Bronchodilators and Glaucoma

Dear Dr. Mahler: My father has chronic COPD, while also battling severe glaucoma. I know the most common treatment for COPD is an inhaler, however, most of those medicines are not compatible with those meds used to treat glaucoma.  So in essence, my father can either treat his breathing or eyesight?  To date, he has chosen to treat his eyes with proper medications. What would be your recommendations for someone who battles both of these illnesses? Thank you so much for your time and consideration. Sincerely, Alice from Warner, NH Dear Alice: Is your father using any inhaled bronchodilators for his COPD? These medications are the mainstay of treatment for those with COPD by relaxing the muscle that wraps around breathing tubes, open the airways, and makes it easier to breathe. There are two types or classes of bronchodilators – called
  1. beta-agonists
  2. muscarinic antagonists
The muscarinic antagonists (examples by brand name: Atrovent; Spiriva; Tudorza; Incruse) may increase the pressure inside the eye (intraocular pressure) and therefore make glaucoma worse. Doctors do not prescribe this type of bronchodilator if someone has glaucoma. However, the beta-agonists do not affect the intraocular pressure and should otherwise by safe for your father to take. There are short-acting (examples of brand names:  ProAir; Proventil; Ventolin) and long-acting (examples of brand names: Arcapta; Formoterol; Serevent; Striverdi) beta-agonists.  The short-acting bronchodilators are used “as needed” and last about 4 hours. The long-acting bronchodilators are used as maintenance treatment either once (last 24 hours) or twice (last 12 hours) a day . Possible side effects of beta-agonists are shakiness, rapid heart rate, and nervousness. Most individuals with COPD are able to breathe better using a beta-agonist bronchodilator and tolerate the medicine without a problem. I suggest that you and/or your father discuss this with his doctor. If he/she is not comfortable prescribing a beta-agonist bronchodilator for your father, then I would consider having your father see a pulmonary specialist. Best wishes, Donald A. Mahler, M.D.    

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.