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What are Common Medications for COPD?

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Chronic Obstructive Pulmonary Disease, also known as COPD, includes multiple progressive lung disorders with a hallmark of difficulty breathing. Included in the blanket term of COPD are emphysema and chronic bronchitis. Symptoms may vary in severity but typically worsen over time, especially without proper treatment. COPD affects approximately 16 million Americans and countless others who have not been diagnosed yet. 

 

Primary treatment of COPD is aimed at managing your symptoms since there is currently no cure available. 

 

The American Association of Family Physicians recommends treatment of COPD to increase airflow, decrease flare-ups, and improve quality of life. By meeting these measures, COPD exacerbations (or abrupt worsening) can be decreased, which will decrease hospitalizations. By decreasing hospitalizations, we can decrease the overall burden on the healthcare system. 

 

Common Treatments for COPD include: 

 

Bronchodilators

Bronchodilators are a class of medication that relax the muscles in the lungs, and widen the airways. There are three main types that your physician may prescribe. These include beta 2 agonists, anticholinergics, and theophylline. According to the American Lung Association, there is no “best” medication for COPD, and talking with your doctor is the best way to create a treatment plan that works for you.

 

1. Beta2 Agonists

Beta2 Agonists help open the airways and increase the airflow into the lung. The following medications will either be administered by an inhaler or a nebulizer.

 

Short-acting bronchodilators (SABA): 

SABA’s work by opening the airways and increasing airflow into the lung. These are typically used during an acute event (shortness of breath) and are commonly referred to as rescue inhalers. Studies have shown that they improve lung function, dyspnea, fatigue, and decreased breathlessness. The following are examples of common SABA’s:

    • Albuterol (Proair HFA, Proventil HFA, Ventolin HFA)
    • Metaproterenol
    • Levalbuterol (Xopenex HFA)
    • Pirbuterol (Maxair)

 

Long-acting bronchodilators (LABA):

LABA’s have the same bronchodilation mechanism as SABA’s but work over a longer period. These are typically used when SABA’s are not enough to manage your COPD symptoms. They are usually administered two times a day via either inhaler or nebulizer. Types of LABAs include: 

    • Advair
    • Dulera
    • Symbicort
    • Salmeterol (Serevent)
    • Formoterol (Foradil)
    • Indacaterol – once daily use

 

Common side effects of bronchodilator use include:

  • Nervousness
  • Headache

 

More serious side effects may include:

  • Shakiness
  • Palpitations or increased heart rate

 

2. Anticholinergics 

Another class of bronchodilator that works by preventing the muscles in your airway from tightening or constricting. Preventing muscle constriction in the lungs can also help clear mucus and allow cough to clear excess sputum. Anticholinergics are available as both short-acting and long-acting preparations. The following is a list of common anticholinergic medications:

  • Tiotropium (Spiriva)
  • Atrovent (Ipratropium)
  • Aclidinium (Tudorza)

The most common side-effect associated with anticholinergics is dry mouth. 

 

3. Theophylline

Relaxes and opens the airways, making it easier to breathe. This medication is taken orally as prescribed by your doctor and comes in short-acting and long-acting forms.

 

Anti-inflammatory medications

 

1. Inhaled Corticosteroids

This class of medications works as an anti-inflammatory on the lung tissue. People with COPD commonly have inflammation in the lungs which can lead to airway constriction and decreased lung volumes. Inhaled steroids can decrease overall swelling in the lung, and mucus production. It is important to take these medications as prescribed for them to work properly. Although most commonly they are given as an inhaler, you may take a steroid pill or injection during a flare-up. Your doctor may prescribe you one of the following anti-inflammatory medications:

  • Fluticasone (Flovent)
  • budesonide (Pulmicort) 
  • Prednisone

 

2. Combination medications

There are many combination medications available for people with COPD. They exist as combinations of SABA + LABA, and steroids + LABA. The following are examples of some of the available combination inhalers:

