Alternative Medications for Chronic Pulmonary Bullae: Seeking Safer Options

Medication for pulmonary cysts?

Hello Doctor: My father is 84 years old and was diagnosed with chronic emphysema six years ago.
The doctor recommended a medication called "Ding Chuan Le" from Taiwan Bailing Jia Ying Ge Han Co., Ltd., located at 12F, No.
49/51, Section 3, Minsheng East Road, Taipei.
However, the side effects include increased heart rate, dermatitis, and renal atrophy, among others, with a usage frequency of once every two days.
Recently, the doctor informed us that he will be switching to "Bei Lao Chuan" instead of "Ding Chuan Le" (possibly due to the expiration of the contract for the previous medication).
However, after researching "Bei Lao Chuan" online, patients who have used it reported significant side effects.
I would like to ask the doctor if there are other medications with milder side effects that could replace "Bei Lao Chuan"? Or are there any authoritative hospitals or doctors specializing in this area? Thank you for taking the time to answer my questions.

Liao Qi-heng, 40~49 year old female. Ask Date: 2009/06/10

Dr. Ke Bowen reply Pharmacology

Dear Mr.
Liao,
Your father has been diagnosed by the physician with chronic pulmonary emphysema.
The recommended medication is Atrovent MDI (Ipratropium Bromide), which is a parasympatholytic agent that has a high degree of selectivity for local action on the bronchi, leading to bronchodilation.
However, it is not advisable for elderly patients who commonly suffer from glaucoma or benign prostatic hyperplasia.
The medication mentioned, "Berotec N" (Fenoterol), is a beta-2 adrenergic agonist that can also dilate the bronchi and is used for the prevention and treatment of bronchospasm.
Although it may cause side effects such as palpitations and tremors in the fingers, it is still considered a safe medication.
If you have any questions regarding this matter, you should consult your physician or feel free to visit the Chest Hospital of the Department of Health, Executive Yuan, located at No.
69, Section 1, Datong Road, Tainan City.
We are happy to address any questions you may have in person, as we are specialists in thoracic diseases.
Thank you.

Reply Date: 2009/06/10

More Info

When considering alternative medications for chronic pulmonary bullae, particularly for an elderly patient like your father, it is essential to weigh the benefits against the potential side effects of each medication. Chronic pulmonary bullae, often associated with conditions like emphysema, can lead to significant respiratory issues, and managing these symptoms effectively is crucial for maintaining quality of life.

The medications you mentioned, such as "定喘樂" (Atrovent) and "備勞喘" (Berotec), are commonly used bronchodilators. Atrovent is an anticholinergic agent that helps to open the airways, while Berotec is a beta-agonist that stimulates the sympathetic nervous system to achieve the same effect. Both medications can be effective in managing symptoms of chronic obstructive pulmonary disease (COPD) and other respiratory conditions, but they do come with potential side effects.

Side Effects and Alternatives:
1. Atrovent (Ipratropium Bromide): While generally well-tolerated, it can cause dry mouth, dizziness, and in some cases, urinary retention, especially in older adults. If your father experiences significant side effects, alternatives could include:
- Tiotropium (Spiriva): A long-acting anticholinergic that may have a more favorable side effect profile and is taken once daily.

- Formoterol or Salmeterol: These are long-acting beta-agonists that can be used in conjunction with inhaled corticosteroids for better control of symptoms.

2. Berotec (Fenoterol): This medication can cause increased heart rate, tremors, and palpitations. If these side effects are problematic, consider:
- Levalbuterol (Xopenex): A more selective beta-agonist that may have fewer cardiovascular side effects.

- Budesonide/Formoterol (Symbicort): This combination inhaler provides both a corticosteroid and a long-acting beta-agonist, which can help reduce inflammation and dilate the airways.

Consultation with Specialists:
Given your father's age and the complexity of his condition, it would be prudent to consult with a pulmonologist who specializes in respiratory diseases. They can provide a comprehensive evaluation and tailor a treatment plan that minimizes side effects while effectively managing his symptoms.
In Taiwan, hospitals such as National Taiwan University Hospital or Taipei Veterans General Hospital have reputable pulmonary departments. Seeking a second opinion or referral to a specialist can provide additional insights into safer medication options and alternative therapies.

Non-Pharmacological Approaches:
In addition to medication, consider non-pharmacological interventions that can support your father's respiratory health:
- Pulmonary Rehabilitation: This program includes exercise training, nutritional advice, and education on managing lung disease, which can significantly improve quality of life.

- Oxygen Therapy: If your father's oxygen levels are low, supplemental oxygen can help alleviate symptoms and improve overall function.

- Lifestyle Modifications: Encourage a smoke-free environment, a balanced diet, and regular physical activity as tolerated.

Monitoring and Follow-Up:
Regular follow-up appointments are essential to monitor your father's condition and adjust treatment as needed. If he experiences worsening symptoms or side effects from medications, it is crucial to communicate these changes to his healthcare provider promptly.

In summary, while there are alternative medications available for chronic pulmonary bullae, it is vital to work closely with a healthcare professional to find the most suitable and safest options for your father. Balancing medication with lifestyle changes and supportive therapies can lead to better management of his condition and an improved quality of life.

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