Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease.
It causes symptoms like:
- difficulty breathing
- increased mucus production
- chest tightness
- chronic coughing
This article will review the current COPD treatments as well as the ones that show promise for the future.
There’s no cure for COPD, but treatment for the condition can help you manage it and live a long life. Treatments include both medications and lifestyle changes.
Treatment for COPD differs from person to person, and it may change over time as symptoms shift.
Your doctor may also prescribe a bronchodilator, which may be short-acting or long-acting. These medications relax the muscles around your airways to relieve symptoms.
People use long-acting bronchodilators for daily maintenance therapy to control symptoms. These medications relieve symptoms by relaxing muscles in the airways to make breathing easier. The medication can also reduce mucus in the lungs.
Long-acting bronchodilators include:
- salmeterol (Serevent Diskus)
- formoterol (Perforomist)
- vilanterol (Breo Ellipta)
- olodaterol (Striverdi Respimat)
Indacaterol (Arcapta Neohaler) is a newer long-acting bronchodilator. The Food and Drug Administration (FDA) approved the drug in 2011. It treats airflow obstruction caused by COPD.
Indacaterol is taken once daily. It works by stimulating an enzyme that helps muscle cells in your lungs relax. It starts working rapidly, and its effects can last a long time.
This drug is an option if you experience shortness of breath or wheezing with other long-acting bronchodilators. Possible side effects include:
A doctor may recommend a long-acting bronchodilator if you have both COPD and asthma.
Short-acting bronchodilators, sometimes called rescue inhalers, are not meant to be used every day. You use these inhalers as needed to provide yourself with fast relief when you have breathing difficulties.
These types of bronchodilators
- albuterol (Ventolin HFA)
- metaproterenol (Alupent)
- levalbuterol (Xopenex)
An anticholinergic inhaler is another type of bronchodilator for the treatment of COPD. It helps prevent muscle tightening around the airways, too.
It’s available as a metered-dose inhaler and in liquid form for nebulizers. These inhalers can be short-acting or long-acting. Your doctor may recommend an anticholinergic if you have both COPD and asthma.
- tiotropium (Spiriva)
- ipratropium (Atrovent)
- aclidinium (Tudorza)
- umeclidinium (available in combination)
Steroids can also reduce airway inflammation. For this reason, some people with COPD use a bronchodilator inhaler
Some newer inhalers combine the medication of both a bronchodilator and a steroid. These are called combination inhalers.
Other types of combination inhalers exist, too. For example, some combine the medication of short-acting bronchodilators with anticholinergic inhalers or long-acting bronchodilators with anticholinergic inhalers.
There’s also a triple inhaled therapy for COPD that combines three long-acting COPD medications. The first approved triple inhaled therapy for COPD was called fluticasone/umeclidinium/vilanterol (Trelegy Ellipta).
In 2020, the FDA approved a second: budesonide/glycopyrrolate/formoterol fumarate (Breztri Aerosphere).
During oxygen therapy, oxygen is pumped through nasal prongs or a mask directly into your nose or mouth. This direct delivery can help increase your level of oxygen.
Oxygen therapy may not be needed all the time. In fact, some people may only need to use it as symptoms flare. Oxygen therapy can help you perform daily tasks, protect your heart and lungs from damage, and improve alertness.
Roflumilast is specifically for people who have a history of severe COPD flare-ups. It is not for everyone.
Side effects that can occur with roflumilast include:
- back pain
- decreased appetite
Some antibiotics and antivirals are also used to treat symptoms of COPD, especially when there is a flare-up. While these medications do not work to repair damage from the disease, they aim to stop additional damage.
Surgery is typically a last resort as a COPD treatment. It’s usually reserved for people who do not experience relief from other forms of treatment, or for people who have severe, advanced COPD and require greater relief.
COPD can destroy the air sacs in your lungs. This causes large air spaces called bullae to develop. As these air spaces expand or grow, they crowd out better-functioning areas of the lungs. This can make breathing shallow and difficult.
A bullectomy is a surgical procedure that removes damaged air sacs. It can reduce breathlessness and improve lung function.
Lung volume reduction surgery
COPD causes lung damage, which also plays a role in breathing problems. According to the American Lung Association, a lung volume reduction surgery removes about 30 percent of damaged or diseased lung tissue.
With damaged portions removed, your diaphragm can work more efficiently, allowing you to breathe easier.
This type of surgery is only an option for patients who have emphysema, a form of COPD, that mainly affects the upper portion of the lungs.
A new version of this surgery called robotic lung volume reduction surgery aims to achieve the same results but with a less invasive procedure. This can help reduce the risk of infection and complications. It can also speed up recovery time.
Endobronchial valve surgery
This procedure is used to treat people with severe emphysema.
With endobronchial valve surgery, the surgeon places tiny Zephyr valves in the airways to block off damaged parts of the lungs. This reduces hyperinflation, allowing healthier sections of your lungs to work more efficiently.
Valve surgery also reduces pressure on the diaphragm and lessens breathlessness. The FDA approved the use of Zephyr valves in 2018.
Some people with severe COPD eventually need a lung transplant. This procedure is necessary when breathing difficulties become life threatening.
A lung transplant removes a damaged lung and replaces it with a healthy donor lung. However, there is the risk of organ rejection, and most people will need to take immune-suppressing medications daily.
People living with COPD can benefit from a variety of treatment strategies. This includes a treatment plan that addresses lifestyle elements like exercise, nutrition, and wellness. Pulmonary rehab seeks to do just that.
This approach combines:
- exercise training
- nutrition counseling
- wellness planning
It helps people learn to address parts of living with COPD that standard medical treatment might not include.
A team of doctors, nurses, respiratory and physical therapists, dietitians, and exercise specialists will work with you to address topics like:
Doctors and researchers are continually working to develop new medications and procedures to improve breathing for those living with COPD.
Biologics and IL-5 medications
COPD can result from several different mechanisms. Newer treatments aim to target those specific causes in order to eliminate them and stop inflammation. These newer treatments are medications
For example, some people with COPD have a large number of eosinophils, a specific type of white blood cell. A drug called anti-interleukin-5 (IL-5) targets airway inflammation caused by eosinophils. This biologic drug may limit or reduce the number of blood eosinophils, providing relief from COPD and reducing eosinophilic airway inflammation.
More research is needed, however. Currently, some IL-5 drugs are approved for the treatment of severe asthma, but none are approved to treat COPD.
Stem cell therapy
Clinical trials are also evaluating the use of stem cell therapy for the treatment of COPD.
Stem cells are undifferentiated cells that are fed into the body. This means they are not cells with a specific purpose or job. Once they’re injected, they then become specialized to a specific need — in this case, regenerating lung tissue and reversing lung damage.
Researchers believe stem cells could be used to create new alveolar cells. These are the cells that are responsible for the exchange of air and gasses in the lungs.
The FDA has approved stem cell therapy for COPD in human clinical trials, but it is not currently available as a treatment. If approved in the future, this type of treatment could be used to regenerate lung tissue and reverse lung damage.
COPD can range from mild to severe. Your treatment will depend on the severity of your symptoms. If traditional or first-line therapy does not improve your COPD, speak with your doctor. You may be a candidate for an add-on therapy or newer treatments.