How Chronic Obstructive Pulmonary Disease (COPD) Is Treated

Chronic obstructive pulmonary disease (COPD), an irreversible and incurable lung disease, is treated with medication, lifestyle strategies, and sometimes with procedures or surgical intervention. If you have COPD, your treatment regimen can help control your COPD symptoms, which include difficulty breathing, wheezing, cough, and excessive mucus production.

Following your COPD treatment plan is an important way to prevent COPD exacerbations, which are flare-ups characterized by dangerous effects that include severe dyspnea (shortness of breath), chest tightness, weakness, and dizziness. These episodes can be life-threatening and usually require urgent treatment. 

COPD treatment is guided by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guide for diagnosis, management, and prevention.

Lifestyle

When you have COPD, your lifestyle has a major impact on your illness. You can make some healthy lifestyle changes to help control and prevent your COPD symptoms and reduce your risk of COPD exacerbations.

Treating COPD According to the 2020 GOLD Guide
Verywell / Catherine Song

Quit Smoking

Kicking the cigarette habit is the most important step you can take to manage your COPD. Smoking is the leading cause of COPD, and if you already have the disease, smoking makes it even worse. For some people, smoking cessation is enough to help keep symptoms of COPD at bay and prevent the disease from progressing.

However, it's not easy to quit, especially if you've been smoking for years. Tips for quitting include using nicotine replacement therapy or aids such as gum, inhalers, tablets, patches, or nasal sprays to reduce cravings. Prescription medications used for smoking cessation, including bupropion or Chantix (varenicline), can help reduce cravings and withdrawal symptoms.

Counseling or group therapy may help by providing you with guidance, support, and accountability as you take this important step.

Regular Exercise

Getting regular exercise is always good for your overall health and mental wellbeing. For COPD specifically, it can help you optimize your lung function with COPD, maximizing your oxygen exchange and your lung capacity. It can also, therefore, help you maintain your muscle strength and endurance.

Walking is often a great way to start exercising when you have COPD. Talk to your doctor about what kind of exercise is best for you before beginning.

Get Enough Calories

Medications, fatigue, and difficulty breathing may lead to a reduced appetite. Not getting enough calories can make your COPD symptoms worse and may put you at a higher risk for infections, which can lead to COPD exacerbations.

If you have experienced weight loss or a decrease in your appetite, talk to your doctor about ways you can combat malnutrition.

Breathing Techniques

Learning to use techniques to help you breathe more efficiently can improve your muscle control and oxygen exchange. Struggling to breathe when you have COPD uses excessive energy and exhausts your diaphragm.

Your doctor, physical therapist, or respiratory therapist can show you breathing techniques that you can use on your own to help you improve your muscle control.

Stay Up to Date On Medical Care

Make sure you see your doctor for your regularly scheduled appointments, even if you feel well. It's important that your medical team monitor you to track your symptoms and lung function and to keep on top of your treatments.

COPD Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Man

Prescriptions

The medications used to treat COPD include prescriptions for managing symptoms of your disease and treatments for infections. You will be instructed to take your long-acting COPD medications on a regular schedule, whether you have symptoms or not.

You may also be given a prescription for a short-acting COPD medication to take when your symptoms flare-up, with instructions for when to get emergency attention for severe symptoms.

Antibiotics are prescribed for the treatment of bacterial infections.

Bronchodilators

Bronchodilators help relax the muscles in the walls of your airways. This makes it easier to breathe, reduces cough, and improves or prevents acute dyspnea.

These drugs are usually taken with an inhaler or through aerosol therapy, in which the medicine is given in the form of a fine mist through an instrument called a nebulizer.

Rapid vs. Long-Acting

There are two major categories of bronchodilators for treating COPD based on how rapidly they act. You may need only one or both of these, depending on your symptoms:

Short-acting bronchodilators: These medications work within seconds to minutes to relieve shortness of breath, but the effects only last four to six hours. Examples include:

  • Ventolin, Proair (albuterol): A short-acting beta-agonist (SABA)
  • Xopenex (levalbuterol): A short-acting beta-agonist
  • Atrovent (ipatropium): A short-acting anticholinergic/muscarinic antagonist (SAMA)

Long-acting bronchodilators: These medications are used to help keep your airways open and relaxed for extended periods of time (throughout the night, for example). Though the effects last longer, from 12 to 24 hours, these medications start working more slowly than their short-acting counterparts, and they don't help in an emergency situation.

