Treating COPD With Medication

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unidentifiable woman's hands holding a COPD treatment (bronchodilator)
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Medications don't cure COPD, but they do help keep it under control. Here is the information you need to learn more about the medications doctors use to manage COPD. It's important to know the names of the medications you're prescribed and how they work. Be sure to take them as directed by your doctor.

Anticholinergics

How They Work

Anticholinergic drugs are bronchodilators. They work to relax the muscles around the airways. This keeps the airways open to help you cough up mucus more easily. This class includes both short-acting drugs to relieve symptoms and long-acting drugs to prevent flares. The long-acting drugs in this class are abbreviated LAMAs, which stands for long-acting muscarinic antagonists. Muscarinic refers to the specific receptors they affect.

Examples of Medications

Ipratropium (Atrovent, Atrovent HFA) is a short-acting anticholinergic. It is available as an inhaler and a nebulizer solution. There are also products that combine it with albuterol—a fast-acting beta-2 agonist (see below). This combination also comes as an inhaler (Combivent Respimat) and a nebulizer (Duoneb).

LAMAs include:

  • Aclidinium (Tudorza Pressair)
  • Tiotropium (Spiriva)
  • Umeclidinium (Incruse Ellipta)

Like the short-acting agents, LAMAs are also in combination products with long-acting beta-2 agonists, or LABAs (see below).

Possible Side Effects and Special Precautions

Dry mouth is a common side effect of this class. Other possible side effects include nervousness, dizziness, drowsiness, headache, upset stomach, and constipation.

Biologics

How They Work

Biologics are investigational medicines for COPD. They work by regulating or modulating the immune system. At present, there are no approved biologic products for the treatment of COPD. So far, studies on these agents have been inconsistent and variable. In fact, one study of infliximab (Remicade) showed harm instead of benefit in moderate to severe COPD.

Biologics are not recommended therapies in current guidelines from the American Thoracic Society and the Global Initiative for Chronic Obstructive Lung Disease. However, there are biologics with approval for the treatment of severe asthma. Research continues to explore the appropriate use of biologics in COPD.

Examples of Medications

Researchers have studied the following asthma biologics for the management of COPD:

  • Benralizumab (Fasenra)
  • Mepolizumab (Nucala)
  • Reslizumab (Cinqair)

Possible Side Effects and Special Precautions

Side effects vary with biologics. Common ones include flu-like symptoms and injection site reactions, such as pain, redness and itching.

Corticosteroids

How They Work

Corticosteroids are not the same as the anabolic steroids that some bodybuilders abuse. Instead, these steroids powerfully reduce inflammation and swelling in airways. They also reduce mucus production and decrease sensitivity of airways to irritants and allergens.

Examples of Medications

Current COPD guidelines only recommend using inhaled corticosteroids with a LABA. Combination inhalers are available (see LABAs below).

Inhaled corticosteroids include:

  • Beclomethasone dipropionate (Beclovent, QVAR)
  • Budesonide (Pulmicort, Pulmicort Flexhaler)
  • Flunisolide (Aerospan HFA)
  • Fluticasone propionate (Flovent HFA)

Doctors may use oral steroids to quickly control a COPD flare. This includes methylprednisolone (Medrol) and prednisone (many brand names).

Possible Side Effects and Special Precautions

The benefit of using inhaled corticosteroids is that very little drug enters the bloodstream. As a result, there are few side effects. However, long-term use may increase the risk of osteoporosis. Do not stop using your prescribed steroid without consulting your doctor, as a dose taper may be necessary.

You must use inhaled steroids on a daily basis to maintain symptom control. They won’t provide fast relief of shortness of breath. When you use a steroid inhaler, it’s important to rinse your mouth and spit afterwards. This helps prevent problems like oral thrush.

Doctors generally avoid long-term use of oral steroids due to the risk of potentially serious side effects. Oral steroids may cause insomnia, mood changes, skin bruising, weight gain, stomach problems, high blood pressure, glaucoma, cataracts, osteoporosis, or high blood sugar.

Fast-Acting Beta-2 Agonists

How They Work

Beta agonists are bronchodilators, which relax and open the airways. They also increase movement of cilia—tiny hair-like projections lining the airways—to help clear mucus. Doctors use short-acting beta agonists (SABAs) to help prevent exercise-induced wheezing and stop symptoms quickly.

