COPD Treatments and Medications

Chronic obstructive pulmonary disease, commonly called COPD, is a group of lung diseases that block airflow, causing difficulty in breathing. COPD is the fourth leading cause of death in the United States, with 16 million people diagnosed—and many undiagnosed. There are two main forms of COPD: chronic bronchitis and emphysema. While a COPD diagnosis can be overwhelming, proper treatment of symptoms using medication and natural remedies can manage the condition and improve the overall quality of life.

What is COPD?

COPD is a progressive lung disease where the lungs become inflamed and thickened, making it difficult to breathe and cause a decrease in lung function. There are two main forms of COPD: chronic bronchitis, inflammation and irritation of the bronchial tubes characterized by a long-term cough with mucus, and emphysema—damage to the air sacs in the lungs resulting in shortness of breath. Most people have a combination of both conditions.

One of the major causes of COPD is smoking tobacco: 75% of people with COPD smoke or used to smoke. Vaping may appear to be connected to COPD. Those with long-term exposure to harmful airborne irritants, such as chemicals, fumes, air pollution, and dust, are also more at risk.

There is currently no cure for COPD, but there are treatments to help the symptoms, such as medication, pulmonary rehabilitation, oxygen use, and quitting smoking. New treatments, such as precision therapy, are also being trialed, which is showing promising results for treatment-resistant COPD.

How is COPD diagnosed?

“The most at risk are anyone who smokes cigarettes by far. There is a rare genetic form of COPD, but this is not common and found at an earlier age,“ according to Dr. Danielle DonDiego of Your Doctors Online.

Women are also more at risk of developing COPD. According to the American Lung Association, women are 37% more likely to have COPD than men.

Symptoms of COPD start mild in the early stages and progress over time. Common symptoms of COPD include:

• Shortness of breath

• Frequent coughing

• Wheezing

• Excessive mucus, especially noted during coughing (sputum)

• Difficulty taking a full breath

• Decreased energy

• Blue lips or fingernails

• Frequent infections of the respiratory tract

COPD is different than other lung diseases because:

• COPD starts later in life, typically after the age of 40

• Symptoms slowly progress

• COPD is generally associated with a history of tobacco use

“COPD is diagnosed based on a variety and severity of symptoms and spirometry breathing tests. These can be done at your primary care office or a pulmonologist's office, “says Dr. DonDiego. Your appointment to test for COPD will start with an overview of your symptoms and medical history. The healthcare provider may ask questions, including:

• Do you or have you ever smoked?

• Have you had prolonged exposure to secondhand smoke?

• Have you had prolonged exposure to irritants in the air, such as chemicals, fumes, dust, or exhaust?

• How often do you experience shortness of breath?

• How long have you had these symptoms?

• Do you have difficulty taking a full breath?

• Do daily activities make you short of breath, like walking or climbing a flight of stairs?

There are a variety of tests that may be performed at the appointment. These may include:

• Arterial blood gas analysis: Determines the blood's pH levels and carbon dioxide and oxygen within the artery. This blood test takes blood directly from the artery, unlike most blood tests which carry blood from a vein.

• Diagnostic imaging: May be performed to get a visualization of the lungs.

• Chest X-Rays can detect if a person has emphysema, one of the main types of COPD. A chest X-ray can also rule out other conditions, such as heart failure.

• CT scans can also detect emphysema. Other lung issues may be seen during these tests, such as lung cancer.

• Electrocardiograms (EKG or ECG): May be performed to rule out any heart-related issues that can lead to shortness of breath.

• Echocardiography (Echo): Heart failure exacerbation may have similar symptoms as COPD. Echocardiography is an ultrasound of the heart to rule out heart failure.

• Laboratory testing: Lab tests are not used to diagnose COPD but may be performed to rule out other conditions. One test sometimes performed is genetic testing, which determines if the patient has alpha-1 antitrypsin deficiency or AAt deficiency. In some cases, AAt deficiency can cause COPD when someone is diagnosed with COPD at a young age and has a family history of the disease.

• Pulmonary (lung) function tests: Measure how much air is used during an inhale and exhale. This will tell the doctor if your lungs are taking in enough oxygen. There are different pulmonary function tests:

  • Spirometry: Measures how much air your lungs can hold and how fast you can blow out the air. During this test, you will need to blow into a tube. Spirometry is very helpful in the detection of COPD and also helps track the progression of the disease over time.

  • Pulse Oximetry: A simple test where a small machine is placed on your finger and reads blood oxygen levels. A typical person has O2 levels of 95-100%, whereas people with COPD may have levels of 88-92%.

