Help pack a million meals for struggling seniors on Sept. 11. Volunteer today

Ask the Pharmacist

I Have COPD, and My Drugs Cost $1,800 a Month. Help!

Adjusting your medications could improve your quality of life — and save you money

Q: I'm an 83-year-old male with severe COPD [chronic obstructive pulmonary disease]. It's been getting progressively worse, to the point where I need to have constant oxygen and really have to work for each breath.

ask the pharmacist ex smoker lungs inhaler copd bronchodilator breathe oxygen ensure

Your meds may be making your breathing problems worse. — Getty Images

My drugs cost about $1,800 a month — much more than Medicare will cover. I am presently on 80 mg of Zocor daily for high cholesterol and four inhaled medications for my COPD: Symbicort 160/4.5 twice a day, Pulmicort 180 mcg twice a day, Combivent three times a day and Xopenex 1.25 mg in a nebulizer four times a day. I also take Lyrica 200 mg twice a day for muscle cramps and pain, and a bottle of Ensure Plus four times a day. When I develop infections I'm also prescribed expensive antibiotics.

I've become so hyper and restless at night that I'm usually not able to get more than a couple of hours of sleep. I have to sit up to sleep because of my leg and back pain, and when I'm awake my legs are so weak that I can hardly walk. I don't know what to do and am hoping you can recommend something to help me.

A: I truly wish I had a magic pill to give you, but I'm sorry to report that your COPD isn't going to go away. I do, however, see many problems with your current drug therapy that, if corrected, would likely ease many of your health problems, thus giving you a better quality of life, and also reduce your out-of-pocket health costs.

First, you should talk with the doctor treating your pulmonary condition about stopping the Ensure Plus immediately. This product is typically used to help people maintain or gain weight, as each 8-ounce bottle contains 50 grams of carbohydrates and 350 calories.

What's important for you to keep in mind is that when carbohydrates are metabolized in the body, a byproduct of the metabolization is carbon dioxide. Because of their impaired lung function, COPD patients have a very difficult time exchanging the carbon dioxide for oxygen, which dramatically increases their respiration rate. This causes the body to expend more energy, thus causing additional weight loss. I know that this must be miserable for you, and it's almost certainly the main reason that your COPD has gotten worse, not better. Stopping the Ensure Plus will improve your respiration and may even allow you to reduce or stop the oxygen supplementation.

In my judgment, the use of four different bronchodilators — formoterol, in combination with budesonide, a corticosteroid (Symbicort); albuterol and ipratropium (Combivent); and levalbuterol (Xopenex) — and an additional dose of budesonide (Pulmicort) is excessive. The bronchial tubes can only be dilated so far; after that, the extra drugs can't do any more and just cause the kinds of adverse events you're experiencing: insomnia, agitation, restlessness and a weak, washed-out feeling. What's more, the bronchodilators you're using all have short half-lives (four to eight hours), which in your case may be causing rebound bronchoconstriction that makes your breathing problems worse. They're also expensive.

I'd recommend that you talk with your doctor about switching to a bronchodilator that provides 24-hour relief such as Spiriva 18mcg HandiHaler. Using it each morning should last until the next morning — and without the rebound effects. As your breathing volume increases over time, your overall condition should improve.

Both Symbicort and Pulmicort contain corticosteroids, which I do not like to see used on a routine basis, as they then become less effective in crisis situations. In my practice, I recommend the use of the corticosteroids only as a last resort.

Next page: Sleep-related problems. »

Topic Alerts

You can get weekly email alerts on the topics below. Just click “Follow.”

Manage Alerts


Please wait...

progress bar, please wait

Tell Us WhatYou Think

Please leave your comment below.



Discounts & Benefits

From companies that meet the high standards of service and quality set by AARP.

Walgreens 1 discount membership aarp

Members can earn 50 points per $1 spent on select health & wellness products at Walgreens.

member benefit aarp hear usa

Members save 15% on easy listening devices and more at the HearUSA Hearing Shop.

Eye Med 4 Membership Benefit AARP Discount

Members save up to 60% on eye exams and 30% on glasses at Target Optical.

Membership Benefits Discounts Email Genius

Brain boost? Get AARP email for access to memory exercises & more that help you focus.

Most Popular



Social Security

How to strengthen Social Security for future generations. Discuss

Medicare & Insurance

Share health coverage information and experiences common to being age 50+. Join

Health Nuts

Share heart-smart recipes, fitness tips and stress relievers. Join