When you have chronic obstructive pulmonary disease (COPD), medications can go a long way to help you breathe more easily and improve your quality of life.
You take some types of COPD medications every day, but you use others for quick relief only when you need them. Since people respond differently to drugs, it may take some trial and error to figure out which medications work best for you.
Types of COPD Medication
The medications doctors use to treat COPD have different purposes. So you may need two or three kinds to ease your symptoms. Take your medications exactly as your doctor prescribes them to make sure you get the most help from them.
Bronchodilators
These medications help the muscles around your airways relax so you can breathe more easily. They're usually delivered through a handheld inhaler. Sometimes you get them through a nebulizer, which uses battery or electric power to turn the medicine into a mist that you breathe in.
Bronchodilators can be:
- Short-acting, which work fast and wear off in 4 to 8 hours. You might use this kind before you do activities that make it harder to breathe or when you need fast symptom relief. If your COPD is mild, you may only need this type.
- Long-acting, which you use daily to maintain symptom relief. They last between 12 and 24 hours, depending on the type. You may need both short-acting and long-acting bronchodilators if you have moderate to severe COPD.
There are three categories of bronchodilators: beta2-agonists, anticholinergics, and theophylline.
Beta2-agonists. Short-acting beta2-agonists include:
- Albuterol
- Levalbuterol (Xopenex)
Long-acting beta2-agonists include:
- Arformoterol (Brovana)
- Formoterol (Perforomist)
- Indacaterol (Arcapta Neoinhaler)
- Olodaterol (Striverdi Respimat)
- Salmeterol (Serevent)
Beta2-agonists can make you feel shaky and speed up your heartbeat after you take them, but this usually only lasts for a few minutes. You may have trouble sleeping. These medications can also cause cramps in your hands, legs, and feet, but this is unusual.
Anticholinergics. Ipratropium (Atrovent HFA) is the only short-acting anticholinergic. Long-acting ones include:
- Aclidinium (Tudorza Pressair)
- Revefenacin solution (Yupelri)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
You may have a dry mouth when you use an anticholinergic. It’s rare, but you could also have a hard time peeing.
Theophylline. You don’t breathe this medicine. You take it as a pill or liquid. It's not often prescribed in the United States. You might take it if you need a less expensive bronchodilator or if other kinds don't work for you.
While you take it, you need to get your blood levels tested periodically. This helps your doctor make sure you're getting the right amount. Too much could cause bad side effects.
You may notice you’re shaky when you take theophylline. Get medical help right away if you have serious side effects like:
- Extreme nausea
- Vomiting
- Irregular heartbeat
- Seizures
Corticosteroids
Also known as steroids, corticosteroids lessen the swelling in your airway. You usually breathe them in with an inhaler or nebulizer. But for COPD flare-ups, you may take them as pills.
Inhaled steroids include:
- Beclomethasone (Qvar)
- Budesonide (Pulmicort)
- Ciclesonide (Alvesco)
- Fluticasone (Flovent, AmonAir, Arnuity)
- Mometasone (Asmanex)
Side effects may include hoarseness, sore throat, and mouth or throat infections.
Oral steroids used for COPD include:
- Methylprednisolone (Medrol)
- Prednisolone (Flo-Pred, Orapred, Pediapred)
- Prednisone (Liquid Pred, Prednisone Intensol, Rayos)
Doctors usually only prescribe oral steroids for short-term use. That's because they can have serious side effects when you take them for a long time. These include:
- Weight gain
- Bruising
- High blood pressure
- Swelling in your ankles or feet
- Osteoporosis (weak bones)
- Cataracts
- Mood changes
- Muscle weakness
- Higher blood sugar
- Increased risk of infection
Combination Therapies
Sometimes your doctor recommends an inhaler or nebulizer that contains more than one medication. Inhalers with both bronchodilators and inhaled steroids include:
- Budesonide, glycopyrrolate, and formoterol (Breztri Aerosphere)
- Fluticasone and vilanterol (Breo Ellipta)
- Fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta)
- Mometasone and formoterol (Dulera)
- Formoterol and budesonide (Symbicort, Breyna)
- Salmeterol and fluticasone (Advair HFA, Advair Diskus, AirDuo Respiclick)
Inhalers that contain more than one kind of bronchodilator include:
- Aclidinium and formoterol (Duaklir Pressair)
- Albuterol and ipratropium (Combivent Respimat)
- Formoterol and glycopyrrolate (Bevespi Aerosphere)
- Glycopyrrolate and indacaterol (Utibron)
- Olodaterol and tiotropium (Stiolto Respimat)
- Umeclidinium and vilanterol (Anoro Ellipta)
Antibiotics
Your doctor may prescribe an antibiotic if you have a bacterial respiratory infection like bronchitis or pneumonia. These infections can make your COPD worse.
If you have frequent COPD flare-ups even though you use bronchodilators and steroids, your doctor might recommend regular use of an antibiotic called azithromycin (Zithromax) to reduce them.
Its side effects include diarrhea, headache, nausea, stomach pain, and vomiting.
Phosphodiesterase Inhibitors
Ensifentrine (Ohtuvayre), is an inhaled phosphodiesterase (PDE) 3 and PDE4 inhibitor that you use twice a day to help keep your airways open. It works by blocking substances in your body that lead to inflammation and swelling. It comes in a nebulizer.
It sometimes causes side effects like:
- Back pain
- Diarrhea
- Trouble peeing
Roflumilast (Daliresp) is a PDE4 inhibitor you take as a pill. People with severe COPD can take it to reduce flare-ups.
Side effects include:
- Weight loss
- Diarrhea
- Nausea
- Dizziness
- Mood or behavioral problems
- Muscle spasms
- Back pain
- Dizziness
- Headache
Mucolytic Drugs
These medications make your mucus (or phlegm) thinner so you can cough it up more easily. They can also reduce flare-ups, so they’re usually used for people with moderate to severe COPD. You can take them by mouth or inhale them.
They include:
- Carbocysteine (either taken by mouth or inhaled)
- Erdosteine (taken by mouth)
- N-acetylcysteine (taken by mouth or inhaled)
Most people can take mucolytics with few problems. The most common side effects of the oral types are nausea, vomiting, upset stomach, diarrhea, and heartburn. The inhaled type can sometimes cause:
- Fever
- Nausea
- Vomiting
- Runny nose
- Clammy skin
- Irritation in your mouth, throat, or lungs
- Breathing difficulties
- Chest tightness
- Wheezing
Over-the-Counter Medications
You need a prescription to get relief from most COPD symptoms. Over-the-counter inhalers aren't meant to be used for COPD.
If you have COPD-related pain, ask your doctor if it's a good idea to take nonprescription pain relievers like aspirin or ibuprofen.
The Future of COPD Medications
Researchers are studying some new drugs that might work to treat COPD.
Cancer drugs. A class of cancer drugs called ErbB inhibitors could one day treat COPD. A 2019 study found potential in these medications to lessen inflammation and limit damage caused by the condition. We need more research on them, though.
Biologics. A type of biologic drug called interleukin-5 (IL-5) antagonists may hold promise for people with COPD who have a high level of eosinophils (a type of white blood cell) in their blood. This condition is known as eosinophilia. The drugs benralizumab (Fasenra), dupimulab (Dupixent), mepolizumab (Nucala), and reslizumab (Cinqair) are already used in people with severe asthma who have eosinophilia.
