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What Are the Treatments for COPD?

Medically Reviewed by Paul Boyce, MD on March 18, 2021

Chronic obstructive pulmonary disease (COPD) makes it hard to breathe. Narrowed airways can make you cough, wheeze, and feel short of breath. It can affect how you exercise, work, and do other daily activities.

The goal in treating COPD is to help you breathe easier and get you back to your regular activities. There are a number of treatment and lifestyle approaches that can help. You may also wish to try some natural and alternative treatments, but always get your doctor’s OK first.

And keep in mind that COPD treatment is a long-term journey with many facets, and each case is different. For example, you might be great at keeping up with your medications and doctor appointments, but not so good with proper diet and exercise. A nutritionist and physical therapist might be able to help.

Or maybe you’re good at both, but depressed because you can’t do as much as you used to or anxious about your health. In that case, the American Lung Association and other organizations have resources and support groups that can help. 

In addition, symptoms and effective treatments can change quite a bit as the disease gets worse, so it’s good to stay vigilant and check in with your doctor on a regular basis. Wherever you are on your journey with COPD, and whatever your frustrations, don’t be afraid to reach out for the help you need to get the most out of your daily life.

Quit Smoking

Cigarette smoke is the leading cause of COPD, and it can make the disease worse People with COPD who stop smoking improve their breathing capacity, health, and overall quality of life.

It may not be easy for you to quit, but there are many ways to get help. Ask your doctor about nicotine replacement, medicine, and counseling.

Short-Acting Bronchodilators

These medications work quickly to relax the muscles around your airways and ease symptoms like coughing and shortness of breath. You take them through an inhaler. The effects last about 4 to 6 hours. You use them only when you have symptoms or before you exercise.

These drugs can help if you have symptoms only from time to time. Short-acting bronchodilators include:

You can get dry mouth and headaches from these medications. Other side effects include:

 

Long-Acting Bronchodilators

These medications also relax the muscles around your airways, but their effects last up to 12 hours. You take them with an inhaler every day to prevent symptoms:

Side effects include:

 

Steroids

These bring down swelling in your airways. You usually breathe them in through an inhaler. Inhaled steroids can help if you have many COPD flare-ups. You might take steroids as a pill if your symptoms get worse.

Examples of inhaled steroids are:

Some medicines combine a bronchodilator and inhaled steroid. These include:

Side effects of steroid medicines depend on how long you take them. You may find yourself gaining weight or bruising easily. Other side effects might include:

  • Coughing
  • Higher chance of infections
  • Infections of the mouth
  • Hoarse voice
  • Sore mouth or throat
  • Weakened bones

 

Phosphodiesterase-4 (PDE-4) Inhibitor

A drug called roflumilast (Daliresp) can help with severe COPD symptoms.

It brings down swelling in the lungs and opens your airways. You might take it with a long-acting bronchodilator. Side effects include diarrhea and weight loss.

Theophylline

This medicine works like a bronchodilator, but it's less expensive.

Theophylline can help your lungs work better, but it may not control all of your symptoms.

Antibiotics

An infection can make your COPD symptoms worse. Your doctor will give you antibiotics to kill the bacteria and treat the infection.

Take all the medicine you're prescribed. If you stop taking the antibiotics too early, the infection could come back.

Pulmonary Rehabilitation

Pulmonary rehab is a program to help you manage COPD. It can ease shortness of breath, help you exercise more easily, and improve your quality of life. At a hospital or clinic, you'll work with a team of doctors, nurses, dietitians, physical therapists, and respiratory therapists.

Typically, this includes:

Breathing exercises. A respiratory therapist will show you specific ways of breathing in and ways to measure your progress with a device called a spirometer that you can use at home. These techniques, combined with a physical exercise program, can help lessen breathlessness and increase stamina. Your doctor or a specialized breathing therapist can help design a program for you.

Nutritional therapy. This means advice on what to eat and how much. It may differ, depending on where you are in your COPD journey. For example, in the early stages, you may need to lose weight, while in later stages, you may have the opposite problem. But each case is different, and your experience may differ. Your doctor or nutritionist can help design a diet that works for your weight, health, and activity level.

Exercise. This is also important when you have COPD. It helps increase your stamina and strengthens the muscles that help you breathe. Your doctor or physical therapist can help you design a fitness program that's safe for you. 

Smoking counseling.

Tracking. Your rehab team may suggest you keep a journal of your daily symptoms and check them against an action plan. Here’s one example of a COPD action plan from the American Lung Association. It’s a good idea to fill the plan out with your doctor and update it on each visit.

