COPD: Management, Medications, and Treatment Options

Chronic obstructive pulmonary disease (COPD) is managed using a combination of lifestyle changes, medications, oxygen therapy, and surgery.1 While there isn’t currently a cure for COPD, these treatments can help you breathe easier and live a more comfortable life.

If you’re living with COPD and your symptoms aren’t well-controlled with your current treatment plan, talk to your doctor or pulmonologist (a doctor who specializes in treating lung diseases).

Quitting Smoking to Treat COPD

If your COPD was caused by smoking, the most important thing you can do to treat and manage it is to quit.2 By quitting smoking, you prevent thousands of chemicals from entering and damaging your lungs. Quitting smoking can also help your COPD treatments work better. Many of them help treat inflammation caused by smoking — when you quit, your lungs are able to heal and breathe better.

It can feel nearly impossible to quit smoking — but quitting when living with COPD can help you live a longer, healthier life. The Centers for Disease Control and Prevention (CDC) offers free resources to people looking to quit smoking. The American Lung Association also has the Lung HelpLine and other programs available. If you’re looking for local programs, your hospital, workplace, or doctor’s office may offer group classes. Ask your family and friends to help support you on your journey to quit as well.

Short-Acting Bronchodilators for COPD

Bronchodilators are medications that relax the smooth muscle lining the airways (bronchi). They’re breathed in as powders or mists, typically using inhalers or nebulizers. Short-acting bronchodilators work quickly (within 15 to 20 minutes) to help open the airways and treat shortness of breath. However, their effects only last for three to six hours. Short-acting bronchodilators are best for treating mild cases of COPD or if you occasionally have symptoms.3

There are two types of short-acting bronchodilators — short-acting beta2-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs). They’re used alone or in combination with each other to help treat COPD symptoms. SABAs are typically referred to as “rescue inhalers” because they can treat severe and sudden symptoms quickly. SAMAs stop your airway muscles from tightening and help clear mucus out of your lungs.4

Examples of SABAs include albuterol (Ventolin HFA®, ProAir HFA®) and levalbuterol (Xopenex®). A commonly prescribed SABA and SAMA combination bronchodilator uses albuterol and ipratropium (sold under the brand names Duoneb® or Combivent®).

The side effects you may experience using short-acting bronchodilators depend on which medication you use.5 Common side effects of SABAs include:

  • Fast heartbeat
  • Upset stomach
  • Feeling shaky, nervous, hyperactive, or overexcited
  • Having trouble sleeping

Common side effects of SAMAs include:

  • Nausea
  • Vomiting
  • Dry eyes, nose, and throat
  • An unusual or bad taste in your mouth

Long-Acting Bronchodilators for COPD

As their name suggests, long-acting bronchodilators work for up to 12 hours to relieve shortness of breath, cough, and other COPD symptoms.5 They don’t work as quickly as short-acting bronchodilators to stop sudden and severe symptoms that are already happening. Instead, long-acting bronchodilators are used as maintenance medications to stop new symptoms before they even start.

There are two types of long-acting bronchodilators — long-acting beta2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs).4 They’re prescribed alone or in combination with one another, depending on your needs.

Examples of LABAs include:

  • Indacaterol (Arcapta®)
  • Arformoterol (Brovana®)
  • Formoterol (Perforomist®)
  • Salmeterol (Severent®)
  • Olodaterol (Stiverdi®)

Examples of LAMAs include:

  • Umeclidinium (Incruse Ellipta®)
  • Glycopyrrolate (Seebri®)
  • Tiotropium (Spiriva®)
  • Aclidinium (Tudorza®)

Examples of combination LABA and LAMA inhalers include:

  • Umeclidinium and vilanterol (Anoro®)
  • Glycopyrrolate and formoterol (Bevespi®)
  • Olodaterol and tiotropium (Stiolto®)
  • Indacaterol and glycopyrrolate (Utibron®)

If you have moderate-to-severe COPD, your doctor or pulmonologist may prescribe you both a short-acting and long-acting bronchodilator.

The side effects of long-acting bronchodilators are similar to those caused by short-acting bronchodilators.5 Common side effects of LABAs include:

  • Upset stomach
  • Fast heartbeat
  • Having trouble sleeping
  • Feeling shaky, hyperactive, overexcited, or nervous

Common side effects of LAMAs include:6

  • Dry mouth
  • Constipation
  • Diarrhea
  • Cough
  • Headache

Inhaled Steroids for COPD

Corticosteroids (steroids) are medications that help treat inflammation in your airways.7 These medications are inhaled directly into your lungs to help reduce swelling and mucus production. Your doctor or pulmonologist will prescribe an inhaled steroid together with a bronchodilator if you have moderate-to-severe COPD.

