Treatments for COPD

Posted on August 08, 2018

Although COPD cannot be cured, there are effective treatments that have been proven in clinical studies to improve symptoms, prevent flares, and slow the progression of the disease. Guidelines for COPD medications are based on the stage of the disease, what type of COPD you have, your age and overall health, and any other health conditions or medications that are being taken.

Studies have found that between 43 and 59 percent of people with COPD do not take their medications as prescribed. COPD medications are most effective when taken correctly. Stopping or underusing a medication allows the disease to flare and progress to later stages with a higher risk for complications and death. For this reason, it is important to continue taking all medications as prescribed even if you feel better. If side effects bother you, talk to your doctor about switching medications or timing them differently. Set reminders and ask for help from family if you have trouble remembering to take your COPD treatments.

Types of treatments for COPD

The single most important thing people with COPD can do to slow the progression of the disease and the loss of lung function is to stop smoking. Medications can make it easier to breathe, help prevent flare-ups, and help stop flare-ups once they start. Surgeries can improve lung function or – in the case of lung transplants – restore it. Lifestyle changes such as exercise, improved nutrition, and completing pulmonary rehabilitation therapy can have a major impact on the quality of life.

Many people with COPD are prescribed multiple medications that work together to better control symptoms and prevent flares.

Bronchodilators

Bronchodilators are medications that relax the muscles around airways, opening the airways and making it easier to breathe. Bronchodilators are usually taken using an inhaler or nebulizer.

Short-acting bronchodilators begin working almost immediately and are used as rescue medications in case of sudden asthma attacks. Short-acting bronchodilators include Albuterol (sold under the brand names Ventolin HFA, Proventil HFA, and ProAir HFA) and Xopenex HFA (Levalbuterol). These medications are members of a class of drugs called short-acting beta-2 agonists. The effects of short-acting bronchodilators do not last very long.

Long-acting bronchodilators are used daily as maintenance treatment to prevent COPD flare-ups. Long-acting bronchodilators are not effective immediately and cannot be used as rescue medications in the event of an attack. Examples of long-acting beta-2 agonists include Formoterol (sold under the brand names Foradil and Perforomist) and Serevent Diskus (Salmeterol). Long-acting bronchodilators need to be taken regularly to keep working.

Atrovent (Ipratropium), Spiriva (Tiotropium), Tudorza (Aclidinium), and Seebri Neohaler (Glycopyrrolate) are long-acting bronchodilators from a different class of medications called anticholinergics or muscarinic antagonists. They can improve the effectiveness of other bronchodilators.

Theo-24 (Theophylline) is one other type of long-acting bronchodilator.

Common side effects of bronchodilators include headache, upset stomach, jittery feeling, rapid or irregular heartbeat, and hyperactivity. Long-acting bronchodilators have been associated with increased risk for death from asthma.

Long-acting bronchodilators are typically taken in combination with a corticosteroid.

Corticosteroids

Also called glucocorticosteroids or simply steroids, corticosteroids are powerful medications that suppress immune activity and relieve inflammation. In cases of COPD, steroids decrease swelling and inflammation in the lungs, making it easier to breathe.

Steroids are commonly taken by inhaler or nebulizer on a daily basis as maintenance medications to prevent COPD flare-ups. During COPD flares, steroids may be administered at a higher dosage intravenously or taken orally. Steroids inhaled for COPD include Budesonide (sold under the brand name Pulmicort) and Fluticasone (sold under the brand names Arnuity Ellipta and Flovent). Rayos is a branded version of the steroid Prednisone approved by the Food and Drug Administration (FDA) to be taken orally to treat COPD flares.

Taken for short periods of time, corticosteroids are safe and effective. However, taken long-term at higher dosages, corticosteroids can cause serious side effects including osteoporosis, cataracts, and serious metabolic disorders such as diabetes and Cushing syndrome. These side effects are more likely when corticosteroids are swallowed or administered intravenously.

Corticosteroids are most commonly taken in combination with a long-acting bronchodilator.

Combination medications

Medications that combine a long-acting bronchodilator with a corticosteroid are among the most common maintenance drugs taken for COPD. Advair (Fluticasone/Salmeterol), Symbicort (Budesonide/Formoterol), Breo Ellipta (Fluticasone/Vilanterol), and Dulera (Mometasone/Formoterol) are a few examples.

Other types of combination drugs include Anoro Ellipta (Umeclidinium/Vilanterol), composed of two classes of long-acting bronchodilators, and Combivent Respimat and DuoNeb, both combinations of short-acting bronchodilators Ipratropium and Albuterol.

Alpha1-proteinase inhibitors

People with the genetic disorder alpha-1 antitrypsin deficiency (alpha-1) do not make enough of a protein (alpha-1-antitrypsin, or AAT), leading to lung damage. Alpha1-proteinase inhibitors such as Aralast NP, Glassia, Prolastin-C, and Zemaira replace the missing protein, providing protection from damage.

