COPD: treatment and management

Older couple walking

While there is no cure for chronic obstructive pulmonary disease (COPD), there are treatments that can relieve your symptoms and help you stay active. Treatments can also slow down the progression of the disease and prevent and treat complications.

COPD is a long-term (chronic) condition that affects the lungs and airways, causing breathlessness and cough.

Quit smoking

The most important thing you can do for yourself if you have COPD is to stop smoking immediately. You may have tried quitting in the past, but if you have been diagnosed with COPD it is even more important that you talk to your doctor about stopping.

Stopping smoking is the only thing that has been shown to improve the natural progression of COPD. Quitting will improve your cough, ease your breathlessness and you will also slow down further lung damage.

Put simply, stopping smoking will help you feel better and live longer.

Talk to your doctor about quitting strategies and available medicines and nicotine replacement products that can help.

Medicines to treat COPD

Medicines can be used to:

  • relieve symptoms of COPD;
  • prevent and treat flare-ups (episodes when your symptoms are worse than usual, also known as exacerbations); and
  • improve lung function and your quality of life.

COPD medicines may be prescribed for ongoing use or use as needed. Some medicines may be used only in the short-term for flare-ups. Often, a combination of several medicines is used.

Different medicines are used in different people; the medicines used will depend on the severity of your disease.

Medicines used to treat COPD

Medicines used to treat COPD

Type of medicine

Use

Class

Examples

Brand names

Reliever

Short-acting bronchodilators

Expand your airways and help you breathe more easily. Relieve symptoms (breathlessness). Used only when needed – effects last about 4 to 6 hours.

Usually given by inhaler.

Short-acting beta2-agonists (SABAs)

salbutamol

Ventolin, Asmol, Airomir

terbutaline

Bricanyl

Short-acting muscarinic antagonist

ipratropium bromide

Atrovent

Maintenance

Long-acting bronchodilators

Relieve breathlessness, improve lung function, improve quality of life, reduce frequency and severity of flare-ups.

Given by inhaler. Used regularly - every day. Effects last 12 hours or more.

Long-acting beta2-agonists (LABAs)

salmeterol

Serevent Accuhaler

eformoterol

Foradile, Oxis Turbuhaler

indacaterol

Onbrez Breezhaler

olodaterol

Striverdi Respimat

Long-acting muscarinic antagonists (LAMAs)

tiotropium

Spiriva

glycopyrronium

Seebri

umeclidinium

Incruse Ellipta

aclidinium

Bretaris Genuair

LABA/LAMA combination medicines

indacaterol plus glycopyrronium

Ultibro Breezhaler

vilanterol plus umeclidinium

Anoro Ellipta

olodaterol plus tiotropium

Spiolto Respimat

eformoterol plus aclidinium

Brimica Genuair

Maintenance

Inhaled corticosteroids

Treat or prevent flare-ups (for people with COPD and asthma) by reducing inflammation.

Given by inhaler.

 

fluticasone propionate

Flixotide

beclomethasone

Qvar

budesonide

Pulmicort

ciclesonide

Alvesco

Maintenance

Combination inhalers

Reduce frequency of flare-ups and improve quality of life. Given by inhaler.

Inhaled corticosteroid plus long-acting beta2-agonist (LABA)

budesonide plus eformoterol

Symbicort Turbuhaler

fluticasone furoate plus vilanterol

Breo Ellipta

fluticasone propionate plus salmeterol

Seretide

Flare-ups

Oral corticosteroids

Used to treat flare-ups. Given as tablets.

 

prednisone, prednisolone

 

Maintenance in severe COPD

Theophylline

Used in the treatment of severe COPD that is not responding to other treatment or in people not able to use inhaled treatments. Given as tablets or oral syrup.

 

theophylline

Nuelin

Flare-ups

Antibiotics

Treatment of bacterial infections that can cause flare-ups. Usually given as tablets.

 

Examples include amoxicillin and doxycycline

 

Side effects

Side effects will depend on the type of COPD medicine you are taking. It’s important to mention any side effects to your doctor as it may be possible to swap to another similar medicine that is not associated with the same side effects.

Side effects associated with oral corticosteroids can include weight gain, mood changes, the development of diabetes, cataracts (clouding of the lens in the eye, which interferes with vision) and osteoporosis (thinning of the bones). These side effects are usually associated with prolonged use of oral corticosteroids (tablets).

Devices used to give COPD medicines

Many COPD medicines are given via an inhaler. Devices called spacers can be used with inhalers to help increase the amount of inhaled medicine that reaches your lungs.

Regular review of your inhaler technique with your doctor and/or pharmacist is important because many people do not use inhalers properly and so are not getting the full benefit of their medicines.

It’s recommended that inhalers containing corticosteroids should always be used with a spacer and that you rinse your mouth with water after using any corticosteroid inhalers. This is to reduce side effects from corticosteroids, including oral thrush (fungal infection in the mouth).

A nebuliser can be used to give some inhaled medicines, but is usually only recommended for people who are unable to use an inhaler (with or without a spacer).

