DEAR DR. ROACH: I am a 73-year-old male with chronic obstructive pulmonary disease (COPD). I pretty much have it under control with medication, but I am still not able to do a whole lot, as I feel shortness of breath easily. But, that is not my main problem! I have a dry mouth from the medication I am taking for it. I am taking Stiolto Respimat inhalation spray.
I have tried toothpastes, mouthwashes, sugar-free lemon drops, gargles, etc. Nothing helps. I am having many dental problems due to this dry mouth, and my dentist told me that it will continue, as it is caused by the medication I am taking for COPD. Is there any help for this dry mouth? I am desperate to get this under control and save my teeth. — J.C.
ANSWER: Chronic obstructive pulmonary disease is an extremely common condition in North America. The major symptom is shortness of breath, and the most likely cause is smoking, although there are less-common causes.
Inhaled medications are the first-line treatment for COPD. These are often comprised of a combination of a medicine to open airways (a bronchodilator, but commonly a long-acting formulation is used in people with COPD, except those with very mild COPD) along with an inhaled anticholinergic medicine, also called an antimuscarinic.
Antimuscarinics also open up the airways, but through a different mechanism. The Stiolto you take is a long-acting bronchodilator (olodaterol) and a long-acting antimuscarinic (tiotropium). These two medicines work very well together and are commonly co-prescribed.
It’s the tiotropium that commonly causes dry mouth. Most people have mild dry mouth symptoms, but severe dry mouth is a real problem, both for your quality of life, but also for your teeth, as you correctly point out. You have tried many of the first-line treatments for dry mouth. Although there are mouth lubricants you can use, I think it would make more sense to try a different anticholinergic drug that is less likely to cause dry mouth.
The newer agents, such as aclidinium, have much less dry mouth symptoms than the tiotropium in the Stiolto you are taking. Using one medicine to counteract the side effects of another medication is sometimes necessary; however, it may be possible for you to get the same relief as you receive with your current treatment, but with fewer side effects if you switch medications.
DEAR DR. ROACH: Do you know if there have been any advancements in the treatment of arachnoiditis?
My best friend received this diagnosis last week following an epidural steroid injection for back pain in February. She takes naproxen, Tylenol 3, and Lyrica. She says that Lyrica provides relief from severe nerve pain. It’s sad that she went in for pain relief and ended up with this life-changing diagnosis. Thanks for your help. — J.B.
ANSWER: Arachnoiditis is a type of meningitis, one that may be caused by an adverse reaction to the medications used for an epidural steroid injection. I do not know of any cure for arachnoiditis. The condition is treated with pain medications of the type she is getting, and only occasionally with surgery in people with very disabling symptoms. Some people get slightly better over time, while others can worsen. This is a rare and very unfortunate outcome. Epidural injections are usually safe, but shouldn’t be undertaken lightly.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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