Examples of Medications

Inhaled SABAs come as inhalers and nebulizer solutions including:

  • Albuterol (Accuneb, Proair HFA, Proair Respiclick, Proventil HFA, Ventolin HFA)
  • Levalbuterol (Xopenex, Xopenex HFA)
  • Metaproterenol (Alupent)

Possible Side Effects and Special Precautions

Common side effects include dizziness, nervousness, shakiness and headache. SABAs can also cause insomnia, fast heartbeat, or increased blood pressure. If you use a SABA with other inhalers, use it before other bronchodilators and inhaled corticosteroids.

Long-Acting Beta-2 Agonists

How They Work

Long-acting beta agonists (LABAs) work the same way as SABAs. However, they take effect more slowly and work longer than SABAs. They work best in combination with another bronchodilator to control symptoms and prevent flares.

Examples of Medications

Single-drug inhaled LABAs include:

  • Arformoterol (Brovana)
  • Formoterol fumarate (Foradil)
  • Indacaterol (Arcapta Neoinhaler)
  • Salmeterol (Serevent)

Because inhaled corticosteroids should only be used along with a LABA, combination products are common. Triple combination products with two different bronchodilators and a steroid are also available. Combinations include:

  • Aclidinium/formoterol (Duaklir Pressair)
  • Fluticasone/salmeterol (Advair Diskus, Advair HFA)
  • Fluticasone/vilanterol (Breo Ellipta)
  • Fluticasone/vilanterol/umeclidinium (Trelegy Ellipta)
  • Formoterol/budesonide (Symbicort)
  • Tiotropium/olodaterol (Stiolto Respimat)
  • Umeclidinium/vilanterol (Anoro Ellipta)

Possible Side Effects and Special Precautions

Like SABAs, LABAs can cause fast heartbeat, headache, nervousness, or trembling. You should not use LABAs for quick relief. Also, do not take the medicine more often than your doctor prescribes. If you think your maintenance inhaler (long-acting drug) is not controlling your symptoms, contact your doctor to review your treatment plan.

Methylxanthines

How They Work

Methylxanthines are another class of bronchodilators that can ease breathing. They also stimulate the diaphragm. But there is controversy about the exact way they act in COPD. Current guidelines discourage the use of this class due to side effects and toxicity. However, they may have a role when other treatments haven’t worked.

Examples of Medications

Theophylline (brand names Elixophyllin, Theolair, Theochron, Theo-24) is the most common methylxanthine.

Possible Side Effects and Special Precautions

Methylxanthines can cause headache, nervousness, insomnia, irregular heartbeat, diarrhea, and nausea. These side effects are dose related, meaning they get worse with higher doses and at higher blood levels. Methylxanthines can also interact with other medications, leading to potential toxicities. Limit caffeine intake while taking theophylline. Doctors must monitor blood levels regularly while you are on theophylline.

Mucoactive Drugs

How They Work

Mucoactive—or mucolytic—drugs work by thinning mucus, which makes it less sticky. Thin mucus is easier to cough up and clear out of the lungs.

Examples of Medications

Currently, the only mucolytic available in the United States is N-acetylcysteine (Mucomyst). It comes in a solution for nebulization.

Possible Side Effects and Special Precautions

Common side effects include nausea, vomiting, clammy skin, and irritation in the mouth or throat. N-acetylcysteine can also have an unpleasant smell.

Phosphodiesterase-4 (PDE4) Inhibitors

How They Work

PDE4 inhibitors suppress an enzyme that can cause inflammation in the airways. This decreases swelling in the lungs. Doctors use this class of drugs to prevent worsening of COPD in people with severe COPD and chronic bronchitis. PDE4 inhibitors should not be used to treat sudden breathing problems.

Examples of Medications

Currently, roflumilast (Daliresp) is the only medication in this class.

Possible Side Effects and Special Precautions

Common side effects include diarrhea, weight loss, stomach pain, nausea, diminished appetite, headache, and dizziness. Report any new or worsening symptoms to your doctor, such as mood or behavior changes, trouble sleeping, or if you feel impulsive or have disturbing thoughts.

Note: This list is not a complete list of COPD medications and does not imply endorsement of any type or brand. It also does not include all actions, adverse reactions, precautions, side effects, or interactions for these medications. Only your healthcare provider can prescribe these medications.

Talk with your healthcare provider or pharmacist about the possible side effects and drug or food interactions of any medication you use.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 28
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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