Chronic Obstructive Pulmonary Disease (COPD)

Medication

COPD medicines cannot cure COPD, but they can improve your symptoms. Your doctor will prescribe the COPD medicines that are right for you. To help you manage your COPD medicines your doctor may also give you a COPD action plan that explains what you should do when you are not feeling well. 

Your doctor will prescribe you different medicines based on your symptoms. It is important to take your COPD medicines as your doctor prescribes. The different types of COPD medicines include:

Bronchodilators

If you have COPD, your main symptom is probably shortness of breath. You might get short of breath when you exercise, when you do chores, when you feel upset, or for no reason at all.
Bronchodilator medicines open up the airways (breathing tubes) in your lungs. When your airways are more open, it’s easier to breathe. Doctors may prescribe more than one kind of bronchodilator to treat COPD.
There are two main types of bronchodilators that come in inhalers:

  • Beta-2 agonists, for example:
    • salbutamol (Ventolin ® or Airomir ®)
    • terbutaline (Bricanyl ®)
    • formoterol (Oxeze ® Foradil ®)
    • salmeterol (Serevent ®)
    • indacterol (Onbrez ®) 
  • Anticholinergics, for example:
    • ipratropium bromide (Atrovent ®)
    • tiotropium (Spiriva ®)
    • glycopyrronium (Seebri ®)
    • aclidinium (Tudorza ®) 

If you have any questions on medication side effects you should talk to your health care provider or pharmacist. 

Some bronchodilators work quickly, others work slowly.

Rapid-onset bronchodilators (also called quick-relief medicines) act quickly and start to relieve shortness of breath within minutes. They are often used as needed, to help relieve sudden shortness of breath. Quick-relief medicines usually come in a blue puffer.
Some rescue medicines are short-acting and last for 4-6 hours (like Ventolin ® or Bricanyl ®). Some are long-acting and last for up to 12 hours (like Oxeze ®).

Slow-onset bronchodilators take longer to act. Some last for 4 to 6 hours (like Atrovent ®), and some last up to 12 hours (like Serevent ®). Some slow-onset bronchodilator lasts for 24 hours (Spiriva ®).

If you're short of breath and need help right away, take a quick-relief medicine like Ventolin ®, Bricanyl ®. Quick-relief medicines usually come in a blue puffer. Keep your quick-relief medicine with you at all times, so it’s there when you need it.

The bronchodilators listed above come in a spray form (puffers or inhalers), or in a dry powder form that you suck on.  Learn how to use puffers (inhalers) and other devices

There’s another kind of bronchodilator that opens your airways. This one is in pill form:
Xanthines or theophyllines (such as Uniphyl® or Theodur ®)
Xanthines or theophyllines are slow-onset bronchodilator pills. They don’t work the same way as inhaled bronchodilators. They can have serious side effects and drug interactions. For these reasons, xanthines/ theophyllines are not commonly used. When they are used, it’s usually in combination with other bronchodilators.

Xanthines/theophyllines can interact with food and other medicines. Make sure your doctor and pharmacist knows all the other medicines you are taking. If you are taking these pills, your doctor will give you regular blood tests to monitor how much of the medicine is in your body.

Combination medicines: inhalers that combine two bronchodilators together

If you have moderate COPD, your health care provider may prescribe two different types of bronchodilators for you to take as combination medicine. When they are combined as one inhaler, you won't have to carry around two different inhalers to use. For example:

  • AnoroTM (umeclidinium combined with vilanterol)
  • Ultibro ® (glycopyrronium combined with indacaterol)

Talk to your health care provider or pharmacist about possible side effects including shaky hands (tremors and a fast heartbeat). 

Combination medicines: inhalers that combine a bronchodilator and a corticosteroid

If you have moderate or severe COPD, your health care provider may prescribe a combination medicine in order to treat and prevent COPD flare-ups (exacerbations). These medicines combine a bronchodilator to relieve shortness of breath and an inhaled corticosteroid to lessen the swelling in your airways. 
Some combination medicines for COPD are:

  • Advair ® (fluticasone combined with salmeterol)
  • Breo TM (fluticasone furoate combined with vilanterol trifenatate)
  • Symbicort ® (budesonide combined with formoterol fumarate)

Combination medicines are “preventer” medicines that need to be taken every day, usually twice a day. They help over time, but they do not help right away. If you need help right away, take a quick-relief medicine like Ventolin ®, Bricanyl ®.
Some side effects of combination bronchodilator and inhaled corticosteroids include shaky hands (tremor), fast heartbeat, thrush (a whitish film covering your throat and tongue), a sore throat or a hoarse voice. You can have fewer side effects if you:

