Q&A’s

Lunchtime Webinar no.1 – 30th July 2026: Q&A Section

I am on 2 inhalers twice daily: Brimica and Beclazone 200. I have had 4 flare ups within the last year requiring antibiotics and steroids, can you please advise whether I need medications reviewed.

Answer: In terms of the agents you are receiving, you are on a fairly broad, comprehensive treatment for COPD that would usually work for most people. Your inhaler technique can be good at the beginning and slide over time so fundamentally, yes, you could potentially be referred on for a further opinion and is something worth discussing with your GP and depending where you are living, this is exactly the purpose of the hubs but the fundamentals would be – are you up to date on your vaccines, do you have nasal conditions that are giving you a lot of post nasal drip and is your inhaler technique as good as it can be or is there an inhaler that might suit you better.

Which vitamins or supplements, if any, have good evidence for helping people with COPD?

Answer: There isn’t any research for that at the moment. Vitamin D is important that everyone takes during winter months, the only people who shouldn’t take it are people with sarcoidosis. In regards to a daily vitamin, there is not enough strong evidence. If you are not eating well, do take a multivitamin but that’s only if you are not eating well. You should be able to get what you need from a healthy balanced diet.

I wonder about 'staging' of COPD. I got a call recently from someone who said he has stage 4. I never remember being staged

Answer: It depends on the individual. The staging is very much a physiological staging and is just a way of catergorising the amount of obstructive airflow and that doesn’t mean everything for each patient. You can meet patients who have been going about their business, have no limitation and have stage 3 or 4 COPD and have never noticed it. There are scientifically evidence of associations and outcomes with it but if you are getting on fine and not having exacerbations, there is no change in drugs. None of the treatments are specifically linked to the staging. It’s just a way for consultants to look at the physiological change in someones lungs and how obstructed they are.

What is the issue with Reflux?

Answer: It depends on what the issues are. For some people it may go beyond a bit of reflux to aspirations, where that is actual contents going down and causing inflammation and potentially triggering a non infectious or a secondary infectious exacerbation. Some of it is, when we ask symptoms and are trying to gauge peoples symptoms, a lot of the symptoms are non specific – lots of things can make you cough, lots of things can make you bring up phlegm. The challenge is you end up on more medication for their inhalers or a change in their inhalers but if you have reflux and acidic stomach contents, sometimes not just acidic, some refluxes are gaseous refluxes irritating the vocal chords. People can describe having lots of throat and chest infections and actually that is just irritation sometimes from reflux. We would usually say treatment with an antacid tablet for a trial period. If things improve, it’s a hint that reflux is playing a part.

Are there, or is there soon going to be, alternatives to anticholinergics in COPD inhalers? Given the clear connection between dementia and anticholinergics, this is a vital piece of information, for me at least.

Answer: In the first instance, there are already alternative options to anticholinergics. Long acting Beta agonists can be prescribed with, or without joint anticholinergics, as well as with or without inhaled steroids. However, I would stress that the link between anticholinergics and dementia is very far from clear with inhaledanticholinergics. This point is important. The link you have described, has been assessed in systemic anticholinergic use (by mouth, etc), and has been linked to total exposure (amount over time). This is a significant point of difference. Anticholinergics taken by mouth (for conditions other than COPD) achieve levels in the blood (and therefore the body in general) thousands (maybe tens of thousands) of times higher than what is achieved by inhaled route. The initial safety studies for inhaled anticholinergics assessed how much gets into the blood and body as part of routine pharmacodynamic studies, with the levels found to be in the pg/L range, orders of magnitude lower than oral anticholinergics. To date there has been no clear signal that inhaled anticholinergics raise a risk of dementia, and the levels getting into the blood are so miniscule they likely do not compare in any meaningful way to oral.

I’ve had COPD for over 10 years. I stopped smoking 7 years ago, I go to exercise class twice a week, I go to aqua aerobics once a week, I average 5000 steps a day, I go walking with the Wheezy Walkers once a week, and although I’m overweight I eat healthy home cooked meals, I take my medication as prescribed. Despite all that, breathlessness still has a big impact on my daily life. I don’t ever feel refreshed a night’s sleep. My oxygen levels usually sits at 95 when at rest but goes up when I exert myself. I don’t have flare ups. For someone who’s already doing all the recommended things, what else should I be looking at?

Answer: It sounds as though you are doing almost everything you can to keep well. It is hard to comment on specific cases, and this should not be considered exact medical advice. However in these situations, it is sometimes worth looking at alternative causes. Weight can be a contributor to breathlessness, and so can cardiac causes. Your oxygen levels going up when you walk is reassuring. The symptoms of non restorative sleep, and overweight raise the question of sleep apnoea. It would be worth discussing these questions with you GP when you next see them.

Lunchtime Webinar no.1 – 30th July 2026: Q&A Section

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