COPD: What Are Your Treatment Options?

A variety of medications may be used to treat COPD symptoms.

Bronchodilators

Bronchodilators usually come in an inhaler or nebulized form.

Inhaling the medication delivers it directly to your lungs and airways. These medications help to open constricted (narrowed) airways so you can breathe easier.

There are two classes of bronchodilators: β-agonists and anticholinergics.

β-agonists bind directly to beta receptors on smooth muscle cells to mediate their bronchodilatory effect. β-agonists may be short-acting (e.g., albuterol) or long-acting (e.g., salmeterol).

Short-acting β-agonists are often referred to as “rescue medications” because they can be used to improve breathing during a COPD flare-up.

Long-acting β-agonists, which are used twice a day, are a part of maintenance therapy.

Anticholinergic medications, such as Atrovent, also come in inhalers and can be used every 4 to 6 hours (short-acting) or once a day (long-acting).

Anticholinergic medications work by blocking the chemical acetylcholine, which causes the airways to constrict. They may also play a role in decreasing mucus production and secretions.

Corticosteroids

Corticosteroids, such as prednisone, reduce irritation and swelling in the airway. They’re particularly effective if you’ve been exposed to an infection or an irritant such as:

• secondhand smoke
• extreme temperatures
• harsh fumes

Corticosteroids can be delivered by:

• inhaler
• nebulizer
• tablet
• injection

Keep in mind that corticosteroids can cause unpleasant side effects.

When taken in tablet form, corticosteroids can cause:

• weight gain
• water retention
• elevated blood sugar levels

If taken long term, they can cause weakening of the bones and may depress the immune system.

Inhaled forms of corticosteroids have fewer side effects and may be used for maintenance, especially for asthma patients. They may also be useful in patients with COPD who have frequent exacerbations.

Antibiotics

Respiratory infections can make the symptoms of COPD worse. If you have an infection, which is often the case when symptoms suddenly worsen, your doctor may prescribe antibiotics.

Antibiotics kill bacteria, but they do not kill viruses. Your doctor may order tests to determine the type of infection you have and what kind of antibiotic will be most effective.

Smoking cessation medications

If you smoke, quitting smoking can improve your health and your quality of life, whether or not you have COPD.

Because nicotine is highly addictive, many doctors offer patients nicotine replacement therapy to help ease their tobacco cravings.

Recommended nicotine replacement treatments are available in the form of:

Some types of antidepressants have been clinically proven to help reduce or eliminate tobacco cravings. If your doctor prescribes a smoking cessation medication, be sure to ask about any possible side effects.

Anxiolytics (anti-anxiety treatment)

As COPD progresses, you may have difficulty breathing. This can cause anxiety. Treating anxiety symptoms is important to decrease the discomfort that often accompanies shortness of breath.

Anti-anxiety drugs, known as anxiolytics, help reduce anxiety symptoms, allowing you to breathe more easily.

Opioids

Opioids, also known as narcotic medications or pain relievers work by depressing the central nervous system. Opioid medication can help ease that feeling of “air hunger.”

Opioids are commonly prescribed as a liquid that’s swallowed and absorbed through the membranes in the mouth.

It’s also prescribed as a patch that’s placed on the skin.

Several medications have shown to be effective in:

• lessening distressing symptoms
• slowing disease progression
• improving quality of life
• even extending life

Your doctor can tell you more about the medications that may be right for you.

Here we look at COPD therapy and rehabilitation options and their benefits.

Oxygen therapy

COPD interferes with your ability to breathe. If you’re not inhaling enough oxygen, you won’t have enough oxygen in your blood. There are medical devices available that deliver oxygen to your lungs.

Many of these devices are small and portable so you can take them with you wherever you go.

Your doctor may suggest that you use oxygen therapy all the time. Or, you may only need to use the device while you’re sleeping or during certain activities.

Oxygen therapy can help you:

• stay active with fewer symptoms
• protect your heart and other organs from further damage caused by oxygen deprivation
• sleep better and be more alert
• live longer

Pulmonary rehabilitation

Pulmonary rehabilitation may involve:

• exercise
• nutritional and psychological counseling
• education in the management of COPD

It often involves a team of doctors and specialists. The primary goal is to help you stay active.

Surgery is beneficial to a small percentage of people with COPD and is only an option in severe cases.

Bullectomy

When the walls of the air sacs in your lungs are destroyed, large air spaces can form. These are called bullae. These open spaces can interfere with your breathing.

