Drugs

Chronic obstructive pulmonary disease, or COPD, is a condition that damages the lungs and airways, making it difficult to breathe. While there is no cure for COPD, doctors use several medications to slow the course of the disease and to ease symptoms of this chronic condition.

Bronchodilators

Bronchodilators usually come in an inhaler form. Inhalers deliver the medication directly to your lungs and airways. There are several classes of bronchodilators, but they all help to open constricted (narrowed) airways so that you can breathe easier.

Beta2-agonists

Beta2-agonists work on the part of the nervous system that controls the muscles around the airways. This makes the nervous system signal the muscles to relax, which in turn opens the airway. Beta2-agonists may be short acting (e.g. albuterol) or long acting (e.g. salmeterol).

The short acting beta2-agonists are often referred to as “rescue inhalers,” because they can be used to swiftly improve breathing during a COPD flare-up or exacerbation.

Long acting beta2-agonists, which are used twice a day, are part of maintenance therapy. They have been shown to reduce mortality among senior citizens who have COPD.

Anticholingerics

Anticholinergic medications, like Atrovent, are another type of bronchodilators. They also come in inhalers and can be used every four to six hours. Anticholinergic medications work by blocking the chemical acetylcholine that causes the airways to constrict.

Corticosteroids

Corticosteroids, such as prednisone, reduce irritation and swelling in the airway. They are particularly effective if you have been exposed to an infection or an irritant such as second-hand smoke, extreme temperatures, or harsh fumes. Corticosteroids may be delivered by inhaler, nebulizer, tablet, or injection form.

Corticosteroids are associated with many unpleasant side effects such as weight gain, water retention, weakening of the bones, and a depressed immune system. For this reason, they are primarily used during a severe flare-up or exacerbation of COPD symptoms. They may also be used late in the disease process if you are troubled by shortness of breath and if bronchodilators alone are not helpful.

Antibiotics

Nearly 50 percent of people who have a sudden increase in their COPD symptoms, known as an exacerbation, have a high concentration of bacteria in their lower airways. Generally there are more than one type of bacteria present in the lungs. Treating bacteria with oral, injected, or nebulized antibiotics can help to prevent treatment failure and death.

Some doctors prefer to use broad spectrum antibiotics, which can destroy many different types of bacteria, while others want to run tests to find out exactly what kind(s) of bacteria are present and then use a narrow spectrum antibiotic to treat only what is present.

According to an article written by A. E. Evensen and published in American Family Physician in 2011, broad-spectrum antibiotics appear to have a slight but definite edge of narrow-spectrum antibiotics. Evensen also reports that there is no benefit to taking broad-spectrum antibiotics for more than five days.

Finally, the article states, using antibiotics regularly as a preventative measure shows no benefit and might actually lead to a resistance to antibiotics, leaving them ineffective in treating an acute infection.

Smoking Cessation Medications

Quitting smoking can improve your health and your quality of life with or without COPD. As nicotine is highly addictive, many doctors offer patients nicotine replacement therapy to ease their cravings for cigarettes. Nicotine replacement treatments may come in gums, patches, and even inhalers. Some antidepressants have been clinically proven to reduce or ?eliminate smoking, but people should be aware of side effects. If your doctor prescribes medication, be sure to ask about any and all side effects.

Anxiolytics (Anti-Anxiety Medications)

As COPD progresses and you have a harder time getting the air you need into your lungs, you may be overcome with anxiety. Anxiolytic medications such as Valium and Xanax have been shown to calm patients in the late and terminal stages of COPD, thus producing an improved quality of life.

Opioids

Opioids, also known as narcotic medications or painkillers, work by depressing the central nervous system. This decreases your need for oxygen and eases that feeling of “air hunger,” the distress signal your brain sends when it is not getting enough oxygen.

Opioids are most commonly given as a liquid and absorbed through the membranes in your mouth. Some people prefer to nebulize opioids in their breathing treatments, which is also an effective means of delivery. 

Because opioids can be addictive and can suppress breathing, they are usually used only during the late and terminal stages of COPD, often when you have decided that you want no further aggressive or life-prolonging treatment.

Throughout the course of COPD, several drugs have shown themselves to be effective in lessening distressing symptoms, slowing disease progression, improving quality of life, and even extending life. Your doctor can tell you more about the combination of medications that may be right for you.