COPD medications & treatments
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COPD, or Chronic Obstructive Pulmonary Disease, is a long-term lung condition that makes it difficult to breathe. The two main types of COPD are emphysema and chronic bronchitis. Emphysema is a condition in which the air sacs in the lungs are damaged, causing them to lose their elasticity. This makes it difficult for the lungs to expand and results in a decrease in the amount of oxygen that the body receives. Chronic bronchitis is a condition in which the airways become inflamed and narrowed, making it difficult for air to flow through the lungs. Both of these conditions can lead to shortness of breath, coughing, and wheezing.
What is COPD?
COPD is a group of diseases that affect your lungs, making it more difficult for you to breathe.
What does COPD stand for?
COPD stands for chronic obstructive pulmonary disease. Chronic, because the diseases are usually long-lasting – in most cases, once you develop COPD, it’s with you for life. Obstructive, because the diseases narrow and block your airways and the sacs inside your lungs, making it harder to breathe. And pulmonary means something that affects your lungs. So, the COPD definition is a long-lasting disease that narrows and blocks the airways and sacs inside your lungs.
COPD is not as prevalent as it used to be in the US, but it’s still a relatively common condition, with at least 6.4% of American adults diagnosed with COPD.
Types of COPD
COPD is an umbrella term for a group of diseases that have similar effects on your lungs. The two most common COPDs are emphysema (see below) and chronic bronchitis (see below), but refractory asthma is often also classed as COPD.
What is emphysema?
Emphysema, sometimes called pulmonary emphysema, is a disease that damages the walls of the air sacs (alveoli) inside your lungs.
The alveoli air sacs are where the oxygen you breathe in crosses over into your bloodstream to be used by your body. But with emphysema, the damaged air sacs collapse when you breathe, meaning you can’t get as much oxygen into your blood. The damaged air sacs can also block areas of your lungs, trapping air inside them.
What is chronic bronchitis?
Chronic bronchitis is a disease that affects the bronchial tubes that lead into and through the lungs. These tubes carry air to and from the air sacs.
Hair-like fibers, called cilia, line the inside of your bronchial tubes and help move mucus through and out of the tubes. But with chronic bronchitis, you lose the cilia in your bronchial tubes. This, combined with inflammation, causes mucus to accumulate in your lungs, making you cough and making it harder to breathe.
COPD signs and symptoms can vary depending on what disease you have and by person, but there are a common set of COPD symptoms.
Typically, COPD comes on gradually and slowly gets worse as the damage progresses. For most people, symptoms gradually worsen, but you can have occasional flare-ups of severe symptoms and periods where symptoms ease off.
Common early COPD symptoms include:
- Shortness of breath after exerting yourself
- Clearing your throat more than usual, especially in the morning
- A mild, but lasting cough
COPD symptoms as your condition worsens can include:
- Shortness of breath becoming more common
- A tight chest
- A permanent cough
- Wheezing when you breathe
- Coughing up mucus (sputum) that can be clear, white, yellow, or greenish
- Swollen feet, ankles, and legs
- A lack of energy
- Weight loss
- Frequent respiratory infections like colds and the flu
As the disease progresses, your symptoms worsen until it becomes difficult to breathe even when you’re sitting still.
What are the 4 stages of COPD?
Doctors often classify COPD into 4 stages depending on how far the disease has progressed. Symptoms can vary by these COPD stages, as will treatment and management of your disease.
- Stage 1: Mild – You’re in the early stages of COPD and your airflow is becoming limited. You feel few symptoms, except you feel out of breath when you exercise or exert yourself, and you may occasionally cough up mucus.
- Stage 2: Moderate – Your airflow worsens, and you begin to find it hard to catch your breath even when walking on flat ground, and you may need to stop periodically to catch your breath. This is the stage when most people notice their symptoms.
- Stage 3: Severe – Your airflow is low enough that you can’t exercise anymore. You get out of breath when you perform even simple activities like dressing, and you may find it difficult to leave the house. Your symptoms may flare up and periodically get worse.
- Stage 4: Very severe – You’ve entered the final stages of COPD. You find it hard to breathe even when sitting or lying. Your quality of life is low, and you may develop heart or lung failure.
What causes COPD?
COPD is usually caused by inhaling substances into your lungs that trigger inflammation and cause damage.
In the US, cigarette smoke is the single biggest cause of COPD, with around 90% of Americans with COPD being current or former smokers. Other forms of smoking can also be a cause, like cigars and pipes. Second-hand smoke you breathe in from someone smoking nearby can also be a cause. Generally, the longer and the more a person smokes, the greater their risk of developing COPD.
