Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases that make it difficult to breathe. COPD can include emphysema and chronic bronchitis.
If you have COPD, you may have symptoms such as trouble breathing, cough, wheezing, and tightness in your chest. COPD is often caused by smoking, but in some cases it’s caused by breathing in toxins from the environment.
There is no cure for COPD, and the damage to the lungs and airways is permanent. However, several medications can help reduce inflammation and open your airways to help you breathe easier with COPD.
Bronchodilators help open your airways to make breathing easier. Your doctor may prescribe short-acting bronchodilators for an emergency situation or for quick relief as needed. You take them using an inhaler or nebulizer.
Examples of short-acting bronchodilators include:
- albuterol (Proair HFA, Ventolin HFA)
- levalbuterol (Xopenex)
- ipratropium (Atrovent HFA)
- albuterol/ipratropium (Combivent Respimat)
Short-acting bronchodilators can cause side effects such as dry mouth, headache, and cough. These effects should go away over time. Other side effects include tremors (shaking), nervousness, and a fast heartbeat.
If you have a heart condition, tell your doctor before taking a short-acting bronchodilator.
With COPD, your airways can be inflamed, causing them to become swollen and irritated. Inflammation makes it harder to breathe. Corticosteroids are a type of medication that reduces inflammation in the body, making air flow easier in the lungs.
Several types of corticosteroids are available. Some are inhalable and should be used every day as directed. They’re usually prescribed in combination with a long-acting COPD drug.
Other corticosteroids are injected or taken by mouth. These forms are used on a short-term basis when your COPD suddenly gets worse.
The corticosteroids doctors most often prescribe for COPD are:
- Fluticasone (Flovent). This comes as an inhaler you use twice daily. Side effects can include headache, sore throat, voice changes, nausea, cold-like symptoms, and thrush.
- Budesonide (Pulmicort). This comes as a handheld inhaler or for use in a nebulizer. Side effects can include colds and thrush.
- Prednisolone. This comes as a pill, liquid, or shot. It’s usually given for emergency rescue treatment. Side effects can include headache, muscle weakness, upset stomach, and weight gain.
For some people with severe COPD, the typical first-line treatments, such as fast-acting bronchodilators and corticosteroids, don’t seem to help when used on their own.
When this happens, some doctors prescribe a drug called theophylline along with a bronchodilator. Theophylline works as an anti-inflammatory drug and relaxes the muscles in the airways. It comes as a pill or liquid you take daily.
Side effects of theophylline can include nausea or vomiting, tremors, headache, and trouble sleeping.
Long-acting bronchodilators are medications that are used to treat COPD over a longer period of time. They’re usually taken once or twice daily using inhalers or nebulizers.
Because these drugs work gradually to help ease breathing, they don’t act as quickly as rescue medication. They’re not meant to be used in an emergency situation.
The long-acting bronchodilators available today are:
- aclidinium (Tudorza)
- arformoterol (Brovana)
- formoterol (Foradil, Perforomist)
- glycopyrrolate (Seebri Neohaler, Lonhala Magnair)
- indacaterol (Arcapta)
- olodaterol (Striverdi Respimat)
- revefenacin (Yupelri)
- salmeterol (Serevent)
- tiotropium (Spiriva)
- umeclidinium (Incruse Ellipta)
Side effects of long-acting bronchodilators can include:
- dry mouth
- runny nose
- irritated or scratchy throat
- upset stomach
More serious side effects include blurry vision, rapid or irregular heart rate, and an allergic reaction with rash or swelling.
Several COPD drugs come as combination medications. These are mainly combinations of either two long-acting bronchodilators or an inhaled corticosteroid and a long-acting bronchodilator.
Triple therapy, a combination of an inhaled corticosteroid and two long-acting bronchodilators, may be used for severe COPD and flare-ups.