In a bullectomy, the doctor removes some of these spaces. This can help your lungs function better.

Lung volume reduction surgery (LVRS)

During surgery, the doctor removes sections of damaged lung tissue.

This procedure may help your lungs work better, but it can be risky and may not always be effective. Nevertheless, for some patients, it can help improve breathing and quality of life.

Lung transplant

In severe cases, a damaged lung may be removed and then replaced with a healthy lung from a donor. Lung transplants have many risks. You may develop an infection, or your body might reject the new lung.

Either of these occurrences can be fatal. A successful lung transplant can improve lung function and your quality of life.

Bronchial rheoplasty

A new method of treating COPD is a minimally invasive procedure called bronchial rheoplasty. It’s currently being tested and may reduce the number of mucus-producing cells in the lungs.

During the procedure, electrical bursts destroy the cells that produce too much mucus, paving the way for new, healthy cells to grow.

For some patients with COPD or severe asthma, the failure to respond to the anti-inflammatory effects of corticosteroids can be a major barrier to effective treatment.

According to the American Journal of Respiratory and Critical Care Medicine, drugs to reverse corticosteroid resistance may be developed in the future.

Some large clinical trials are already underway with low-dose oral theophylline.

The National Heart, Lung, and Blood Institute (NHLBI) leads and sponsors studies on COPD. To learn more about clinical trials, visit the NIH Clinical Center website.

Complementary treatments that have proven successful in reducing anxiety include:

• pulmonary rehabilitation
• guided muscle relaxation
• yoga
• tai chi
• behavioral therapy
• singing groups

Other examples of complementary treatment methods that have produced positive results include:

• Identifying the situations, places, or people that can trigger anxiety. Knowing what causes stress can help you avoid it.
• Limiting work, chores, and activities. If you have a job, learn how to manage your workload to keep from feeling overwhelmed.
• Carefully following your treatment plan. When your illness is managed well, you’ll have more energy to enjoy life.
• Talking to someone. Relieve anxiety by sharing your feelings with a trusted friend, family member, or religious leader.

Finding a doctor who specializes in palliative care or hospice can help during the late stages of the disease to make comfort a priority.

Effective end of life care for COPD patients involves the supportive and palliative care needs of both the patient and their family:

• pain and symptom management
• provision of spiritual, psychological, social, and practical support
• an active partnership of care involving the patient, family, social care, and health professionals
• a compassionate approach to care that ensures respect for and dignity of the patient and family
• advanced care planning according to the patient’s preferences

Opioids are often prescribed during the late and terminal stages of COPD and usually when a person has decided that they do not want any further aggressive or life-prolonging treatment.

Most COPD patients notice their first symptoms around the age of 40. Treatments proven particularly beneficial to older patients include:

• Pulmonary rehabilitation. Pulmonary rehabilitation includes breathing techniques, exercise, education, and mental health support. It also provides social support, which can be helpful to older patients.
• Supplemental oxygen. Some doctors offer a trial of supplemental oxygen as some older COPD patients may benefit.
• Tobacco cessation. Older patients who stop smoking may see a reduction in symptoms.

For some older patients, lung surgery may be beneficial. Lung surgery may not be appropriate for those with cardiovascular disease.

Quit smoking

The first and most important thing that’s recommended is quitting smoking, if you smoke, or don’t start. Do your best to reduce air pollution in your environment as much as possible.

Try to also avoid secondhand smoke and stay away from places with dust, fumes, and other toxic substances you might inhale.

Diet and exercise

It’s also important to eat a healthy diet. The fatigue and breathing difficulty that comes with COPD might make it difficult to eat.

Eating smaller meals more frequently may help. Your doctor might suggest nutritional supplements. It may also be helpful to rest before meals.

Exercise is important, but it may be difficult for some. Physical activity can strengthen the muscles that help you breathe. Talk to your doctor about the physical activities that are right for you.

Pulmonary rehabilitation can also be a way to improve stamina and help with breathing issues, so ask your doctor about your options.

Even with treatment, symptoms can worsen. This is especially true if you have a lung infection or a heart condition related to your lung damage.

Seek immediate medical attention if your regular treatments aren’t helping with the following symptoms:

• unusual difficulty walking or talking (it’s difficult to complete a sentence)
• fast or irregular heart rate
• new or worsening chest pain
• blue lips or fingernails
• hard and fast breathing