Smoking isn’t the only cause of COPD. It can also be brought on by:
- Air pollution, particularly particulates in the traffic exhaust gas
- Inhaling certain dusts, like silica and fiberglass dusts
- Fumes from burning fuel
- Exposure to inhaled chemicals, fumes, and dusts in the workplace
COPD becomes more common in people over the age of 40, and it’s thought the disease develops slowly over time with prolonged exposure to the substances that damage your lungs.
Genetics may also play a role, as people with close relatives who have COPD are more likely to develop it, showing there’s some degree of inheritance. Research has found that people with genes that cause them to have low levels of a protein called alpha-1 antitrypsin (AAT) are more likely to develop COPD.
COPD risk factors
Your chances of developing COPD increase if you:
- Smoke tobacco or are regularly exposed to second-hand tobacco smoke
- Are over 40 years of age
- Have asthma
- Are regularly exposed to air pollution
- Have a job where you’re exposed to chemical fumes, vapors, and dusts
- Have a mining job
- Are exposed to fumes from burning fuels (more common in the developing world where people burn fuel for heat and cooking in poorly ventilated homes)
- Have a close family member with COPD
- Have a low level of a protein called alpha-1 antitrypsin (AAT)
- Have had a history of respiratory infections
Complications of COPD
COPD can cause a wide range of complications, including:
- Being less able to exercise
- Being less able to walk, climb stairs, and perform daily tasks like dressing
- Not being able to work
- Not being able to engage in social activities like eating out or going to places of worship
- Experiencing more respiratory infections, like colds, the flu, and pneumonia
- A higher risk of developing lung cancer
- High blood pressure in the blood vessels in your lungs (pulmonary hypertension)
- An increased risk of heart disease, like congestive heart failure and coronary heart disease
- An increased risk of other chronic diseases, including arthritis, diabetes, and asthma
- Cognitive problems, like confusion and memory loss
- Developing mental health disorders, like depression
How to prevent COPD?
COPD can’t be cured, and it’s a disease that usually gets progressively worse over time. It’s far better to prevent COPD than it is to treat it.
The best way to prevent yourself from developing COPD is to never smoke tobacco products or to stop smoking them as fast as possible. Quitting smoking is tough for most people that go through it, so talk to your doctor for advice and support.
You can also identify other areas in your life where you may regularly breathe in harmful substances and take protective measures to help with COPD prevention. If you’re exposed to harmful substances at work, make sure you use the available protective equipment or ask your supervisor for equipment if it’s lacking. If you cycle to work every day through heavy traffic, see if you can change your work hours to avoid peak traffic, or consider wearing a protective face mask.
There’s no one test for COPD. A diagnosis is usually made through a combination of physical exams, talking through your symptoms, medical imaging, and diagnostic tests.
Diagnosis usually starts with a conversation with your doctor about your symptoms and lifestyle. Be sure to mention:
- If you have any breathing difficulties, and when you experience these difficulties
- If you’re coughing more than usual and bringing up mucus
- If you smoke or have ever smoked
- If you’re exposed to any possible irritants at work
- If you have asthma or any other respiratory conditions
- If anyone in your family has COPD
Your doctor will then likely perform a physical exam, including listening to your breathing through a stethoscope.
Depending on the results of your conversation and physical exam, your doctor may then arrange for you to have imaging scans and diagnostic tests.
Imaging scans can include X-rays and CT scans that can give detailed views of your lung tissues and blood vessels.
Diagnostic tests can include:
- Spirometry: a simple test to measure your lung function. You take a deep breath, then blow into a tube connected to a spirometer that measures the volume of air your lungs expel. Low volumes can show you have a lung problem.
- An arterial blood gas test: where some of your blood is drawn from an artery and is tested to measure the levels of oxygen, carbon dioxide, and other substances in your blood. Low levels of oxygen, and higher levels of carbon dioxide, can show your lungs aren’t working as effectively as they should be.
Finally, other tests may also be performed to rule out other conditions that may cause similar symptoms, like congestive heart failure, pulmonary embolism, or pneumonia.
As there’s no cure for COPD, the goal of treatment instead is to ease any symptoms and slow the progression of the disease to maintain a good quality of life for as long as possible. Effective treatments are available, including medication and surgery, that can help you manage your COPD and minimize your complications.
COPD treatments include:
A range of medications are available to help manage COPD, while new COPD medications are being released as research progresses. The following are some of the most common types of COPD medicines:
Inhaled steroids: a type of steroid (man-made hormone) you inhale directly into your lungs using an inhaler. They reduce inflammation in your airways, helping to ease your symptoms.