Combinations of two long-acting bronchodilators include:
- aclidinium/formoterol (Duaklir)
- glycopyrrolate/formoterol (Bevespi Aerosphere)
- glycopyrrolate/indacaterol (Utibron Neohaler)
- tiotropium/olodaterol (Stiolto Respimat)
- umeclidinium/vilanterol (Anoro Ellipta)
Combinations of an inhaled corticosteroid and a long-acting bronchodilator include:
- budesonide/formoterol (Symbicort)
- fluticasone/salmeterol (Advair)
- fluticasone/vilanterol (Breo Ellipta)
Combinations of an inhaled corticosteroid and two long-acting bronchodilators, called triple therapy, include fluticasone/vilanterol/umeclidinium (Trelegy Ellipta).
A 2018 research reviewTrusted Source found that triple therapy reduced flare-ups and improved lung function in people with advanced COPD.
However, it also indicated that pneumonia was more likely with triple therapy than with a combination of two medications.
Roflumilast (Daliresp) is a type of drug called a phosphodiesterase-4 inhibitor. It comes as a pill you take once per day.
Roflumilast helps relieve inflammation, which can improve air flow to your lungs. Your doctor will likely prescribe this drug along with a long-acting bronchodilator.
Side effects of roflumilast can include:
- weight loss
Let your doctor know if you have liver problems or depression before taking this medication.
COPD flare-ups can cause increased levels of mucus in the lungs. Mucoactive drugs help reduce mucus or thin it so you can more easily cough it up. They typically come in pill form, and include:
A 2019 studyTrusted Source suggested that these medications may help reduce flare-ups and disability from COPD. A 2017 study also found that erdosteine lowered the number and severity of COPD flare-ups.
Side effects of these medications may include:
- stomach pain
It’s important for people with COPD to get a yearly flu vaccine. Your doctor may recommend that you get the pneumococcal vaccine as well.
These vaccines reduce your risk of getting sick and can help you avoid infections and other complications related to COPD.
A 2018 research review found that the flu vaccine may also reduce COPD flare-ups, but noted that there were few current studies.
Have medical questions? Connect with a board-certified, experienced doctor online or by phone. Pediatricians and other specialists available 24/7.
Regular treatment with antibiotics like azithromycin and erythromycin may help manage COPD.
A 2018 research review indicated that consistent antibiotic treatment reduced COPD flare-ups. However, the study noted that repeated antibiotic use can cause antibiotic resistance. It also found that azithromycin was associated with hearing loss as a side effect.
More studies are needed to determine the long-term effects of regular antibiotic use.
Several cancer drugs could possibly reduce inflammation and limit damage from COPD.
A 2019 study found that the drug tyrphostin AG825 lowered inflammation levels in zebrafish. The medication also sped up the rate of death of neutrophils, which are cells that promote inflammation, in mice with inflamed lungs similar to COPD.
Research is still limited on using tyrphostin AG825 and similar drugs for COPD and other inflammatory conditions. Eventually, they may become a treatment option for COPD.
In some people, inflammation from COPD may be a result of eosinophilia, or having a higher-than-normal amount of white blood cells called eosinophils.
A 2019 studyTrusted Source indicated that biologic drugs may be able to treat this form of COPD. Biologic drugs are created from living cells. Several of these drugs are used for severe asthma caused by eosinophilia, including:
- mepolizumab (Nucala)
- benralizumab (Fasenra)
- reslizumab (Cinqair)
More research is needed on treating COPD with these biologic drugs.
Different types of medications treat different aspects and symptoms of COPD. Your doctor will prescribe medications that will best treat your particular condition.
Questions you might ask your doctor about your treatment plan include:
- How often should I use my COPD treatments?
- Am I taking any other drugs that might interact with my COPD medications?
- How long will I need to take my COPD medications?
- What’s the proper way to use my inhaler?
- What happens if I suddenly stop taking my COPD medications?
- Besides taking medication, what lifestyle changes should I make to relieve my COPD symptoms?
- What should I do if I have a sudden worsening of symptoms?
- How can I prevent side effects?
WARNINGS FOR COPD MEDICATIONSWhatever medication your doctor prescribes, be sure to take it according to your doctor’s instructions. If you have serious side effects, such as an allergic reaction with rash or swelling, call your doctor right away. If you have difficulty breathing or swelling of the mouth, tongue, or throat, call 911 or your local emergency medical services. Because some COPD medications can affect your cardiovascular system, be sure to tell your doctor if you have an irregular heartbeat or cardiovascular problems.
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