A Guide to Treatment and Prevention

There are a number of prescription medications available to manage COPD. When you start a new medication, make sure you understand how and when to take it. Up to 58.7 percent of people with COPD who use inhaled medications take them incorrectly, according to research, which increases risk of hospitalization and death.

Medication costs prevent up to 19 percent of adults from being able to take their COPD medication reliably, which can worsen symptoms and hasten the decline of lung function. Programs are available if you need help paying for COPD medications. Prescription assistance programs offer discount cards, financial aid is available through select government and charitable programs, and some nonprofits provide advocates to help you apply for assistance.

Bronchodilators

Bronchodilators relax the muscles that tighten around the airways. This allows the airways to expand, making it easier to breathe and alleviating coughing and shortness of breath. Most bronchodilators are delivered through an inhaler or can be nebulized, so you breathe the medicine straight into your lungs.

Short-Acting Beta-Agonists This type of bronchodilator is used as a “rescue inhaler” for sudden bouts of shortness of breath, such as during exercising.

They include:

albuterol (ProAir, Proventil, Ventolin)

levalbuterol (Xopenex)

Long-Acting Beta-Agonists This type of bronchodilator is taken every 12 to 24 hours to consistently manage symptoms. These medications provide relief for many hours, but may take longer to start working. They include:

arformoterol (Brovana)

formoterol fumarate (Perforomist)

olodaterol hydrochloride (Striverdi Respimat)

salmeterol (Serevent)

Short-Acting Anticholinergics Anticholinergics block a chemical that causes the airways to contract and can be either short-acting or long-acting. The medication lasts for four to six hours and starts working 15 minutes after using an inhaler. A common short-acting anticholinergic is ipratropium bromide (Atrovent).

Long-Acting Anticholinergics These last between 12 and 24 hours, depending on the medication.

aclidinium bromide (Tudorza Pressair)

glycopyrrolate (Lonhala Magnair)

revefenacin (Yupelri)

tiotropium bromide (Spiriva)

umeclidinium (Incruse Ellipta)

Theophylline

Theophylline is a bronchodilator in pill form, though it isn’t commonly used in the United States, and according to the American Academy of Allergy, Asthma & Immunology, this medication isn’t preferred. It requires blood level monitoring to make sure the drug level is high enough to be effective, but not high enough to cause serious side effects. Shakiness is a common side effect, but serious side effects may include severe nausea, vomiting, irregular heartbeat, and seizures.

Common brand names of theophylline include Elixophyllin, Theo-24, and Uniphyl.

Corticosteroids (Steroids)

These drugs help reduce swelling and mucus production in the airways, making it easier to breathe. Steroids usually involve an inhaler device but can also be taken as a pill or an injection for short periods of time if your symptoms are more severe. Long-term use can cause other health problems, including diabetes, weight gain, osteoporosis, cataracts, and increased susceptibility to infections.

beclomethasone dipropionate (Qvar Redihaler)

betamethasone (Celestone)

budesonide (Pulmicort)

ciclesonide (Alvesco)

fluticasone furoate (Arnuity Ellipta, Flovent)

mometasone (Asmanex)

prednisone (Deltasone, Prednicot, predniSONE Intensol)

Combination Medicines

Sometimes COPD treatment involves an inhaler or nebulizer with a combination of bronchodilators and steroids, or more than one type of bronchodilator. For some individuals, a combination inhaler can act to both control current symptoms and prevent future symptoms.

Medications that include a bronchodilator plus an inhaled steroid include:

budesonide, glycopyrrolate, and formoterol fumarate (Breztri Aerosphere)

fluticasone furoate and vilanterol (Breo Ellipta)

fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta)

formoterol and budesonide (Symbicort)

mometasone furoate and formoterol fumarate dihydrate (Dulera)

salmeterol and fluticasone (Advair, AirDuo)

Medications with multiple bronchodilators include:

aclidinium and formoterol (Duaklir)

albuterol and ipratropium (Combivent Respimat)

budesonide formoterol and glycopyrrolate (Breztri Aerosphere)

glycopyrrolate and formoterol fumarate (Bevespi Aerosphere)

glycopyrrolate and indacaterol (Utibron)

ipratropium bromide and albuterol (Combivent Respimat, DuoNeb)

olodaterol and tiotropium (Stiolto Respimat)

umeclidinium and vilanterol (Anoro Ellipta)

Phosphodiesterase-4 Inhibitors

This oral medication reduces airway inflammation and is used to prevent worsening COPD symptoms. Roflumilast (Daliresp) is approved in the United States for people with severe COPD and symptoms of chronic bronchitis. Side effects may include diarrhea, weight loss, stomach pain, headache, and dizziness.

Ensifentrine (Ohtuvayre), approved by the U.S. Food and Drug Administration in 2024 as a maintenance therapy for COPD, is designed to work as both a bronchodilator and an anti-inflammatory to ease breathing while also helping to clear mucus from the lungs. Ensifentrine accomplishes this by acting on two enzymes in the lungs — phosphodiesterase 3 and phosphodiesterase 4 — that play a role in managing airway inflammation and muscle movements in the lungs. The medication is delivered directly to the lungs through a standard jet nebulizer. Side effects include minor issues such as back pain, diarrhea, and trouble sleeping, and more serious concerns such as signs of an allergic reaction, wheezing, and mood changes.

Antibiotics

Bacterial or viral infections can lead to COPD symptom exacerbations, like intensified coughing, mucus production, and shortness of breath. Antibiotics, like azithromycin (Zithromax), can help treat those infections, but side effects and antibiotic resistance may limit their use.

Mucolytics

Mucolytics are used to break up mucus in the lungs, making it easier to cough up. It comes in oral, intravenous, and nebulizer forms. Examples include:

guaifenesin (Mucinex)

mucolyte (bromhexine)

mucomyst (N-acetylcysteine)

Biologics

Biologics — which are made from living cells or components of living organisms, like proteins — are a newer class of medication for COPD that works by targeting parts of the immune system that contribute to chronic inflammation. These injectable therapies are for certain adults with poorly controlled COPD who have high levels of eosinophils, white blood cells that can cause inflammation in the lungs and trigger breathing problems. The drugs aren’t approved as a stand-alone treatment, but as an “add-on” therapy, especially for people whose symptoms aren’t adequately controlled with inhaled medications.

The only biologics approved for COPD are:

dupilumab (Dupixent)

mepolizumab (Nucala)

Supplemental Oxygen

If you have severe COPD and low levels of oxygen in your blood, you may require extra oxygen, or oxygen therapy, which is oxygen from a tank that’s provided through nasal prongs or a mask. This can help protect your organs from damage, improve your sleep, and help you become more active with fewer symptoms.

Read the full article here

Bronchodilators

Theophylline

Corticosteroids (Steroids)

Combination Medicines

Phosphodiesterase-4 Inhibitors

Antibiotics

Mucolytics

Biologics

Supplemental Oxygen

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