- Fluticasone (Flovent HFA)
- Budesonide (Pulmicort Flexhaler)
Short-acting Bronchodilators: another form of medication you inhale into your lungs using an inhaler. They relax the muscle tissue in your airways, opening your airways up and helping you breathe more easily. Some are short-lasting and are used before activities like exercise, others are longer lasting and give relief from symptoms throughout the day.
- Albuterol (ProAir HFA, Ventolin HFA)
- Levalbuterol (Xopenex)
- Albuterol/Ipratropium (Combivent Respimat)
- Tiotropium (Spiriva)
Long-acting Bronchodilators: another form of medication that is used to treat COPD over a longer period of time. They are generally used once or twice per day using nebulizers or inhalers. As these medications are used to gradually help with breathing, they should not be used in emergency situations.
- Aclidinium (Tudorza)
- Arformoterol (Brovana)
- Formoterol (Foradil, Perforomist)
- Glycopyrrolate (Seebri Neohaler, Lonhala Magnair)
- Indacaterol (Arcapta)
- Olodaterol (Striverdi Respimat)
- Formoterol (Perforomist)
- Umeclidinium (Incruse Ellipta)
- Revefenacin (Yupelri)
- Salmeterol (Serevent Diskus)
Combination inhalers: inhaled medications that combine both a steroid and a bronchodilator into one medicine.
- Fluticasone and vilanterol (Breo Ellipta)
- Formoterol and budesonide (Symbicort)
- Salmeterol and fluticasone (Advair HFA)
- Olodaterol and tiotropium (Stiolto Respimat)
- Umeclidinium and vilanterol (Anoro Ellipta)
- Aclidinium/Formoterol (Duaklir)
- Glycopyrrolate/Formoterol (Bevespi Aerosphere)
Oral steroids: taken as tablets that should be swallowed. They can also reduce inflammation in your lungs and airways. Oral steroids are typically prescribed as short-course treatments to lessen flare-ups of severe symptoms.
- Prednisone (Deltasone, Liquid Pred, Orasone, others)
Phosphodiesterase-4 inhibitors: can also be used to reduce inflammation. They come as a tablet you swallow and are usually used for more severe, later-stage COPD.
- Roflumilast (Daliresp)
- Cilomilast (still in development)
Antibiotics: can be taken to reduce respiratory infections, like the flu or pneumonia, which can make your COPD worse.
Vaccines: can also help prevent you from getting respiratory infections that can exacerbate your COPD, including a yearly flu shot, and pneumococcal and whooping cough vaccines.
Surgery can be used in more severe cases of COPD when medications and other treatments aren’t sufficient for managing your condition. COPD surgery can include:
Lung volume reduction surgery: a surgeon removes damaged tissue from your lungs, creating more space in your chest cavity for healthy lung tissue to expand into. This can help your lungs work more effectively and get more oxygen into your blood. This surgery can now be done via minimally invasive keyhole surgery (endoscopic lung volume reduction).
Bullectomy: sometimes large air spaces, called bullae, form in damaged lungs that can trap air in your lungs and make breathing harder. In a bullectomy, a surgeon removes bullae from the lungs to help improve your breathing.
Lung transplant: in severe cases and when people meet specific criteria, their lungs can be removed and replaced with healthy donor ones. This can be a very effective treatment but is a major procedure that has significant risks. You will also need to take immune-suppressing medications for life to prevent organ rejection too.
These are additional therapies that can help your lung function. They’re often used in moderate to severe cases of COPD. They include:
COPD oxygen therapy involves using a device to deliver more oxygen into your lungs, such as a face mask connected to an oxygen supply. These devices are usually lightweight and portable and can be taken with you. They may be used periodically when your symptoms are worse, or all the time, including when you’re asleep.
Pulmonary rehabilitation: combines education about COPD, counseling, exercise, rehabilitation, and diet and lifestyle advice to help you manage your condition and maintain lung function. It can help keep you fit enough to keep up with everyday activities and your social life, and can improve your quality of life.
Managing COPD exacerbations
Even if you’re treating your COPD, you can still get flare-ups of severe symptoms, that usually last from days to weeks, called exacerbations.
COPD exacerbation symptoms can include worse coughing, wheezing, and shortness of breath; producing more and thicker mucus; swelling in your feet, ankles, and legs; and fatigue. In severe cases, exacerbations can cause serious health problems, including lung and heart failure.