• Sputum examination: Performed to rule out respiratory infections or lung cancer. Sputum is a mixture of saliva and mucus, which can be coughed up from the lungs.

During this appointment, it is a good time to ask your healthcare provider any questions you may have about COPD. Questions to ask your doctor may include:

• What is the best treatment for COPD?

• How can I stop the progression of COPD?

• What is the best medication for COPD?

• What does the course of medication look like?

• What lifestyle changes can I make to improve my symptoms?

• Are there any clinical trials I can join?

• Do I need to use oxygen?

• Can I lead a normal life with COPD?

COPD treatment options

COPD can progress over time and lead to death if not managed properly. Worldwide, 3.2 million people died from COPD in 2015. A COPD diagnosis can be scary, but there are many treatment options to help those diagnosed. People with COPD can lead a healthy and fulfilling life. There is no cure for COPD, but there are medications and treatments to help improve symptoms of COPD.

Common medications prescribed to treat COPD include inhalers of bronchodilators and steroids, phosphodiesterase-4 inhibitors to decrease lung inflammation, or theophylline to improve breathing. Besides medicine, other standard treatments for COPD include stopping smoking or vaping, lung therapies, oxygen, or surgery.

COPD medications

Your healthcare provider may prescribe various medications to treat COPD; some are used regularly, and others as needed. The following is a list of potential drugs for those diagnosed with COPD.

Bronchodilators

Bronchodilators help manage COPD symptoms by relaxing the muscles around the airways, making breathing easier. Typically, bronchodilators are inhalers or nebulized treatments. Long-term bronchodilators may be prescribed for those needing help breathing all day. Common long-acting bronchodilators include Brovana (arformoterol), Spiriva (tiotropium), Serevent Diskus (salmeterol), and Tudorza (aclidinium).

Short-acting or short-term bronchodilators are used before activities or as needed for shortness of breath. Commonly prescribed short-term bronchodilators include Ventolin HFA (albuterol) and Xopenex (levalbuterol). Common side effects of short-acting bronchodilators include increased heart rate, shakiness, and nervousness.

Inhaled Steroids

A corticosteroid inhaler can help decrease inflammation in the lungs, improving the ability of air to move in and out of the lungs. Pulmicort Flexhaler (budesonide) is a commonly prescribed inhaled steroid. Side effects of inhaled steroids include hoarseness or oral fungal infections. Rinsing with water (and spitting) after using an inhaled steroid can reduce the risk of getting an oral fungal infection. Inhaled corticosteroids increase the risk of serious pneumonia in people with COPD.

Oral steroids like prednisone may also be prescribed in short courses. Though more effective, oral steroids have more side effects than inhaled steroids.

Combined Bronchodilator/Steroid Inhalers

Some inhalers for COPD come in a combination of two different bronchodilators or a bronchodilator and corticosteroid combination as a combination therapy. Bronchodilator combination inhalers include Stiolto Respimat (tiotropium/olodaterol) and Anoro Ellipta (umeclidinium/vilanterol). Bronchodilator and corticosteroid combination inhalers include Advair (fluticasone/salmeterol), Breo Ellipta (fluticasone/vilanterol), and Symbicort (budesonide/formoterol).

Phosphodiesterase-4 inhibitor

Daliresp (roflumilast) is a phosphodiesterase-4 inhibitor that can be used to lower the risk of COPD exacerbations associated with chronic bronchitis and a history of exacerbations. This oral tablet is taken once daily with or without food. Common side effects include diarrhea, nausea, headache, and weight loss.

Xanthines

Theophylline is a drug in the methylxanthines or xanthines, drug class. This drug helps relax the airway muscles. Common side effects include headache, upset stomach, or trouble sleeping.

Mucolytics

Mucolytic drugs are used to break up mucus in the lungs, making it easier to cough out. Acetylcysteine is a mucolytic drug that is commonly used as an inhaled nebulizer treatment for COPD.

Oxygen Therapy

Some people with COPD have a low level of oxygen, so oxygen therapy can help these individuals breathe better, have a better quality of life, and live longer. Long-term oxygen treatment should be used for at least 15 hours per day, with as few interruptions as possible.

What is the best medication for COPD?

There is no overall best medication for COPD. The best medication for COPD depends on a patient’s medical condition, medical history, and current medications they may already be taking that could interact with COPD medications, as well as their response to treatment. You should always discuss with your healthcare provider the best medication for you. This table includes some examples of commonly prescribed COPD medications.

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Best medications for COPD