Chronic obstructive pulmonary disease (COPD) is the collective term for a group of conditions that damage tissues in the lungs and airways. This damage affects airflow in and out of the lungs, making breathing difficult.
While there is no cure for COPD, a range of medications can help manage the condition and prevent flare-ups, or exacerbations.
This article describes the different types of COPD medications available, including how well they work and what side effects to watch out for. Next, we outline how a doctor diagnoses this health issue.
Bronchodilators are medications that relax the muscles around the airways, allowing them to open more fully so that air can move in and out of the lungs more freely.
Below are some examples of bronchodilators that a doctor may prescribe for someone with COPD.
A person might take a fast- or slower-acting formula of this type of bronchodilator.
Fast-acting beta-2 agonists begin working within 3–5 minutes, and a person may use a rescue inhaler that contains this medication before any activity that can trigger a flare-up of COPD symptoms.
Slower-acting beta-2 agonists begin working within around 20 minutes.
Examples of beta-2 agonists include:
- salbutamol or albuterol (Ventolin)
- levalbuterol (Xopenex)
- terbutaline (Bricanyl)
- pirbuterol (Maxair)
Side effects can include:
- cramping in the hands or legs
- a faster heartbeat
Anticholinergics are a type of inhaled bronchodilator that a person takes regularly throughout the day. They are not intended for use in rescue inhalers.
Anticholinergics are available in short- and longer-lasting formulas. Short-lasting versions are effective for around 6–8 hours, while longer-lasting versions are effective for 12 or 24 hours, depending on the drug.
The side effects are similar to those of beta-2 agonists, but they can also include dry mouth and difficulty passing urine.
Theophylline is a bronchodilator that people typically take as tablets. Some brand names of this medication include Theo 24, Theochron, Elixophyllin, and Uniphyl.
However, doctors in the United States do not commonly prescribe theophylline for COPD.
A person taking theophylline needs periodic blood tests to check whether levels of the drug are high enough to be effective but low enough to prevent serious side effects.
The adverse effects of high doses of theophylline be serious, including:
- severe nausea
- heartbeat irregularities
Regular monitoring is also important because various changes can alter the levels of the drug in the body. It is especially important to attend regular blood tests if any of the following have changed:
- the diet
- any other ongoing medications
Corticosteroids are drugs that help reduce inflammation in the body. A doctor may prescribe them to ease swelling in the airways.
People with COPD typically take corticosteroids in inhalers, though they are also available as pills, which contain more of the medication and therefore act faster.
Most people take a corticosteroid in combination with a bronchodilator.
A 2014 study supports the use of corticosteroids in the short term but discourages their use for longer periods. This is mainly because the long-term use of corticosteroids increases the risk of side effects.
The most common side effects of inhaled corticosteroids include:
- a hoarse voice
- a sore throat
- mouth or throat infections
Long-term use of corticosteroid tablets may lead to:
- bruising of the skin
- swelling of the feet or ankles
- weight gain
- high blood pressure
- increased blood sugar levels
- mood changes
- a weakening of the skin, bones, and muscles
For most people with COPD, doctors prescribe a combination of medications. This may involve two different bronchodilators or a bronchodilator and a corticosteroid. A person may take these daily to prevent COPD symptoms.
The authors of a 2019 review report that a combination approach can help with COPD exacerbations as well as persistent symptoms. However, they acknowledge that determining the effectiveness of combination treatments in specific groups will require further research.
Roflumilast is a medication that helps reduce irritation and swelling of the airways in people with severe COPD. A common brand name is Daxas.
According to a 2016 study, roflumilast is often effective in people with severe to very severe COPD who have a history of exacerbations and chronic bronchitis.
Some reported side effects of roflumilast include:
Azithromycin is an antibiotic, and a doctor may prescribe a low dosage over a long period to help reduce COPD exacerbations. A person may take a branded version, such as Zithromax, Zithromax Tri-Pak, Zithromax Z-Pak, or Zmax.
An older study, from 2011, found that participants who took low doses of azithromycin with supplemental medications for a year experienced fewer COPD exacerbations and saw improvement in the quality of life.
The study noted two potential side effects, however: partial hearing loss and a change in patterns of microbial resistance.
These medications help clear mucus from the lungs and airways. According to a 2017 review, mucoactive drugs may provide the following benefits for people with COPD:
- reduction in airway inflammation
- reduction of acute COPD exacerbations
- improved quality of life
The researchers noted, however, that determining the effects of these drugs in specific groups of people with COPD will require further research.
Though flu shots do not directly treat COPD, they are an important part of any treatment plan for someone with this type of disease.
The flu is a highly infectious respiratory illness, and people with COPD are more susceptible to these types of infections. COPD also reduces lung capacity, increasing a person’s risk of developing flu complications.
For these reasons, the Centers for Disease Control and Prevention (CDC) recommend that people with COPD or other lung conditions receive a yearly flu vaccine.
The American Lung Association describe the following steps that a doctor takes before diagnosing COPD:
- taking account of the person’s symptoms
- assessing their medical history and related factors, such as smoking
- conducting a physical examination
The doctor may also perform or request the following tests:
- Spirometry: The aim is to assess lung function. The test involves blowing air into a mouthpiece, which detects how much air the person can blow out and how fast they can do it.
- Arterial blood gas test: This measures levels of oxygen in the blood. It can help show how effective the lungs are at moving oxygen into the blood and removing carbon dioxide from the blood.
- Chest X-ray: This can help the doctor identify lung damage.
Contact a doctor if any of the following COPD signs and symptoms develop:
- increased breathlessness
- persistent wheezing
- a persistent cough that produces phlegm
- frequent chest infections
It is also important to let the doctor know if COPD symptoms are getting worse or flaring up more often. The doctor may recommend additional treatment or change existing dosages.
A doctor can also provide information about new therapies and clinical trials.
Though preventing COPD is not always possible, taking the following steps may help:
- quitting or never starting smoking
- avoiding secondhand smoke
- limiting exposure to air pollution
- avoiding exposure to chemicals, dust, and fumes, which might involve wearing protective equipment at work, for example
- working with others to campaign for clean air and related environmental standards
COPD is a chronic disease that damages the lungs and airways, making breathing difficult.
There is no cure, but medications can manage the condition and reduce COPD symptoms, significantly improving the quality of life.
It is important to note that a variety of medications can help treat COPD. If a person’s current treatment plan is not effective, they should contact a doctor and ask about other options.