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COPD treatment and medications

Cropped SingleCare logo By | January 9, 2020
Medically reviewed by Anis Rehman, MD

What is COPD? | COPD diagnosis | COPD treatment options | COPD medications | Best COPD medications | Side effects of COPD | COPD home remedies | FAQ | Resources

Chronic obstructive pulmonary disease, commonly referred to as COPD, is a lung disease that blocks airflow causing difficulty in breathing. COPD is the leading cause of death in the United States with 16 million people diagnosed and many undiagnosed. There are two types 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 decreasing lung function. There are two types: chronic bronchitis, where there is damage to the bronchial tubes characterized by a cough with mucus, and emphysema—damage to the air sacs in the lungs resulting in shortness of breath.

The COPD Foundation also includes refractory asthma, or non-reversible asthma as a type of COPD. However, many sources claim asthma and COPD are different diseases with overlapping symptoms.

One of the major causes of COPD is smoking tobacco, 75% of people with COPD have smoked or used to smoke. Long-term vaping may also lead 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 are also being trialed, such as precision therapy, 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 versus men.

Symptoms of COPD start out mild 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 typically 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 office, says Dr. DonDiego. Your appointment to test for COPD will start with an overview of your symptoms and medical history. The doctor may ask questions including:

  • Do you or have you ever smoked?
  • Have you had prolonged exposure to second-hand 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 everyday activities make you short of breath, like taking a short walk 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: This is a test that determines blood pH levels and levels of carbon dioxide and oxygen within the artery. This blood test takes blood directly from the artery, unlike most blood tests which take blood from the vein.
  • Diagnostic imaging: These may be performed to get a visualization of the lungs.
    • Chest X-rays are able to detect if a person has emphysema, one of the main types of COPD.
    • 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 to COPD. Echocardiography is a sort of ultrasound of the heart to rule out heart failure.
  • Laboratory testing: 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 be the cause of COPD when someone is diagnosed with COPD at a young age and who has a family history of the disease.
  • Pulmonary (lung) function tests: These tests measure how much air is used during an inhale and exhale. This will tell the doctor if your lungs are intaking enough oxygen. There are different pulmonary function tests:
    • Spirometry: This test 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: This is a simple test where a small machine is placed on your finger and reads blood oxygen levels. A typical person has 02 levels of 95-100%, where people with COPD may have levels from 88-92%.
  • Sputum examination: This test is 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

If not managed properly COPD can lead to death, 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 deal with the symptoms of COPD.

Common medications prescribed to treat COPD including inhalers of bronchodilators and steroids, phosphodiesterase-4 inhibitors to decrease lung inflammation, or theophylline to improve breathing. Other common treatments of COPD include stopping smoking or vaping, lung therapies, or surgery.

COPD medications

There are a variety of medications your doctor may prescribe to treat COPD, some used regularly and others as needed. The following is a list of potential medications used for those diagnosed with COPD.

Bronchodilators

Bronchodilators help manage COPD symptoms by relaxing the muscles around the airway making it easier to breathe. Typically bronchodilators are inhalers. For those that need help breathing all day, long-term bronchodilators may be prescribed. Common long-term bronchodilators include Arcapta (indacaterol), Brovana (arformoterol), Spiriva (tiotropium bromide), Serevent Diskus (salmeterol), or Tudorza (aclidinium). Short-acting or short-term bronchodilators are used before activities. Commonly prescribed short-term bronchodilators include Ventolin Hfa (albuterol sulfate), Xopenex (levalbuterol Hcl), and Atrovent Hfa. Common side effects of bronchodilators include increased heart rate, shakiness, and nervousness.

Inhaled steroids

An inhaler of corticosteroids can help decrease inflammation in the lungs, improving the ability of air to move in and out of the lungs. Common inhaled steroids include Flovent (fluticasone) or Uceris (budesonide). Side effects of inhaled steroids include hoarseness or oral infections. Inhaled corticosteroids increase the risk of serious pneumonia in people with COPD. Oral steroids may also be prescribed in short courses. Oral steroids though more effective, have more side effects than the inhaled steroids.

Combined bronchodilator/steroid inhalers

Some inhalers for COPD come in a combination of two different bronchodilators together or a bronchodilator and corticosteroid combination. 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 decrease lung inflammation and improve the flow of air into the lungs. This pill is taken once daily. Common side effects include diarrhea, headache, and weight loss.

Xanthines

Theochron (theophylline) is a drug in the methylxanthines, or xanthines, drug class that is often prescribed to help bronchodilators and corticosteroids work better. This drug helps relax the airway muscles. Common side effects include headache, upset stomach, or trouble sleeping.

What is the 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 doctor the best medication for you. This table includes the most commonly prescribed COPD medications.