Pulmonary rehabilitation (exercise and education) programmes

Pulmonary rehabilitation programmes are programmes designed to improve overall wellbeing and quality of life in people with COPD. These programmes can reduce breathlessness and tiredness, and help you stay active and able to do your usual activities.

A variety of health professionals may be involved in your rehabilitation programme. Carers and family members should also be involved.

Pulmonary rehabilitation usually involves:

  • physical activity and exercise training;
  • advice on nutrition;
  • education about your illness; and
  • counselling and behaviour modification.

Pulmonary rehabilitation can also help reduce symptoms of anxiety and depression in those who are affected.

Physical activity and exercise training

Physical activity and exercise training is an important part of pulmonary rehabilitation.

Although it may seem difficult to get up the energy to exercise, prolonged inactivity leads to increased disability, so it is important you regularly try to do whatever physical activity you feel you are capable of, even if this is just a short gentle walk every day. Physical exercise helps your body function more efficiently, improves lung function and may protect against depression.

Strength training for your arms and legs, flexibility exercises and breathing techniques are also often included as part of exercise training.

Talk to your doctor, who may recommend a special exercise programme for you or refer you to a physiotherapist or rehabilitation specialist for pulmonary rehabilitation exercises. These exercises should improve your exercise capacity and quality of life.

COPD Action plans

Many people with COPD will have a management or action plan that they have discussed with their doctor. Your action plan will outline how to monitor your COPD symptoms so that flare-ups (worsening of symptoms) are detected early.

Your action plan will also outline what to do if you are having a flare-up to make sure it is treated early.

Flare-ups

Flare-ups are usually caused by a respiratory infection (such as a chest infection or flu), but can also be due to exposure to inhaled irritants such as air pollution.

Symptoms that indicate you are having a flare-up include:

  • increased breathlessness;
  • increased coughing;
  • coughing up more mucus/phlegm than usual, or a change in colour or thickness of mucus;
  • usual medicines not relieving symptoms adequately;
  • loss of appetite;
  • tiredness;
  • reduced sleep; and
  • fever.

Depending on the symptoms at the onset of a flare-up, management may include:

  • adjusting the dose and/or frequency of some regular medicines to control symptoms; and
  • adding extra medicines (such as corticosteroids, or antibiotics if infection is suspected).

Your action plan may involve making medication adjustments yourself before organising to see your doctor for review as soon as possible.

Oxygen

Supplemental oxygen therapy is often helpful to people who have severe COPD and a low level of oxygen in their blood. You will need to be assessed first by a respiratory medicine specialist who will test your lung function to see if you would benefit from oxygen therapy.

Depending on your lifestyle and the results of the tests, you may be given an oxygen supply at home. This is either a machine known as a concentrator, which purifies the oxygen in the air in your room, or compressed oxygen in a cylinder. To gain benefit from the oxygen you will probably need to use it for at least 18 hours a day.

Portable oxygen cylinders are used by some people for short walking trips of an hour or so.

Surgery

Some people with emphysema may be suitable for surgery called lung volume reduction surgery, which gives some people improvement.

Lung transplantation can also provide symptom relief for some people with severe COPD that is not responding to other treatments.

Self-care

Here are some other practical things you can do that should benefit you in coping with COPD.

  • Drink plenty of liquids, to help thin your mucus and make it easier to cough up.
  • Eat a healthy and varied diet. Being either overweight or underweight can make symptoms worse, so try to maintain a healthy weight.
  • Keep as active as you can.
  • Prevent infections if possible. Avoid crowded places and ill people during the cold and flu seasons, and boost your immunity by eating properly and getting enough rest.
  • Avoid contact with substances that irritate your lungs, for example smoke, dust, fumes, animal hair and aerosols.
  • Try to maintain a positive attitude to life and find things you enjoy doing.
  • Keep in regular contact with your doctor so your health can be monitored.

Preventing flare-ups

See your doctor every autumn for an influenza (flu) vaccination. Being immunised against influenza reduces your chances of getting the flu and having a COPD flare-up.

Pneumococcal vaccination should also be given to help prevent pneumonia caused by pneumococcal bacteria. Your risk of pneumonia and its complications is increased if you have COPD. Some people will need a booster dose after 5-10 years to maintain their immunity.

Support groups

Join a support group to meet other people with COPD. You can help each other manage by giving support, advice and understanding.

Last Reviewed: 1 April 2016
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References

1. Abramson M, Frith P, Yang I, McDonald C, et al. COPD-X concise guide for primary care. Brisbane. Lung Foundation Australia. 2014. http://copdx.org.au/ (accessed Feb 2016).
2. Chronic obstructive pulmonary disease (revised February 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Jul. http://online.tg.org.au/complete/ (accessed Nov 2015).
3. National Heart, Lung and Blood Institute. What is COPD? (updated 31 Jul 2013). http://www.nhlbi.nih.gov/health/health-topics/topics/copd (accessed Feb 2016).
4. Lung Foundation Australia. COPD Action Plan. http://lungfoundation.com.au/health-professionals/clinical-resources/copd/copd-action-plan/ (accessed Mar 2016).
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