Types of Long-Acting Bronchodilators

There are also two major categories of bronchodilators based on mode of action. These drugs work to keep your airways open and relaxed but by somewhat different methods.

Long-acting beta-agonists (LABAs): Examples include:

  • Serevent (salmeterol)
  • Arcapta (indacaterol)
  • Brovana (aformoterol)
  • Performist (formoterol)

Long-acting anticholinergic/muscarinic antagonists (LAMAs): Examples include:

  • Spiriva (tiotropium)
  • Tudorza Pressair (aclidinium)

For people with moderate to severe COPD who experience shortness of breath and/or exercise intolerance, 2020 guidelines recommend treatment with both a long-acting beta-agonist (LABA) and a long-acting anticholinergic/muscarinic antagonist (LAMA) rather than either of these medications alone. Examples of inhalers that include both a LABA and an LAMA include:

  • Bevespi Aerosphere (formoterol/glycopyrrolate)
  • Duaklir (formoterol/aclidinium)

Inhaled Corticosteroids

Your doctor may also prescribe a daily inhaled corticosteroid. This can help keep inflammation down and reduce the number of exacerbations you have.

There are two settings in which an inhaled corticosteroid may be recommended:

  1. In people who have asthma or a high eosinophil count (a type of white blood cell that is often elevated in people with allergies).
  2. For people who have one or more COPD exacerbations each year. If you have not had an exacerbation in a year and do not have asthma, it's now recommended that these medications be discontinued.

While inhaled corticosteroids reduce COPD exacerbations, they also increase the risk of pneumonia.

Hoarseness, infections in your mouth, and skin bruising are other potential side effects.

Examples of inhaled corticosteroids include:

  • Flovent (fluticasone)
  • Pulmicort (bedesonide)

Combination Inhaled Corticosteroid and Bronchodilator Inhalers

Some COPD inhalers and nebulized solutions contain a combination of one or two long-acting bronchodilators and a corticosteroid. Examples include:

  • Symbicort (formoterol and bedesonide)
  • Advair (salmeterol and fluticasone)

Oral Corticosteroids

During a COPD exacerbation, oral corticosteroids like prednisone can shorten your recovery time, improve your lung function, and relieve hypoxemia (low levels of oxygen in the blood). They also may reduce the risk of relapse, prevent treatment failure, and, if you end up in the hospital, shorten the amount of time you're there.

Long-term use of oral corticosteroids can result in serious side effects, however, so these medications are typically used for only a short period of time. Side effects include osteoporosis, diabetes, an increased risk of infection, cataracts, and weight gain.

Phosphodiesterase-4 (PDE4) Inhibitors

COPD can cause an overproduction of phosphodiesterase-4 (PDE4), an enzyme that causes lung inflammation. PDE4 inhibitors, which block this enzyme, are taken to help to reduce COPD exacerbations in people with chronic bronchitis, a history of exacerbations, and severe to very severe COPD.

Daliresp (roflumilast) is one such PDE4 inhibitor. Side effects can include diarrhea, weight loss, abdominal pain, disrupted sleep, nausea, loss of appetite, and headache.

Antibiotics

If you come down with a bacterial respiratory infection such as bronchitis or pneumonia, your doctor may prescribe an antibiotic. These medications work against bacteria but not viruses, so they won't knock out a common cold or the flu.

If you're prescribed a course of antibiotics, it's very important to take the entire prescription, even after you start feeling better. Not finishing the prescription can increase your risk of antibiotic resistance.

Surgeries and Specialist-Driven Procedures

A variety of interventions can help alleviate or prevent the effects of COPD. While these treatments aren't curative, they can have a major impact on your disease and its progression.

Vaccinations

Infections, especially lung infections, can be a huge health crisis when you have COPD. Infections can make your COPD symptoms worse or may trigger an exacerbation. While not treatments for COPD itself, vaccination can help you avoid some infections.