 The best medications for COPD
Drug name Drug class Administration route Standard dosage Common side effects
Arcapta (indacaterol) Long-acting beta-agonists (LABAs) Inhaler Inhaled once per day Cough, sore throat, runny nose
Brovana (arformoterol) LABAs Inhaled through nebulizer Inhaled 2x per day, typically morning and night Nervousness, uncontrollable shaking, headache
Spiriva (tiotropium bromide) Bronchodilator Capsule with a specially designed inhaler Inhaled once a day in the morning or evening Dry mouth, constipation, stomach pain
Serevent Diskus (salmeterol) LABAs Dry powder with a specially designed inhaler Inhaled twice a day, 12 hours apart Seizures, chest pain, dizziness
Tudorza (aclidinium) Bronchodilator Dry powder inhaled by mouth Inhaled twice a day, 12 hours apart Headache, runny nose, cough
Ventolin Hfa (albuterol sulfate) Bronchodilator Liquid inhaled by a nebulizer Use every 4-6 hours as needed Uncontrollable shaking, nervousness, headache
Atrovent Hfa Bronchodilator Liquid inhaled with a nebulizer Inhaled 3-4 times a day, every 6-8 hours Dizziness, nausea, heartburn
Flovent (Fluticasone) Corticosteroids Inhaler Inhaled twice daily Headache, runny nose, hoarseness
Advair (fluticasone/salmeterol) Steroid/LABAs Inhaler Inhaled twice a day, 12 hours apart Seizures, chest pain, dizziness
Daliresp (roflumilast) Phosphodiesterase inhibitors Tablet taken by mouth 250 mg tablet taken once daily Diarrhea, nausea, dizziness
Theochron (theophylline) Xanthines Variety of forms: Tablet, capsule, or liquid Taken every 6, 8, 12, or 24 hours Upset stomach, stomach pain, diarrhea

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are the common side effects of COPD medication?

Common side effects of COPD medication vary between drug classes. Common side effects of bronchodilators include increased heart rate, shakiness, and nervousness. The most common side effects of inhaled steroids include hoarseness, oral infections, or runny nose. Daliresp has common side effects of diarrhea, headache, and weight loss. Headache, upset stomach, or trouble sleeping are common side effects with Theochron. This is not a full list of side effects. Please discuss possible adverse events and drug interactions with a healthcare professional.

What are the best natural remedies for COPD?

There are many options to manage symptoms of COPD besides medication. One of the first and most important treatment options for COPD is to quit smoking or vaping immediately. Other natural remedies include:

  • Lung therapies: These help those with moderate to severe COPD. There are two major types of lung therapies.
    • Oxygen therapy is used for those who are not getting enough oxygen into their blood. Supplemental oxygen can be worn on a portable device and is typically received through a face mask or nasal cannula. Supplemental oxygen can be used during activities while sleeping, or throughout the day.
    • Pulmonary rehabilitation programs use exercise, education, counseling, and nutrition to support the patient’s needs. These programs can help people participate in everyday activities. A pulmonologist or primary care doctor can help you find a program in your area.
  • Breathing exercises: Improve breathlessness and help improve exercise capacity in those with COPD. Common breathing exercises include pursed-lip breathing and diaphragmatic breathing.
  • Improving air quality: Vacuuming or using an air filtration system within the home. This can decrease irritants in the air, which may exacerbate COPD.
  • Eating a balanced diet: Shown to help COPD patients.
  • Exercising: Can help improve the ability of patients to endure physical activities. One study has shown that water-based exercises have better results for those with COPD.
  • Managing stress: Is important in those with COPD. Panic attacks can be very dangerous for those with COPD. Counseling, breathing exercises, and yoga are good options for those with COPD.
  • Vitamin D: Vitamin D deficiencies can be common in those with severe COPD. Exacerbation of symptoms can improve with this supplement.
  • Avoiding lung infections: Get flu and pneumococcal vaccines. Lung infections in those with COPD can lead to serious problems.
  • Essential oils: Essential oils such as eucalyptus oil have compounds found to prevent COPD exacerbation according to a 2014 study.
  • Maintaining a healthy weight: Important for those with COPD. Being underweight with COPD increases your chance of mortality.

Frequently asked questions about COPD

What is the best treatment for COPD?

The best treatment for COPD is for those that are currently using tobacco to quit smoking or vaping. Medications and natural remedies also have success for those with COPD.

Can a person with COPD get better?

A person with COPD can improve their quality of life with treatment and medication.

What is the latest treatment for COPD?

One of the newest medications for COPD is Daliresp (roflumilast) which relaxes the airways and decreases inflammation.

What is the life expectancy for someone with COPD?

According to a 2009 study, people around 65 years old with stage 1 or 2 COPD may lose a few years of life expectancy. Those currently smoking with stage 3 or 4 COPD can lose around 6 years of life expectancy.

How to manage COPD?

COPD can be managed with medication like bronchodilators or inhaled corticosteroids, life changes, such as quitting smoking, and other treatments like pulmonary rehabilitation.

What are the specific symptoms of COPD?

Specific symptoms of COPD may include shortness of breath, wheezing, coughing, and difficulty taking a full breath. These are symptoms that will progress over time.

Related resources for COPD