  • Albuterol and ipratropium bromide (Combivent Respimat)
  • Fluticasone-salmeterol (Advair Diskus)
  • Fluticasone-vilanterol (Breo Ellipta)

 

3. Phosphodiesterase inhibitors

For people with severe COPD that is no longer manageable with inhalers, these oral medications may be prescribed. This medication has an anti-inflammatory effect on the lung tissue and decreases episodes of exacerbations. A phosphodiesterase inhibitor that is commonly used for COPD is:

  • Roflumilast (Daliresp)

 

Antibiotics

While COPD is a chronic condition, people with COPD may experience acute exacerbations. These flare-ups cause worsening symptoms like increased coughing, sputum, and shortness of breath. The most common cause of flare-ups is a bacterial or viral infection. Your doctor may choose to prescribe a course of antibiotics during flare-ups to improve your symptoms. Azithromycin is a common antibiotic for lung infections (commonly referred to as a "z-pack"). It is important that you take the full course of the antibiotics prescribed to you, as stopping them early could result in a repeat infection. 

 

Mucolytics

These medications can be used to manage mucus hypersecretion, which can help decrease cough and the incidence of recurrent respiratory infections. Additionally, this class of medications can make it easier to manage and cough up sputum by making it less thick. 

 

Prevention

Preventing acute episodes is paramount in the management of COPD. There are several ways to prevent acute flare-ups and reduce your time spent sick or in the hospital. 

  1. Quit smoking. This is the most important thing you can do to prevent the worsening of COPD and improve your quality of life. Resources are available from the Centers for Disease Control and Prevention to help with smoking cessation.
  2. Avoid exposure to secondhand smoke.
  3. Avoid situations where you may inhale dust, fumes, or other chemicals within your home or at work.  

 

Vaccines

COPD can increase your risk of infections with illnesses like influenza and pneumonia. Vaccines are available for acute illnesses and should be recommended for anyone with COPD. Vaccines.gov has a list of locations to get flu and covid-19 vaccinations. There are several options available for the pneumonia vaccine, and based on your age and medical problems, your doctor can assist you with which type and dose to get. 

 

Pulmonary Rehabilitation

If you have been diagnosed with COPD, pulmonary rehabilitation offers the hope of improving your symptoms and increasing your activity. 

Pulmonary rehabilitation has been shown to improve exercise tolerance, reduce dyspnea, and improve health-related quality of life in patients. In this program where you will receive education on exercise, diet, and other lifestyle changes that will help you improve your lung health. 

 

Other Treatments

 

1. Supplemental oxygen

Based on the severity of your COPD, your doctor may prescribe supplemental oxygen. Your organs need to maintain adequate oxygen levels to keep functioning. To limit potential complications of COPD, you may need to wear a portable oxygen tank to maintain blood oxygen levels and support your organs. 

 

2. Surgery

Not everyone is a candidate for surgery related to COPD. People with emphysema may experience fewer symptoms and have a better quality of life after lung surgery. There are two types of surgeries available:

  • Bullectomy: a surgeon removes the large lung sacs of destroyed alveoli from the lung. These are non-functioning portions of the lung that have been damaged. Removing these destroyed air sacs can improve breathing. 
  • Lung volume reduction surgery: involves reducing the overall size of the lung by approximately 30%, which helps preserve the healthy tissue and allows the diaphragm to return to a normal shape. This surgery has been shown to increase lung capacity. 

 

Lung transplant

Sometimes COPD may become so severe that the lungs can no longer function normally. Your doctor may talk to you about a lung transplant in this instance. Lung transplantation is not without risks and side effects and would require long-term use of immunosuppressant medications. The American Lung Association has a Lung HelpLine to help you find out if you are a candidate for a lung transplant and how to begin the process. 

 

 

Robert Fisher

A Nurse Director at a large medical center in Boston, MA, who holds a Master’s in Nursing Leadership and Administration and an MBA in Healthcare Management.



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