Your Treatment Choices for Moderate-to-Severe COPD

Medically Reviewed by Carol DerSarkissian, MD on April 27, 2023
4 min read

Even though there's no cure for chronic obstructive pulmonary disease (COPD), there are many treatments that make you feel better, stay active, live longer, and just breathe easier.

When you have moderate to severe disease, you and your doctor will work together to find the right therapy for you. Medicine, oxygen therapy, and pulmonary rehab are just some of the tools you can turn to for help.

Your doctor will probably prescribe more than one drug at a time. The three main types of medicines used for COPD are bronchodilatorssteroids, and oral medications.

Bronchodilators. They relax the muscles that control your airways, which eases the flow of air in and out of your lungs.

You usually take bronchodilators through an inhaler or nebulizer -- a machine that turns the medicine into a mist that you breathe in. That way, the drugs go straight to your lungs.

Some types of this drug are called "short-acting," which means they work for 4 to 6 hours. You use it whenever symptoms like shortness of breath flare up.

A longer-lasting version works for at least 12 hours. You take it on a regular schedule, not just when you need it. Most people with advanced COPD take both types.

Some bronchodilators come in pill form, but they either have side effects or limited benefits, so doctors don't suggest them often.

Steroids. They reduce swelling in your airways so you can breathe easier. Like bronchodilators, you usually inhale these drugs.

You take steroids along with bronchodilators. Sometimes your doctor will suggest a combination of two or more drugs in one inhaler. If they don't help, your doctor will ask you to try different combinations or doses. Steroid tablets can be used for limited periods to help with flare-ups.

Oral medications. Roflumilast is an oral medication taken on a regular basis that can be used to treat severe COPD. It may decrease the incidence or severity of flare-ups. 

Even with medications, you may have symptoms like wheezing, coughing, trouble catching your breath, and feeling tired. This is when extra oxygen can help.

Some people take extra oxygen all the time, others just some of the time. It comes in a portable canister. You breathe it in through a face mask or nose prongs.

If you try oxygen therapy, it may not only cut your symptoms, but it could help you live longer.

If drugs and therapy aren't doing enough to help you breathe right, your doctor may suggest surgery. It's not for everybody, but it's useful for some folks.

There are four main types of surgery:

Bullectomy. COPD causes the walls of your lungs' small air sacs to break. When that happens, larger sacs form that don't work as well in handling the air you breathe in. Your lungs will form large air pockets called "bullae."

To fix this problem, your doctor may suggest surgery called bullectomy that removes the bullae, which gives healthy tissue more room to do its job.

Lung volume reduction surgery (LVRS). Surgeons take out the most damaged parts of your lungs, leaving about 70% of the lungs. The operation makes it easier to breathe and may help you live longer.

Lung transplant. Your surgeon removes your lung and replaces it with a healthy one from someone who has just died. It's a major operation with a number of serious risks, including infections.

Endoscopic valve placement. During this surgery, Zephyr Valves are placed to prevent air from entering the damaged parts of the lung. These valves also allow trapped air and fluids to escape. 

If you have surgery on your lungs, your doctor may ask you to take part in pulmonary rehabilitation. You'll work with a team of nutritionists, doctors, exercise experts, and others to learn ways to keep your lungs working as well as possible even with COPD.

Pulmonary rehab is also helpful if you haven't had surgery but your symptoms get in the way of day-to-day living.

People with COPD are more likely to get infections, so your doctor may give you a prescription for antibiotics in case you do get sick. You shouldn't take these unless you come down with an infection and your doctor tells you it's OK to use them.

Once you start, you need to finish the whole prescription to make sure the infection doesn't come back. Don't skip pills or stop as soon as you feel better. You should also keep up to date with flu and pneumococcal pneumonia vaccines. You should also stop smoking.