Chronic obstructive pulmonary disease (COPD) is a term used to describe a few serious lung conditions. These include emphysema, chronic bronchitis, and nonreversible asthma.
The main symptoms of COPD are:
- shortness of breath, especially when you’re active
- buildup of mucus in your airways
While no cure exists for COPD, several types of medication are available that can often reduce the severity of symptoms.
Steroids are among the medications commonly prescribed to people with COPD. They help reduce the inflammation in your lungs caused by flare-ups.
Steroids come in oral and inhaled forms. There are also combination drugs that include a steroid and another medication. Each type of steroid works a little differently in controlling or preventing symptom flare-ups.
You’ll typically use steroids in pill or liquid form for a moderate or serious flare-up, also known as an acute exacerbation.
These fast-acting oral medications are usually prescribed for short-term use, often five to seven days. Your dose will depend on the severity of your symptoms, the strength of the particular medicine, and other factors.
For example, the adult dose of prednisone may be anywhere from 5 to 60 milligrams (mg) daily.
Prescription medication and other treatment decisions should always be made on an individual basis.
Among the more commonly prescribed oral steroids for COPD are:
- prednisone (Prednisone Intensol, Rayos)
- hydrocortisone (Cortef)
- prednisolone (Prelone)
- methylprednisolone (Medrol)
- dexamethasone (Dexamethasone Intensol)
Prednisone and prednisolone are considered off-label drugs for treating COPD.
OFF-LABEL DRUG USE
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care. Learn more about off-label drug use.
Studies show oral steroids often help you start to breathe easier very quickly.
They’re also usually prescribed for short-term use. This makes you less likely to experience complications associated with long-term use of the medication.
Side effects from short-term use of steroids are usually minor, if they occur at all. They include:
- water retention
- swelling, usually in your hands and feet
- increase in blood pressure
- mood swings
Prolonged use of these medications may raise your risk of:
- osteoporosis, or bone density loss
Oral steroids can lower your immune system. Be especially mindful of washing your hands and reducing your exposure to people who may have an infection that can be easily transmitted.
The medications can also contribute to osteoporosis, so your doctor may advise you to increase your vitamin D and calcium intake or start taking drugs to fight bone loss.
Oral steroids should be taken with food.
You can use an inhaler to deliver steroids directly into your lungs. Unlike oral steroids, inhaled steroids tend to be best for people whose symptoms are stable.
You may also use a nebulizer. This is a machine that turns the medicine into a fine aerosol mist. It then pumps the mist through a flexible tube and into a mask that you wear across your nose and mouth.
Inhaled steroids tend to be used as maintenance medications to keep symptoms under control for the long term. Doses are measured in micrograms (mcg). Typical doses range from 40 mcg per puff from an inhaler to 250 mcg per puff.
Some inhaled steroids are more concentrated and powerful so that they can help control more advanced COPD symptoms. Milder forms of COPD may be controlled by weaker doses.
Examples of inhaled steroids for COPD include:
- beclomethasone dipropionate (Qvar Redihaler)
- budesonide (Pulmicort Flexhaler)
- ciclesonide (Alvesco)
- flunisolide (Aerospan)
- fluticasone propionate (Flovent)
- mometasone (Asmanex)
These inhaled steroids are not FDA-approved to treat COPD but may be used as part of some treatment plans. The combination products described below are more commonly used.
If your symptoms are gradually worsening, inhaled steroids can help keep them from progressing too fast. Research shows they may also cut down on the number of acute exacerbations you experience.
If asthma is a part of your COPD, an inhaler may be particularly helpful.
The possible side effects of inhaled steroids include a sore throat and cough, as well as infections in your mouth.
There is also an increased risk of pneumonia with long-term use of inhaled steroids.
Inhaled steroids aren’t meant for fast relief from a COPD flare-up. In these instances, an inhaled drug called a bronchodilator can help relieve coughing and help you catch your breath.
To reduce the risk of oral infections, rinse your mouth and gargle with water after you use the inhaler.
Steroids can also be combined with bronchodilators. These are medicines that help relax the muscles surrounding your airways. Various medications used in a combination inhaler can target the large or small airways.
Some common combination inhalers include:
- albuterol and ipratropium bromide (Combivent Respimat)
- fluticasone-salmeterol inhalation powder (Advair Diskus)
- budesonide-formoterol inhalation powder (Symbicort)
- fluticasone-umeclidinium-vilanterol (Trelegy Ellipta)
- fluticasone-vilanterol (Breo Ellipta)
- mometasone-formoterol inhalation powder (Dulera), which is off-label for this use
Combination inhalers act fast to stop wheezing and coughing, and to help open up airways for easier breathing. Some combination inhalers are designed to provide those benefits for an extended time after use.
Possible side effects of combination inhalers include:
- coughing and wheezing
- heart palpitations
- infection in your throat or mouth
Call your doctor’s office if you experience these or any other side effects after starting a combination inhaler (or any medication). If you’re having trouble breathing or having chest pain, call 911 or seek emergency medical attention immediately.
The best results occur if you take the combination medication every day, even if your symptoms are under control. Stopping suddenly may lead to worse symptoms.
As with a standard steroid inhaler, use of a combination inhaler should be followed with a mouth rinse to help prevent infections in your mouth.
Steroids in any form pose a risk if they’re used over a long period of time.
Steroids may also interact with other medications. Mixing prednisone with painkillers such as aspirin (Bayer) or ibuprofen (Advil, Midol), may raise your risk of ulcers and stomach bleeding.
Taking NSAIDs and steroids together for a long time can also cause electrolyte imbalances, which put you at risk of heart and kidney problems.
You need to let your doctor know all the medications and supplements you take so they can inform you about possible interactions. This includes drugs you may take occasionally for a headache.
In addition to steroids and bronchodilators, other medications may be helpful in reducing flare-ups and controlling symptoms.
Among them are phosphodiesterase-4 inhibitors. They help reduce inflammation and relax the airways. They’re especially helpful for people with bronchitis.
You may also be prescribed antibiotics if you have a bacterial infection that’s making your COPD symptoms worse. Antibiotics may also help control acute exacerbations, but they aren’t meant for long-term symptom control.
Steroids and other medications are only parts of an overall approach to treating COPD. You may also need oxygen therapy.
With the help of portable and lightweight oxygen tanks, you can breathe in oxygen to make sure your body gets enough. Some people rely on oxygen therapy when they sleep. Others use it when they’re active during the day.
If you’ve recently received a COPD diagnosis, you may need pulmonary rehabilitation. This is an education program that helps you learn about exercise, nutrition, and other lifestyle changes you can make to improve your lung health.
One of the most important steps you can take if you smoke is to quit smoking. Smoking is the leading cause of COPD, so giving up the habit is vital to reducing symptoms and slowing the progress of this life-threatening condition.
Talk with your doctor about products and therapies that can help you quit.
A healthier lifestyle
Losing weight and exercising daily are also recommended to help minimize symptoms.
Maintaining a healthy and active lifestyle won’t cure COPD, but it’ll help you improve lung health and boost your energy levels.
COPD is a tremendous health challenge. However, if you follow your doctor’s orders and make the necessary changes in your life, you can extend your respiratory health and your quality of life.