COPD: Treatment Options

Written by Robin Madell | Published on June 23, 2014
Medically Reviewed by Kenneth R. Hirsch, MD on June 23, 2014

Treatment Options

There is no cure for COPD. Treatment can help relieve your symptoms and slow the progression of the disease. The main goals of COPD treatment are to:

  • make you feel better
  • keep the disease from getting worse
  • help you stay active
  • prevent and treat complications
  • improve your overall health

Lifestyle Changes

The first and most important thing you should do is quit smoking, and avoid starting if you don’t smoke. You should also reduce the air pollution in your environment as much as possible. Avoid secondhand smoke and stay away from places with dust, fumes, and other toxic substances you might inhale.

It is also important to eat a healthy diet. The fatigue and breathing difficulty of COPD might make it difficult to eat. Smaller, more frequent meals might help. Your doctor might suggest vitamin and mineral supplements. It might also be helpful to rest before meals.

Exercise is important but may be difficult for some. Physical activity can strengthen the muscles that help you breathe. Talk to your doctor about the physical activities that are right for you.

Medications

A variety of medications might be used to treat the symptoms of COPD.

Bronchodilators

Bronchodilators usually come in an inhaler form. Inhalers deliver the medication directly to your lungs and airways. These medications help to open constricted (narrowed) airways so you can breathe easier. There are two classes of bronchodilators: β-agonists and anticholinergics.

β-agonists bind directly to beta receptors on smooth muscle cells to mediate their bronchodilatory effect.

. β-agonists may be short-acting (e.g. albuterol) or long-acting (e.g. salmeterol).

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

Long-acting β-agonists, which are used twice a day, are part of maintenance therapy.

Anticholinergic medications, such as Atrovent, also come in inhalers and can be used every four to six hours. Anticholinergic medications work by blocking the chemical acetylcholine, which 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 secondhand smoke, extreme temperatures, or harsh fumes. Corticosteroids may be delivered by inhaler, nebulizer, tablet, or injection.

Corticosteroids are associated with many unpleasant side effects. These may include 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

Respiratory infections can make the symptoms of COPD worse. If you have an infection, which is often the case when symptoms suddenly worsen, your doctor may prescribe antibiotics. Antibiotics kill bacteria. They do not kill viruses. Your doctor may do tests to determine exactly what type of infection you have and what antibiotic will be most effective. Antibiotics should be used only when needed.

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 the 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 diazepam (Valium) and alprazolam (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.

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.

Therapy

Oxygen Therapy

COPD interferes with your ability to breathe. If you are not breathing in enough oxygen, you will not have enough oxygen in your blood. There are several devices available that deliver oxygen into your lungs. Many of these devices are small and portable so you can take them with you wherever you go. Your doctor may suggest that you use oxygen all the time. Or you may only need to use it while you are sleeping or during certain activities. Oxygen therapy can help you:

  • stay active with fewer symptoms
  • protect your heart and other organs from damage due to oxygen deprivation
  • sleep better and be more alert
  • live longer

Pulmonary Rehabilitation

Pulmonary rehabilitation may involve exercise, nutritional and psychological counseling, and training in the management of your disease. Rehabilitation involves a team of doctors and specialists. The goal is to help you stay active.

Surgeries

Surgery is of benefit for only a small percentage of COPD patients. It is only used in severe cases. There are three types of surgery that can be used.

Bullectomy

When the walls of the air sacs are destroyed, large air spaces can form. These are called bullae. These spaces can interfere with your breathing. In a bullectomy, the doctor removes some of these spaces. This can make your lungs function better.

Lung Volume Reduction Surgery (LVRS)

In this surgery, the doctor removes wedges of damaged lung tissue. This helps your lungs work better. This surgery involves many risks and is not always effective. Nevertheless, in some patients, it can improve breathing and quality of life.

Lung Transplant

In very severe cases, a damaged lung may be removed and replaced with a healthy lung from a deceased donor. This surgery has many risks. You might develop an infection. Your body might reject the new lung. Either of these can be fatal. When the surgery is successful, it can improve your lung function and quality of life.

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