Medication for chronic obstructive pulmonary disease (COPD) is used to reduce shortness of breath, control any coughing and wheezing, and to prevent and reduce a rapid, sometimes sudden, and prolonged worsening of cough, amount of mucus, and/or shortness of breath (COPD exacerbation). Most people with COPD find that medications make breathing easier.

Bronchodilators and inhaled corticosteroids are often used with a metered-dose inhaler (MDI), a dry powder inhaler (DPI), or through a mouthpiece or mask (nebulizer). Most health professionals recommend that everyone using an MDI also use a spacer, which efficiently delivers medication to the lungs and makes it easier to control the dose. Use of a spacer is especially important when using an inhaler containing a corticosteroid medication. Do not use a spacer with a dry powder inhaler (DPI).

Many people use an MDI incorrectly and do not get the full benefit from the medication. For more information, see:

Using a metered-dose inhaler correctly.

For information on how to use a dry powder inhaler, see:

Using a dry powder inhaler.

Medication Choices

Bronchodilators are used to open or relax the airways of the lung (bronchial tubes) and relieve shortness of breath. Bronchodilators are either short-acting to relieve symptoms or long-acting to help prevent breathing problems.

• Short-acting bronchodilators are considered a first-line therapy for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). Short-acting bronchodilators include:
  • Anticholinergics (such as ipratropium).
  • Beta2-agonists (such as albuterol and metaproterenol).
• Long-acting bronchodilators are effective and convenient for treating COPD in a person whose symptoms do not go away (persistent symptoms). Long-acting bronchodilators include:
  • Anticholinergics (such as tiotropium).
  • Beta2-agonists (such as salmeterol and fluticasone).

Oral corticosteroids (prednisone) may be used for a COPD exacerbation (in pill form) or to prevent COPD exacerbations (in inhaled form). They are often used if you also have asthma.

Other medications, which are not commonly used, include:

• Mucolytics, such as acetylcysteine (Mucomyst or Mucosil-10) or iodinated glycerol (Organidin, Iophen), which thin the mucus in the bronchial tubes and lungs, possibly making it easier to cough up mucus. They are no longer commonly used.
• Expectorants, such as guaifenesin (Fenesin, Humibid L.A.), which also may make it easier to cough up mucus. They are no longer commonly used.
• Methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects.

Other medications used for COPD include leukotrienes, cromolyn, and nedocromil. However, they are not very effective and are rarely used.

What to Think About

The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This does not always mean the medication will not help. It is usually best to try the medicine for a period of time before you decide whether it is working.

Combining beta2-agonists with anticholinergics or corticosteroids provides better results than using these medications alone.^{8, 9} It may also reduce the risk of side effects compared to increasing the dose of one medication.¹⁰

Metered dose inhalers (MDIs) and nebulizers deliver medication equally well. You can carry an MDI more easily than a nebulizer. Nebulizers usually need to be plugged in.

It is important to keep track of your inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medication but also prevents you from inhaling only propellant after the medication has run out.