Examples of combination inhalers used to treat COPD include:

  • Salmeterol and fluticasone (Advair® HFA, AirDuo Digihaler®)
  • Fluticasone and vilanterol (Breo® Ellipta)
  • Formoterol and budesonide (Symbicort®)
  • Fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta)

Common side effects of inhaled steroids include:8

  • Headache
  • Dry throat or mouth
  • Cough
  • Cold-like symptoms
  • Sore throat or hoarseness

Roflumilast for COPD

Roflumilast (Daliresp®) is a medication that treats inflammation and relieves swelling in the lungs in people with COPD. It works by blocking the effects of phosphodiesterase 4 (PDE4), an enzyme that creates inflammation and makes COPD symptoms worse. Roflumilast is the only PDE4 inhibitor approved by the U.S. Food and Drug Administration (FDA) for treating severe COPD.9

Unlike other COPD treatments, roflumilast is taken once a day as a tablet. Your doctor or pulmonologist will prescribe it along with other medications to help prevent your COPD symptoms from becoming worse (known as exacerbations). Your roflumilast prescription can’t be used as a rescue medication, so be sure to keep your inhaler or other medications around in case of sudden breathing problems.

Common side effects of roflumilast include:10

  • Headache
  • Dizziness
  • Nausea
  • Diarrhea
  • Decreased appetite
  • Muscle spasms
  • Back pain
  • Uncontrollable shaking in parts of your body

Leukotriene Modifiers for COPD

When you breathe in a substance you’re allergic to (known as an allergen), your lungs make chemicals known as leukotrienes. They’re responsible for causing many of your allergy or asthma symptoms, including cough, wheezing or tightness in your chest, mucus production, and inflammation.11

Leukotriene modifiers are a class of medications that block the effects of leukotrienes in the lungs. While they’re commonly used to treat asthma, doctors have found these medications are also useful for treating COPD. Your doctor or pulmonologist may prescribe you a leukotriene modifier to help open your airways and treat your cough and shortness of breath.11

It’s important to note that there currently aren’t any leukotriene modifiers approved specifically for treating COPD. Instead, your doctor or pulmonologist will prescribe one “off-label” or outside of its approved use for your COPD. This practice is safe and common for many available medications.

Examples of leukotriene modifiers include:

  • Montelukast (Singulair®)
  • Zileuton (Zyflo®)
  • Zafirlukast (Accolate®)

Side effects of leukotriene modifiers include:11

  • Headache
  • Flu or cold-like symptoms, such as fever, sore throat, runny nose, and/or cough
  • Heartburn
  • Diarrhea
  • Nausea
  • Stomach pain
  • Decreased appetite
  • Skin itching or rash
  • Ear infections
  • Tiredness or fatigue

Treating and Preventing Infections when Living with COPD

COPD damages your lungs over time, making it easier for you to get sick. People with COPD are more likely to have bacterial or viral infections that can quickly become dangerous if they’re left untreated.12

Your doctor or pulmonologist will recommend that you keep up with your vaccinations every year. Be sure to get the flu vaccine (which prevents infection with the influenza virus) every fall. The CDC also recommends receiving COVID-19 boosters as needed.13 The pneumococcal (pneumonia) vaccine is recommended for people ages 65 and older, as well as for people under the age of 65 with underlying heart or lung conditions such as COPD.14 Both of these infections affect the lungs, making it harder for you to breathe.

If you’re suffering from a bacterial infection, your doctor or pulmonologist will prescribe you antibiotics. The most important thing to remember when taking antibiotics is to take the entire prescribed amount. If you stop taking your medication after you start feeling better, it might not have had the chance to kill all of the bacteria, and you could get sick again.12

Oxygen Therapy for COPD

One type of COPD, known as emphysema, can destroy the tiny air sacs in your lungs, known as alveoli. These sacs are responsible for bringing oxygen from your lungs into your bloodstream. Other people have chronic bronchitis or inflammation, swelling, and excess mucus in their lungs that makes it hard to breathe. Both types of COPD make it hard for you to get enough oxygen.

Supplemental oxygen or oxygen therapy is used to help treat COPD by boosting blood oxygen levels.15 You’ll wear a cannula or nosepiece to breathe oxygen from a tank or other portable system. Oxygen therapy helps treat shortness of breath and fatigue in people with COPD. While it can’t make your symptoms completely go away, it can help make you more comfortable and increase your energy levels. Many people with COPD who use oxygen therapy get better sleep as well.15

Surgery for COPD

If you’re living with emphysema, your doctor or pulmonologist may suggest having surgery. There are three types of surgery used to treat emphysema — bullectomy, lung volume reduction surgery (LVRS), and endobronchial valve volume reduction.16

Some people with severe emphysema have large bullae or areas with large, stretched-out air sacs that don’t work properly. These large sacs press on healthy ones nearby, making it harder for them to bring oxygen into the bloodstream. A bullectomy is a surgery that removes bullae that cover at least one-third of your lungs. However, many people have smaller bullae randomly throughout their lungs, so they can’t have this surgery.

Others may have bullae only in the top portions of the lungs and healthy air sacs in the bottom portions. LVRS is a procedure used to remove the bullae in the top portions — however, it may also remove some of the healthy air sacs. This is a major surgery, and you’ll need to be generally healthy and will need to stop smoking beforehand.

Endobronchial valve volume reduction is another, less intense surgery that can be used instead of LVRS. It’s a relatively new treatment that’s only available at medical centers with specially trained doctors. You might need extra testing to see if you’re a candidate.

The Future of COPD Treatments

Clinical trials are always recruiting participants with COPD to try out new medications. As we learn more about COPD and how to manage it, more studies will be needed to make sure these treatments are safe and effective for the general public.