Other medications

Phosphodiesterase-4 (PDE4) inhibitors are a newer class of drugs that can help relieve swelling and inflammation in the lungs that make it difficult to breathe. Daliresp (Roflumilast) is the only PDE4 inhibitor currently approved for treating COPD.

People with COPD are susceptible to lower respiratory infections. Antibiotics may be prescribed to fight bacterial infections during flare-ups.

Mucinex (Guaifenesin), available over the counter, can help thin mucus and make it easier to cough up.

Depression and anxiety are common in people with COPD, as with all chronic illnesses. Antidepressants such as Celexa (Citalopram), Cymbalta (Duloxetine), Prozac (Fluoxetine), and Zoloft (Sertraline) can address depression in people with COPD.

Oxygen therapy

People with severe cases of chronic obstructive pulmonary disease (COPD) may develop hypoxia, or low levels of oxygen in the blood. Some people with hypoxia only require oxygen therapy when they are walking, eating, sleeping, or during airline flights. Others may have resting hypoxia and need supplemental oxygen even when they are sitting still. When someone needs oxygen therapy 24 hours a day, this is known as long-term oxygen therapy (LTOT).

There are three main types of oxygen delivery devices: Oxygen-gas cylinders, oxygen concentrators, and liquid-oxygen devices. Devices differ in portability, expense, and noise. If your doctor prescribes supplemental oxygen, they will help you decide which device is right for you.

Surgeries

Bullectomy is a surgery to remove bullae, large air pockets that can form in lungs damaged by COPD. Bullectomy can improve lung function in some people with COPD.

Lung volume reduction surgery removes damaged portions of one or both lungs that have become overinflated due to emphysema, leaving healthier parts of the lung more room to expand.

Lung transplant may be an option for some people with end-stage COPD who have tried every other avenue of treatment. Lung transplants may involve one (single-lung transplantation) or two (bilateral lung transplantation) lungs harvested from an organ donor in your region who is a close genetic match. There are extensive criteria for becoming a candidate for lung transplant in addition to the severity of your disease. Wait time for a lung transplant is usually one to three years.

Pulmonary rehabilitation

Multiple studies have proven that pulmonary rehabilitation programs can significantly reduce shortness of breath and fatigue and increase the ability to walk and exercise. Some people with COPD who complete a course of pulmonary rehabilitation report improved quality of life. There is also evidence that pulmonary rehabilitation programs may result in less time spent in the hospital. In order to begin a program of pulmonary rehabilitation, you must receive a referral from your physician and provide spirometry test results taken within the past year that prove a diagnosis of COPD.

Lifestyle

As mentioned before, quitting smoking is vital for anyone with COPD who wants to improve symptoms, slow disease progression, and prolong life.

Even small amounts of exercise can improve symptoms and promote general health in people with any stage of chronic obstructive pulmonary disease (COPD). Fatigue and breathlessness lead many people with COPD to give up on exercise and become increasingly sedentary. Many people with COPD believe that exercise will cause their symptoms to become worse. However, the reverse is true. Physical activity can improve symptoms, while remaining sedentary exacerbates symptoms and contributes to the development of osteoporosis, heart disease, diabetes, depression, and obesity.

There is no specific diet for COPD, but many physicians and researchers studying the effects of nutrition in people with COPD recommend a diet higher in fat, protein, vegetables, and fruits and lower in carbohydrates. Limiting salt intake can help prevent swelling. Eating a nutritious diet can help you fight COPD symptoms and infections and maintain optimal health. Optimizing your nutrition will help you remain strong, fight infections and feel more energetic. Consistently eating a healthy diet and ensuring that you receive enough calories can help you breathe better and may reduce your dependence on oxygen therapy.

Some people with COPD incorporate natural treatments and report relief from certain symptoms when they use complementary or alternative treatments such as acupuncture, massage, or herbal supplements. It is important to notify your doctor of any natural treatments you use, since some can interact with medications in dangerous ways, or make them less effective. Complementary therapies should not replace prescribed medications, which have been proven effective in clinical studies.

Resources

External resources

MyCOPDTeam resources

FAQ

Is vaping better than smoking for people with COPD?

Vaping, or smoking e-cigarettes that vaporize nicotine, is too new a habit for there to be any clinical studies available about its long-term effects on people with COPD. Existing studies indicate that vaping is less harmful for people with COPD than smoking traditional cigarettes. Switching from traditional smoking to vaping may improve COPD symptoms and lead to fewer disease flare-ups. E-cigarettes can also be effective in helping smokers in quitting tobacco altogether, which is the healthiest and safest choice for people with COPD. However, according to the Lung Institute, vaping can increase airway resistance, making it harder to breathe for 10 minutes afterward. The Lung Institute recommends against vaping for anyone, especially people with lung disease. More research is needed on the subject of e-cigarettes and COPD.

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