs even with advanced COPD. It can be used alone or with Pulmicort, an inhaled corticosteroid solution. Both medicines are taken twice daily. So, that makes it easy. This is another option helping you keep your airways open long-term.
9. Researchers. They are working so hard. They have learned so much over the past 20 years. It’s almost amazing how much they have learned. I could write a whole series of articles on this topic alone. Maybe I will.
10. Doctors. As researchers learn more, so do doctors. I would go as far to say their knowledge of COPD has improved incrementally. It is amazing to see how better equipped and prepared doctors are today than 20 years ago. They have at their disposal everything on this list and more. Plus, we’re all better equipped and prepared too.

What to make of this? It’s gotten so much better for people living with COPD over the past 20 years. And, I can envision it getting even better over the next 20. I see the research being done. I know studies are ongoing. And this is all in an effort to make life easier and better for people living with COPD.