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COPD: Treatment Options

Treatment options

While there is no known cure for chronic obstructive pulmonary disease (COPD), treatment can help to relieve your symptoms and slow its progress. The main goals of COPD treatment are to:

  • make you feel better
  • allow you to participate more in life
  • help you stay active
  • prevent and treat complications
  • improve your overall health

Lifestyle changes

home treatment

The first and most important thing you should do is quit smoking and avoid starting if you don’t already 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 that come with COPD might make it difficult to eat. Smaller, more frequent meals might help. Your doctor might suggest nutritional 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

Treatment

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

Bronchodilators

Bronchodilators usually come in an inhaler or nebulized form. Inhaling the medication delivers it 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 medications” 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. They may also play a positive role in decreasing mucus production and secretions.

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 can cause unpleasant side effects. When taken in tablet form, these typically include weight gain, water retention, and higher blood sugars. Long term they can cause weakening of the bones and a depressed immune system.

The inhaled forms have fewer side effects and may be used for maintenance, especially in people who also have asthma. They may also be useful if you are troubled by shortness of breath and 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, but 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. Recommended nicotine replacement treatments come in the form of gums, patches, and inhalers.

Some antidepressants have been clinically proven to reduce or eliminate smoking, but you should be aware of side effects. If your doctor prescribes medication, be sure to ask about what to expect.

Anxiolytics (anti-anxiety treatment)

As COPD progresses and you have a harder time getting the air you need into your lungs, you may be overcome with anxiety. Adequate treatment of anxiety is important to decrease the discomfort and aggravation that comes with this shortness of breath. Studies have shown significant improvement in anxiety through treatment with SSRI medications, like paroxetine and sertraline. Complimentary treatments that have also proven successful include pulmonary rehabilitation, guided muscle relaxation, yoga, tai chi, behavioral therapy, and singing groups.

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 that can be swallowed, absorbed through the membranes in your mouth or given as a patch on the skin.

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. Finding a doctor that specializes in palliative care or hospice can be useful during this stage of the disease in order to make comfort a priority.

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

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 further damage due to oxygen deprivation
  • sleep better and be more alert
  • live longer

Pulmonary rehabilitation

Pulmonary rehabilitation might 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

hospital

Surgery is of benefit for only a small percentage of people with COPD. 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 in your lungs 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 help 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, 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 donor. This surgery has many risks. You might develop an infection or 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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