Chronic Obstructive Pulmonary Disease(COPD):
What do chronic obstructive pulmonary disease medicines do? — If you have chronic obstructive pulmonary disease (also called COPD), your doctor can prescribe medicines that will:
●Help you feel better and more able to do everyday activities
●Reduce or prevent COPD symptoms, such as coughing or shortness of breath
●Help reduce the risk of future attacks or flares
If you smoke, the best thing you can do for your health is to quit smoking. It's also important to stay away from secondhand smoke (from other people's smoking).
Which medicines might I need? — There are several different medicines available to treat COPD. Most people use inhalers that help open up their airways or decrease swelling in the airways. The airways are the branching tubes that carry air inside the lungs (figure 1). Depending on how severe your symptoms are, you might need more than 1 inhaler. The doses and choices of medicines you need might be changed as your symptoms change over time.
The list below gives basic information on COPD inhalers and other medicines, and the table lists the names of COPD medicines (table 1). Your doctor, nurse, or pharmacist will explain how to use your inhalers.
Inhaler medicines to treat COPD
Bronchodilator inhalers – Bronchodilator inhalers are the main medicines used to treat COPD. They help open the airways. They might also help lower the amount of mucus in the lungs.
Bronchodilator inhalers come in "short-acting" forms that relieve symptoms quickly and "long-acting" forms that control symptoms over time.
Short-acting bronchodilator inhalers include:
●Short-acting beta agonists – Short-acting beta agonists, or "SABAs," include albuterol (salbutamol) and levalbuterol (levosalbutamol). They relieve shortness of breath quickly by relaxing tight muscles around the airways. SABAs usually come in a "metered dose" inhaler or a "dry powder" inhaler. They can also be taken by nebulizer, which is a machine that turns the medicine into a fine mist.
●Short-acting muscarinic antagonists – Ipratropium is a short-acting muscarinic antagonist, or "SAMA." These medicines are also called "anticholinergics." They relax the lung muscle in a different way to open airways and reduce symptoms. If you have mild COPD, you might use a SAMA inhaler only when you have symptoms. If symptoms are more severe or happen often, you might use it every day to help keep symptoms from happening. This medicine comes in a metered dose inhaler and can also be taken by nebulizer.
●Short-acting combination medicine – A combination inhaler has 2 medicines in the same inhaler. Taking them together can work better than taking them alone. These medicines come in a soft mist inhaler and can also be taken by nebulizer.
Long-acting bronchodilator inhalers include:
●Long-acting beta agonists – Long-acting beta agonists, or "LABAs," include salmeterol (brand name: Serevent), indacaterol (brand name: Arcapta), and olodaterol (brand name: Striverdi). These relax the muscles around the airways like short-acting beta agonists do. But the effects last much longer. LABAs help control symptoms for 12 to 24 hours, depending on the exact one being used.
●Long-acting muscarinic antagonists – Long-acting muscarinic antagonists, or "LAMAs," are also called "long-acting anticholinergics." They include tiotropium (brand name: Spiriva), glycopyrrolate (brand name: Seebri Neohaler), umeclidinium (brand name: Incruse Ellipta), and aclidinium (brand name: Tudorza Pressair). They help the lungs work better and decrease symptoms over time. They also reduce the risk of COPD attacks, called "flares." A flare is when symptoms suddenly get worse. There are several types of LAMA inhalers. These are listed in the table (table 1).
●Long-acting combination medicine – Long-acting combination inhalers come as "dual inhalers" with both a LABA and a LAMA. These are listed in the table (table 1).
Inhaled steroids – Steroids work by reducing swelling in your airways. These are not the same as the steroids some athletes take illegally. If a long-acting bronchodilator inhaler does not control your symptoms, your doctor might prescribe a steroid, too. Steroids are usually prescribed as a combination inhaler that also contains a LABA. There is also a "triple inhaler" with a steroid, LABA, and LAMA. Each time you use an inhaler that contains steroid medicine, you need to rinse your mouth out and gargle with water afterwards.
How do I use the different kinds of COPD inhalers? — Medicines for COPD come in different kinds of inhalers, and each kind has its own directions.
For example, you need to prepare metered dose inhalers (also called "MDIs" or "HFA inhalers") before using them for the first time, or if you haven't used them in more than a week or 2. You get them ready by shaking them for 5 seconds, spraying medicine into the air (away from your face), and then repeating these steps 3 times before using the inhaler. On the other hand, you do not need to shake or prime dry powder inhalers (like Diskus or HandiHaler) before using them.
The medicine for some dry powder inhalers (called single-dose inhalers, like HandiHaler and Neohaler) comes in a pill that you put into the inhaler when it is time to take a dose. The pill does not work if you swallow it. It must be used with the inhaler.
The soft mist (Respimat) inhaler does not need to be shaken before use, but you do need to insert the canister into the holder and follow a couple of steps to get it ready for use. You will need to prime the inhaler before using it the first time or if you haven't used it in more than 3 weeks (4 sprays pointed to the ground). If you haven't used it in more than 3 days, prime once (1 spray pointed to the ground). Unlike other inhalers, the medicine comes out in a mist.
Your doctor, nurse, or pharmacist can explain how to use the inhaler you are prescribed. Most patients find it easy to use an inhaler once someone shows them how.
More information about how to use each type of inhaler can be found in the tables:
●Metered dose inhalers (table 2)
●Dry power inhalers (table 3)
●Soft mist inhalers (table 4)
What if I have a COPD flare? — A COPD flare is when symptoms suddenly get worse. Doctors sometimes call flares "exacerbations." If you have a flare, you might need some new medicines. Or you might need to take medicine in a different way than through an inhaler for a while.
Medicines for COPD flares include:
●Short-acting beta agonists (SABAs) and short-acting muscarinic antagonists (SAMAs) – You might need to take these medicines from a nebulizer. A nebulizer might work better than an inhaler when you have a COPD flare.
●Steroids that come in pills – Most likely, you will need to take steroid pills for several days. If you have diabetes, steroid pills can increase your blood sugar.
●Steroids that come in an "IV" – An "IV" is a thin tube that goes into a vein. It is usually given in the hospital. A person who has a severe COPD flare might need treatment with IV steroids in the hospital.
●Antibiotic medicines – You may need to take an antibiotic if you have a lung infection or if your symptoms are more severe. Most often, the antibiotic is given as a pill. If you need to stay in the hospital, you might need an IV antibiotic.
How can I prevent flares of my COPD? — If you have COPD, you need a flu shot every fall and the pneumonia vaccine at least once. This is because infections like the flu and pneumonia can be very hard on your lungs. It is important to try to prevent them.
People who have more than 2 COPD flares a year might need a medicine to help prevent them. These include:
●Azithromycin – This is an antibiotic pill that is taken at a low dose. It can help prevent flares in some people, but is not used in everyone with COPD. That's because antibiotics can cause other problems.
●Roflumilast – This medicine comes in a pill you take by mouth. It can help reduce flares, but only in people with chronic bronchitis and severe COPD.
It is a good idea to keep a list of all the medicines you take and bring it with you every time you visit a doctor or nurse. You can find an example of this kind of list at the following website: www.fda.gov/drugs/resources-you-drugs/my-medicine-record
For more detailed information about your medicines, ask your doctor or nurse for information from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.