COPD Treatments and Medications

Chronic obstructive pulmonary disease (COPD) entails various lung conditions that can inflame the lungs and cause breathing problems. It’s one of the leading causes of death in the U.S., with cigarette smoking as the most common cause. Chronic bronchitis and emphysema are the two main types of COPD. Although lung damage can’t be reversed, various treatments are available to help control symptoms and slow disease progression. See a healthcare provider if you experience a persistent cough, wheezing, or shortness of breath, especially if you smoke or are over 40. 

How is COPD diagnosed?

COPD is diagnosed by a healthcare provider, usually a primary care provider or a pulmonologist (lung specialist). They will generally perform a physical exam and breathing tests, alongside asking about your symptoms and medical history. The following are potential tests they might do:

• Spirometry tests: A spirometer measures how much air your lungs can hold and how quickly you can exhale. This type of test can help diagnose and track COPD over time.

• Blood gas tests: Pulse oximetry is a test that measures your blood oxygen level using a device on your finger, while arterial blood gas tests can measure your oxygen and carbon dioxide levels more accurately.

• Chest imaging: A CT scan or chest X-ray can help get a better picture of any lung damage and differentiate it from other conditions like lung cancer or heart failure.

• Other lab and genetic tests: A blood test can assess your overall health, while a genetic test can look for alpha-1 antitrypsin deficiency, an inherited condition that can be a potential cause of COPD. 

An early diagnosis can help make sure the right treatment is recommended. Since the condition is irreversible, allowing it to worsen could lead to more serious outcomes. 

COPD treatment options

COPD has no cure, but treatment can help control symptoms, prevent flare-ups (exacerbations), and slow how fast the disease progresses. The main treatment options besides quitting and avoiding smoking include inhaled medications, such as bronchodilators and inhaled corticosteroids. Long-acting bronchodilators can help widen the airways, while steroids can help reduce inflammation for people who experience flare-ups often. Some people could also benefit from biologic injections, oxygen therapy, and even surgical procedures for severe cases. 

Types of COPD medication

Most medications for COPD need to be inhaled by mouth. More than one may be prescribed depending on the severity of the condition, with some acting as long-term controller medications and others used as needed for flare-ups. 

Short-acting bronchodilators

Short-acting bronchodilators are considered rescue inhalers used to relieve symptoms quickly. They can help improve breathing when symptoms come on quickly. Common ones include Ventolin HFA (albuterol), Xopenex (levalbuterol), and Combivent Respimat (ipratropium-albuterol).

Long-acting bronchodilators

Long-acting bronchodilators make up the backbone of treatment and are used daily for long-term symptom control. Options include long-acting muscarinist antagonists (LAMAs) such as Spiriva Respimat (tiotropium) and Tudorza Pressair (aclidinium), as well as long-acting beta agonists (LABAs) such as Serevent Diskus (salmeterol) and Brovana (arformoterol). In many cases, a combination of a LABA and LAMA is used.

Inhaled and oral corticosteroids

Corticosteroids are used to help decrease inflammation in the lungs and airways. However, they’re not typically used alone for COPD. Instead, people who use a bronchodilator and still experience flare-ups could benefit from adding an inhaled corticosteroid (ICS). Pulmicort Flexhaler (budesonide) is one example. In some cases, a short course of an oral steroid like prednisone may be prescribed during a flare-up. 

Roflumilast and other add-ons

Daliresp (roflumilast) is a phosphodiesterase-4 inhibitor taken by mouth to help reduce the risk of flare-ups in people with severe chronic bronchitis. Older treatment options may be added in some cases, including theophylline, which can relax the airways, and acetylcysteine, which can help thin mucus. 

Biologics

For people with COPD who still experience severe symptoms even with recommended inhalers and who have high eosinophil levels, a biologic medication is an option. A biologic injection like Dupixent (dupilumab) or Nucala (mepolizumab) can be added to treatment to help reduce COPD exacerbations. 

Over-the-counter COPD medicine

There are no over-the-counter medicines approved to treat COPD. It’s best to avoid OTC cough suppressants or antihistamines unless directed by a healthcare provider, as these products can worsen symptoms such as chest congestion. Guaifenesin is an expectorant that may help thin mucus, making it easier to cough up, but evidence is mixed on whether it’s actually beneficial for COPD. Nicotine replacement patches or gum products can be used to help quit smoking, which is a key factor in managing the progression of COPD.

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