These plans guide you on how to make assessments about:

  • When and how to take your medication
  • How well your treatment is working
  • When to call your health care provider
  • When to get emergency care
  • How you feel from day to day
  • Health changes to discuss with your doctor

 

Oxygen Therapy

Severe COPD can prevent you from getting enough air into your lungs. As a result, oxygen levels in your blood can get too low. Therapy increases these levels to help you stay active and healthy.

You breathe in oxygen through a mask or prongs in your nose. It can come from a big home unit, or from a small tank you carry around with you. You might need oxygen all the time or only when you're active.

Breathing Machines for Sleep

This typically means a CPAP or BiPAP machine.

CPAP stands for continuous positive airway pressure. Light air pressure from the CPAP machine helps make sure your airway doesn’t close and interrupt your breathing as you sleep.

The CPAP machine has a small motor that blows air into a tube that connects to a mask that covers your nose and mouth, or in some cases just your nose.

The BiPAP machine works in a very similar way. The “Bi” in BiPAP stands for “bilevel.” It means there are two levels of pressure: A normal one as you breathe in and a lower one that makes it easier to breathe out. Many people find this more comfortable than the constant airflow from a CPAP machine. 

People with moderate to severe COPD may use these machines at the hospital to help with sudden, intense symptoms or at home to help with sleep and to keep blood oxygen levels up and remove carbon dioxide.

Just remember that regular use of these machines isn’t always helpful for COPD. Talk to your doctor about whether you are a good candidate for consistent machine-aided breathing for your COPD.  

Intubation and Ventilators

If your symptoms are serious enough, you may need mechanical help to breathe. This involves tracheal intubation and a ventilator.

If your symptoms don’t improve with other treatments within a certain amount of time -- 1 hour is a common guideline -- intubation and mechanical ventilation will be the next treatment offered.

You’ll have a breathing tube (also called a tracheal tube) put into your mouth and down into your windpipe (trachea). Then the tube is connected to the ventilator, a machine that pushes air into your lungs.

You’ll get medicine to ease your discomfort.

While the machine keeps you breathing, your respiratory system -- which has been struggling to work very hard -- can rest. Doctors also will do tests to identify and treat any other problems, such as pneumonia, that caused the flare-up.

Vaccinations

Get a yearly flu shot to reduce the number of COPD flare-ups you have. Ask your doctor whether you should also get a pneumonia vaccine.

Surgery

If other treatments don't work and your COPD is severe, you might need one of these surgeries to treat it:

  • Bullectomy. Air sacs are the tiny pouches in your lungs where oxygen travels into your blood vessels. COPD destroys the walls of these air sacs. When the walls come down, they create large spaces in your lungs called bullae. These bullae make it hard to breathe. A bullectomy is surgery to remove the air spaces and improve the flow of air in your lungs.
  • Lung volume reduction surgery. The surgeon removes small pieces of your lungs that COPD has damaged. Removing the damaged parts helps the healthy parts of your lungs expand so they can take in more oxygen.
  • Lung transplant. If you have severe lung damage, your doctor can remove your lung and replace it with a healthy one from a donor. This surgery has risks, and you will need to take medicines for the rest of your life to prevent your body from rejecting the new organ.

 

Lifestyle Changes

Treatment from your doctor is just one part of COPD care. A few changes to your daily life can also help you breathe easier.

Once you've quit smoking, try to stay away from anyone else who smokes. Avoid dust and chemical fumes, too.

WebMD Medical Reference

Sources

SOURCES:

American Family Physician: “Treatment of Stable Chronic Obstructive Pulmonary Disease: the GOLD Guidelines.”

Mayo Clinic: "COPD Treatment," "COPD."

National Health Service (U.K.): "Bronchodilators -- Side Effects."

National Heart, Lung, and Blood Institute: "How Is COPD Treated?" "What Causes COPD?" "What is COPD?"

Aastweb.org: “BiPAP (Bilevel positive airway pressure) or CPAP Therapy?” “What is CPAP (Continuous Positive Airway Pressure) Therapy?”

American Lung Association: “COPD Management Tools,” “Breathing Exercises.”

Cleveland Clinic: “Coping with COPD,” “Nutritional Guidelines for People with COPD.”

Medscape: “Noninvasive Ventilation.”

National Library of Medicine: “Smoking cessation, pulmonary rehabilitation and quality of life at smokers with COPD.”

National Sleep Foundation: “COPD and Difficulty Breathing,” “What is Sleep Apnea?”

UpToDate: “Nocturnal ventilatory support in COPD.”

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