It has an onset of 15 minutes peak effect within 1 to

it has an onset of 15 minutes, peak effect within 1 to 2 hours and a duration of 2 to 5 hours, while
long acting (LAMAs) tiotropium bromide, aclidinium bromide, and umeclidinium bromide have
action duration of 24 hours or more (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). These
medications also work by relaxing airway smooth muscle and increasing bronchial ciliary

activity. Adverse effects are dry mouth, cough when inhaled and blurred vision when it gets in
the eyes.
Corticosteroids: Short course oral corticosteroids like prednisone is used for acute COPD
exacerbation while inhaled corticosteroids are used in combination with long acting
bronchodilators to reduce the risk of exacerbations (Arcangelo, Peterson, Wilbur, & Reinhold,
2017). Adverse effects of inhaled corticosteroids include oral candidiasis and dysphonia;
therefore, patients should be educated to rinse their mouth, gargle, and spit out the water after
each dose (Arcangelo, Peterson, Wilbur, & Reinhold, 2017).
Age (Geriatrics) as a factor
In most cases, older persons are more prone to cardiovascular diseases; therefore, they
may be at risk from cardiovascular stimulatory effects of beta 2 adrenergic agonists especially
with higher doses (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In older adults as well, the
theophylline clearance may be decreased, thus resulting to increased risk of theophylline
cardiovascular stimulatory adverse effects. The blood theophylline needs to be monitored closely
(Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Older adult in most cases take multiple drugs,
therefore, drug to drug interaction is a possibility. Higher doses of inhaled corticosteroids can