  • take the medicine as directed by your health care provider
  • rinse your mouth with water after each dose: rinse, gargle, and spit the water out.
  • use a spacing chamber with your inhaler

Corticosteroid pills

Corticosteroids also come as pills, (for example, Prednisone ®). Corticosteroid pills have more side effects than the inhaled corticosteroids that are in combination medicines.  Corticosteroid pills are oftain used for short periods of time, usually when you have a COPD flare-up. However, in some cases they may need to be taken on a regular basis if you health care provider feels that inhalers alone are not enough. If you need to take corticosteroid pills on a regular bases, your health care provider will work to keep you on the lowest dose necessary. 
You can talk with your health care provider about side effects of your medication.

Antibiotics

COPD flare-ups can be caused by viral infections (for example, the flu) or bacterial infections (for example, bacterial pneumonia). If you have a bacterial infection, you can treat it with antibiotics. If you have a viral infection, antibiotics won't work.

It’s important to take your antibiotics as directed by your doctor and to take all of the antibiotics. When people don’t take all of their antibiotics, infections can become stronger and harder to treat.

As part of a COPD action plan, your health care provider may give you an antibiotic prescription to have on hand, and tell you to fill the prescription if you feel a COPD flare-up (exercerbation) starting. If you don't already have one, ask your health care provider for a COPD action plan. It is very imporant for you to reconize the signs of worsening COPD. Be sure to ask questions to you health care professional so you understand your action plan. 

Flu and Pneumonia shots

Shot (vaccines) can help protect you against some strains of flu and pneumonia. Flu and pneumonia shots can lower your chances of getting a flare-up and needing hospital care.
You need to take a flu shot every year, usually in the fall. Learn more about the flu shot

Most people with COPD need to take the pneumonia shot every 5- 10 years. Learn more about the pneumonia shot

Supplemental Oxygen

If you have more severe COPD, it may be hard for you to get enough oxygen from the natural air. Low oxygen levels can make you more short of breath and tired. If your blood oxygen level is very low, the doctor may prescribe supplemental oxygen. Studies show that when people who need supplemental oxygen get it, they can live longer.
People who take supplemental oxygen must continue taking their other medications.
Not everyone who has COPD needs to be on oxygen. To find out if you need supplemental oxygen, speak to your doctor or certified respiratory educator.
Generally, oxygen therapy can help people with:

  • Very low blood-oxygen levels (hypoxemia)
  • Temporary lung damage from infections (for example, pneumonia)

Oxygen only helps people who have very low blood-oxygen levels. Ask your doctor to test to see if oxygen might help you.

Benefits of oxygen

If your doctor says oxygen is right for you, you can enjoy these benefits:

  • Improves the way you feel and think
  • Decreases shortness of breath
  • Helps you exercise more easily
  • Cuts down on your need to go to the hospital
  • Can prevent heart strain from low levels of oxygen

How does oxygen therapy work? 

Oxygen therapy is generally delivered as a gas from a cylinder or concentrator. Most often you will be on oxygen through small nasal "prongs" that fit into your nostrils,  but sometimes you may need to use a mask that covers your mouth and nose. Breathing in this extra oxygen raises low blood-oxygen levels, eases the strain on your body and makes breathing easier.
Because your body can't store oxygen, the therapy works only while you use it. If you take off your oxygen mask or remove the prongs, your blood-oxygen level will drop within a few minutes.
Like any other prescription medicine, oxygen must be used carefully. You need to follow instructions and follow all the safety precautions. Your health care provider will tailor your oxygen prescription to your individual needs. Be sure you get instruction on how to use your oxygen and how to clean your equipment.

How long do people use oxygen therapy? 

You may be on oxygen therapy for a few weeks or months, or for the rest of your life. It depends on why you need it. If you have a lung infection, you may need to be on oxygen only until the infection clears and your blood-oxygen levels return to normal. If you always have low blood-oxygen levels, you may need to be on oxygen permanently.

More information about oxygen

To learn more about taking supplemental oxygen, download our fact sheet on oxygen therapy for COPD (PDF).  It talks about oxygen tanks, nasal prongs, and other oxygen equipment. It answers common questions about oxygen and includes tips on using oxygen safely.

References: 

This content was review on October 4th, by the Canadian Thoracic Society's COPD Clinical Assembly.

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Page Last Updated: 05/12/2014