COPD Treatment

There’s no cure for chronic obstructive pulmonary disease (COPD). However, there are a range of treatments you can do and behaviors you can adopt to help stop it from progressing – helping you to live well with the condition. Your doctor will work closely with you to develop a personalized self-management plan to cover daily living and what to do if you start to feel worse.

Help to stop smoking

If you have COPD and smoke, quitting can be the biggest single thing you can do to minimize your symptoms and help stop your condition worsening. Ask your family doctor for support with this. They may be able to offer:

  • Nicotine-replacement products, which are available in a variety of forms such as gum, inhaler, nasal spray, skin patch, lozenge or an under-tongue tablet
  • Medication to reduce your nicotine cravings and withdrawal symptoms
  • Behavioral support such as individual, group, or online counseling.

Those who adopt a combination of support and medication are around three times more likely to quit successfully.

Get vaccinated

Have an annual flu jab to protect you from the latest flu viruses each winter. You’re less likely to have COPD flare-ups or become seriously ill and need to go into hospital.

You can also ask your doctor for a pneumococcal vaccination. This will protect against the pneumococcal infection, which causes pneumonia and other illnesses. You’ll only need this once, not every year.

If you didn’t have the combined whooping cough/diphtheria/tetanus jab as a teenager, it’s recommended to have that too.
You should also have the COVID-19 vaccination as soon as this is available in your area. Research shows that the risk of suffering from severe symptoms with COVID-19 is higher in those with COPD.

Pulmonary rehabilitation

Pulmonary rehabilitation (PR) is an individual program of exercise, information, and advice that helps you to stay active if you have a lung condition like COPD that makes you breathless. Most PR programs last about six weeks, in which you’ll be invited to attend the group sessions a couple of times a week.
PR is usually delivered by a team of health professionals – including physiotherapists, specialist nurses, and dietitians – in community settings. About half of each group session is spent on supervised exercise. The idea is to become just a little bit out of breath – you’ll be monitored so you can exercise safely.
Although PR is not a cure for COPD, it has proven benefits to:

  • Improve muscle strength, so you breathe more efficiently and become less breathless
  • Enable you to learn ways to cope better with feeling out of breath
  • Increase your fitness level
  • Improve your mental wellness
  • Help you to learn about how your condition affects you and how you can manage it better. Examples of topics include inhaler technique, eating healthily, managing anxiety and low mood, and what to do if you feel poorly.

There’s evidence that people who engage with PR can walk further, feel better in their day-to-day activities, are less likely to need to go to hospital, improve their social life and often be able to return to work.

Manage any other health problems

Common conditions to have with COPD include cardiovascular diseases, lung cancer, osteoporosis, depression, anxiety, and gastro-esophageal reflux. They can affect how your COPD progresses, especially if they are undiagnosed and remain untreated.
Your doctor will ask you about this to optimize your overall treatment and general health.

Medicines

There’s a wide range of medications used to treat COPD. They can help to reduce symptoms of COPD, minimize how many flare-ups you have and how severe they are, improve your ability to take exercise, and keep you as healthy as possible. COPD affects everyone differently so your doctor will work with you to make up the best treatment package to suit your needs. The aim is to optimize how well you respond to treatment and balance that against side effects, symptom control, flare-ups, and possibly cost.

Inhalers

An inhaler delivers medicine directly into your airways and lungs as you breathe in. Not all inhalers are the same, so a doctor or nurse will show you how to use your device correctly. Inhaled therapies used for COPD include:

Short-acting beta-2-agonists (SABA) or short-acting anti-muscarinics (SAMA)

SABA and SAMA are often the first choice. These are bronchodilators – they make breathing easier by relaxing and widening the small airways. That can relieve the uncomfortable feeling when your lungs are overinflated. You use this kind of inhaler whenever you feel breathless up to four times a day.

Long-acting beta-2-agonists (LABA) and long-acting anti-muscarinics (LAMA)

LABA and LAMA are used if you still have daily symptoms despite using your SABA or SAMA inhaler correctly. Their bronchodilation effects last longer so you’ll only need to use them once or twice a day.

Inhaled corticosteroid (ICS)

If necessary, an ICS can be added to your long-acting bronchodilator inhaler to help reduce inflammation in your airways. ICS can prevent about a quarter of flare-ups.

Oral tablets

If your COPD symptoms are not well controlled with inhaled therapy, your doctor may recommend adding an oral tablet, pill, or capsule. Depending on which medicine they recommend, you may need to take these every day, or just when you experience a flare-up or develop a respiratory infection.