Vaccinations your doctor may recommend for you include:

  • Pneumococcal pneumonia vaccine: With COPD, you are at increased risk of developing bacterial pneumonia, such as pneumonia that caused by the Streptococcus pneumoniae bacterium. A vaccine can help prevent this infection.
  • Flu: Getting your recommended flu shot can keep you from coming down with the flu. This preventative strategy may reduce your urgent doctor's visits and hospitalizations when you have COPD.

Keep in mind that there aren't vaccines for every type of infection, so do your best to avoid catching an infection by regularly incorporating strategies such as proper handwashing and avoiding people who are sick whenever possible.

Pulmonary Rehabilitation

Your pulmonary rehabilitation program will include an assessment and a tailored exercise program that includes physical exercises, breathing exercises, a nutrition plan, and counseling.

Your team may include respiratory therapists, physical therapists, occupational therapists, dietitians, and psychologists who will work with you to optimize your breathing abilities and follow your progress with measured outcomes.

Oxygen Therapy

You may need to use supplemental oxygen therapy. Some people need to use oxygen only at night, while some need it when going out, and others need it 24 hours a day.

For some people with COPD, supplemental oxygen improves survival rates. It may also help alleviate your symptoms and improve your quality of life by helping you sleep better at night, increase your alertness during the day, and improve your ability to take part in activities with fewer symptoms.

Lung Flute

The Lung Flute is a handheld respiratory device that has been approved by the U.S. Food and Drug Administration (FDA) to help clear your lungs of mucus. It works by creating low-frequency vibrations deep in your lungs when you blow hard through the mouthpiece. This helps break up mucus, making it easier for you to cough up the material.

Surgery

Surgery can be an option in certain situations. Your doctor may talk about lung surgery with you if your lungs could be healthier by removing a specific area of lung damage or if a transplant is the best way to alleviate your disease.

Because COPD is often widespread, affecting multiple areas of both lungs, surgery isn't always a beneficial option. And a major lung surgery is not always feasible if you can't tolerate surgery due to your health status.

Types of lung surgery for COPD include:

  • Bullectomy: This surgery involves the removal of bullae, which are large spaces of air that form when the walls of your air sacs are destroyed. Removing one or more bullae can help improve your airflow.
  • Lung volume reduction surgery: In this surgery, damaged tissue is removed from the upper part of your lungs. This allows your lungs to expand further so that you can breathe more easily, and it may prolong your life.
  • Lung transplant: This is a major surgery that involves removing and replacing your damaged lung with a healthy lung from a deceased donor. It may be an option if your lung is too damaged to make you a candidate for other types of surgery.

Though a lung transplant can improve your quality of life, there are risks, including the risk that your body could reject the donated lung. To reduce that risk, you will need to take medications that suppress your immune system for the rest of your life—and this medication increases the chance of infection.

Complementary and Alternative Medicine (CAM)

Complementary therapies have been considered as potentially beneficial for people with COPD. There is little evidence that herbal remedies could help COPD symptoms, and it's important to be extremely cautious so you won't take anything that inadvertently worsens your lung disease.

Yoga and acupuncture have been evaluated in people who COPD, and while these approaches do not specifically treat COPD, they are safe and can improve quality of life by alleviating stress.

Yoga

A number of small studies suggest that yoga may be beneficial for people who have COPD. One review in the Journal of Thoracic Disease reports positive effects for those that do yoga training for at least 12 weeks. These individuals show better lung function, less shortness of breath, and improved overall quality of life.

Acupuncture

Acupuncture is a technique that involves placing thin needles into specific points in the body. One study of people with COPD who used either medication alone or in conjunction with acupuncture for eight weeks found that shortness of breath with exertion and quality of life were significantly improved in those using the combination of the two treatments.

Another study, done over 10 weeks, showed similar results.

A Word From Verywell

There are a variety of different treatments used for managing COPD and for treating acute exacerbations. If you have COPD, your treatment plan is guided by your symptoms based on the GOLD recommendations.

Over time, your COPD treatment may change as your symptoms change. Be sure to see your medical team on a regular basis so that you can have your condition monitored closely and your treatment updated as needed.

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