Exacerbations may be triggered by breathing in irritants that cause inflammation in your lungs, like air pollution, seasonal pollen, or animal dander (fur, skin, and feathers). They can also be caused by respiratory infections like colds and the flu.
You can take steps to make COPD exacerbations less likely, including:
- Quitting smoking
- Avoiding other potential irritants
- Using an inhaled steroid medication, like fluticasone (Flovent HFA) or budesonide (Pulmicort Flexhaler)
- Using a long-acting bronchodilator medication, like umeclidinium (Incruse Ellipta) or tiotropium (Spiriva)
- Using a long-acting combination inhaled steroid and bronchodilator medication, like Fluticasone and vilanterol (Breo Ellipta) or Formoterol and budesonide (Symbicort)
- Having a yearly flu shot
During an exacerbation, you’ll likely need treatment to lessen your symptoms and ensure you get enough oxygen. COPD exacerbation treatments can include:
- Oxygen therapy
- Fast-acting inhaled steroid and bronchodilator medications, like albuterol (ProAir HFA)
- Hospital treatment
COPD diet recommendations
A healthy diet can keep you fit and strong and can help minimize your risks of complications. Maintaining a healthy weight is also important: COPD can cause you to lose weight, which may hamper your immune system while being overweight can put extra stress on your body and may make it harder to breathe.
In terms of foods for COPD, your goal should be to try and eat a varied and healthy diet. Your diet doesn’t have to be perfect, but try to make sure the following foods make up the bulk of what you eat:
- Pulses and lentils
- Whole grains
- Potatoes with skin
- Lean meat, dairy, and other good sources of protein, like eggs
Foods rich in potassium may help your COPD, as potassium is important for proper lung function. Potassium-rich foods include:
- Dark leafy greens
In terms of foods to avoid with COPD, try to limit your intake of fast food, processed foods, and food rich in saturated fats and refined sugar. Specific foods you may want to avoid include:
- Salt – it can make you retain water that can make it difficult to breathe
- Fruit that gives you gas, like apples, apricots, peaches, and melons, as this may make it more difficult to breathe (but only avoid these if they give you gas, eat them otherwise)
- Vegetables that gives you gas, like Brussels sprouts, cabbage, and cauliflower, as this may make it more difficult to breathe (but only avoid these if they give you gas, eat them otherwise)
- Other foods that may give you gas, like dairy, beans, and lentils
Living with COPD
Living with COPD requires a lifelong commitment. Your disease will most likely get worse over time and it will have an effect on your life. But there are steps you can take to help you live a fulfilling life for longer with COPD.
The first and most important step is to stop smoking. This is easier said than done, so talk to your doctor as they can offer advice and may be able to refer you to a support program. You should also try to minimize your daily exposure to any other irritants that could damage your lungs, like pollution or industrial fumes.
Make sure you take any medications for COPD, or for complications, exactly as described by your doctor. You’ll need to stay on top of your treatment plan and update your doctor of any changes, like new symptoms or side effects, or changes in effectiveness.
You’ll need to keep yourself healthy in other ways too, such as by eating a nutritious diet and by taking exercise. As your lung function falls, exercise can become more difficult, but even small amounts of light exercise can be beneficial.
A range of support options are also available to you, and you should make sure you use the ones that benefit you.
What is the outlook for people with COPD?
COPD is a chronic progressive disease that can’t be cured. This means that it is a condition you’ll always have and one that will get worse over time.
This worsening can happen slowly, especially during the early stages of the disease. And while it will progress at different speeds in different people, for most, the disease becomes increasingly limiting as your lung function falls.
In the later stages of the condition, where breathing becomes difficult even when sitting still, you may need support to perform even simple daily tasks. Your risk of serious complications also rises, including severe respiratory infections, heart problems, and lung cancer. You’re also at greater risk of developing mood disorders like depression and anxiety.
COPD does reduce life expectancy, although COPD life expectancy can vary considerably by person. If you take protective measures like giving up smoking, engage with your doctor and other health professionals, and take your treatment seriously, you can slow the progression of the disease and lessen your symptoms.
Where to find support?
Finding and getting the right support can make a huge difference to living with COPD. Your doctor is the first place to seek COPD support, as they can refer you to a wide range of specialists, including mental health professionals.
Friends and family can also be important sources of support, but it can also help to talk to others who have COPD and are facing the same challenges as you. If this sounds appealing, you should get in touch with the American Lung Association. In addition to professional support and a wealth of advice, they provide online forums, local support groups, and a Lung HelpLine.