Theophylline

This is an oral bronchodilator, usually taken twice a day. Side-effects can include headache, feeling sick (nausea), problems sleeping (insomnia), heartburn, or a fluttering/irregular heartbeat (palpitations). Your doctor will monitor you and adjust your dose to balance symptom control against minimizing any side effects.

Mucolytic drug

Taking a mucolytic drug daily can sometimes help if you have a persistent phlegmy cough. It makes the phlegm easier to cough up. Carbocisteine is a commonly prescribed mucolytic – it’s taken as a tablet or capsule usually three or four times a day. Another mucolytic – called acetylcysteine – comes as a powder that you mix with water before taking it.

Oral steroids

These reduce airway inflammation. They are mainly used in short courses – over about five days – to treat a particularly severe flare-up. Side-effects can include weight gain, mood swings, and bone weakening (osteoporosis). Therefore, if you need to take steroids for longer periods your doctor will keep the dose as low as possible and monitor any side effects carefully.

As part of your self-management plan, your doctor might give you a short course of steroid tablets to keep at home in case of a flare-up.

Antibiotics

You may need a short course of antibiotics to treat a chest infection and/or COPD flare-up. Your doctor might give you a single course of antibiotics to keep at home and take if you develop chest infection symptoms.

Roflumilast

This is a relatively new type of COPD medicine called a phosphodiesterase-4 enzyme inhibitor. It’s taken as a once-daily tablet and acts to reduce inflammation. A specialist doctor might prescribe roflumilast if you have severe COPD and are still experiencing several flare-ups despite using triple LAMA/LABA/ICS inhaler therapy. Roflumilast has more side effects than inhaled COPD therapy, including diarrhea, feeling sick, reduced appetite, losing weight, abdominal pain, sleep problems, and headaches.

Diuretic drugs

These remove excess water from the body. They can relieve swollen ankles in severe COPD cases.

Other treatments

Nebulizer therapy

If your COPD is severe or you have a bad flare-up, a machine called a nebulizer can help you breathe in your medicine through a facemask or mouthpiece to help relieve the symptoms. If you or your carer are trained to do so, you can use a nebulizer at home.

Oxygen therapy

If the oxygen levels in your blood are persistently low this can put extra strain on your heart. You may be offered equipment so you can have oxygen therapy at home. This won’t stop or reduce your breathlessness, but it can reduce heart complications such as pulmonary hypertension. You’ll be able to breathe in oxygen from a facemask or nose tube. There are different ways you can use home oxygen:

  • Long-term oxygen therapy stabilizes your oxygen levels for 15 hours or more
  • Ambulatory oxygen therapy – also called portable oxygen – allows you to be more active at home or when you go outside
  • Palliative oxygen therapy can help to relieve breathlessness as part of palliative or end of life care.

Oxygen is highly flammable and you must not smoke when having this therapy because of the risk of fire or explosion.

Non-invasive ventilation

Non-invasive ventilation (NIV) is a portable machine that helps you breathe. You breathe through a face or nose mask – doctors will not need to insert a tube into your trachea (windpipe). NIV machines take some of the hard work out of breathing when you have a severe COPD flare-up and need hospital care.

Successful NIV therapy can be effective within one or two hours. You’re less likely to develop complications while in hospital and increases your chances of being able to return home sooner.

Surgery

About one in 50 people with COPD have emphysema that might benefit from a lung volume reduction operation. This operation aims to remove:

  • Damaged lung tissue
  • Large air spaces (called bullae) which trap air.

Reducing the worst affected areas of your lungs allows the remaining healthier parts to relax and work better.

A small number of people with very severe COPD might be considered for a lung transplant. Ask your doctor if you think you might be suitable.

Learn more about easing your COPD symptoms and improving your quality of life in our guide to COPD management.

Sources:
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BLF 2019. What are the treatments for COPD?.

BLF 2020. Pulmonary rehabilitation (PR).

BLF 2021. Home oxygen therapy.

ELF 2021. Living well with COPD.

ELF 2021. Pulmonary rehabilitation in adults.

GOLD 2021.

US NLM. 2021. COPD.

NHS 2019. Treatment. Chronic obstructive pulmonary disease (COPD).

NHS 2020. Champix (varenicline).

NICE 2017. Roflumilast for treating chronic obstructive pulmonary disease.

NICE 2018 (updated 2019). Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NG115.

Soo Hoo GW. 2020. Noninvasive ventilation.