Types of COPD medications and how they work

There is no cure for COPD yet, but medications help make life with the condition easier. Taking it as instructed by your doctor can reduce the likelihood of severe exacerbations by 44%.

If you have COPD, you will likely need to take medication every day. During periods when your symptoms worsen — known as acute exacerbations or flare-ups — you may need other drugs alongside those you take regularly.

Most COPD medications aim to relieve symptoms, such as shortness of breath (dyspnea) and coughing, and to stop symptom flares from happening so often. Note that this list of medications is in no particular order.

1. Bronchodilators

Bronchodilators help open up the airways in your lungs and relax the muscles that line them.

Types of bronchodilators that can help with the day-to-day management of COPD symptoms include:

Beta-2 agonists

These medications relax the lining of the muscles in the lung, making it easier to breathe. Common side effects like nervousness, headaches, and sore throat are generally mild and usually disappear completely after using them for a couple of weeks.

There are three types of beta-2 agonists:

• Short-acting beta-2 agonists (SABAs) can start working in under 5 minutes and last for about 3 to 6 hours. Examples include:
  • albuterol, also known as salbutamol (Ventolin, Proventil, ProAir)
  • levalbuterol (Xopenex)

• Long-acting beta-2 agonists (LABAs) take longer than SABAs to work, sometimes up to 15 minutes, but they last at least 12 hours. Doctors prescribe these if SABAs are not effective enough. Examples include:
  • salmeterol (Serevent)
  • Dulera, a drug that contains formoterol (LABA) and mometasone (inhaled corticosteroid)
  • Symbicort, a drug that contains formoterol (LABA) and budesonide (inhaled corticosteroid)

• Ultra-long-acting beta-2 agonists (ultra-LABAs) last up to 24 hours and are taken once a day. They can start to work in around 5 minutes. Examples include:
  • indacaterol (Arcapta Neohaler)
  • olodaterol (Striverdi Respimat)
  • vilanterol and fluticasone (Breo Ellipta)

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Antimuscarinics

Antimuscarinics, also known as anticholinergics, can relax your airways and reduce how much mucus you produce.

Antimuscarinics put less strain on your heart than beta-2 agonists and were more effective in most studies.

There are both short-acting and long-acting antimuscarinic agents (SAMAs and LAMAs).

Examples of antimuscarinic medications approved by the Food and Drug Administration (FDA) include:

• tiotropium bromide (Spiriva HandiHaler) is a LAMA
• glycopyrrolate (Seebri Neohaler, Lonhala Magnair) is a LAMA
• ipratropium bromide (Atrovent) is a SAMA

Phosphodiesterase-4 inhibitors

Phosphodiesterase-4 inhibitors (PDE4I) reduce the frequency and severity of exacerbations.

A doctor may prescribe these if you have severe COPD or your symptoms often need additional treatment. They work by reducing inflammation in the lungs. A recently developed inhaled PDE4I is under clinical trial.

Roflumilast, taken orally, is an example of this medication.

Theophylline

Theophylline is a bronchodilator that doctors sometimes prescribe.

It’s less effective than other bronchodilators and has a higher risk of side effects. Medical professionals haven’t recommended it as a treatment for COPD since 2018. Doctors usually prescribe it only when other medications are not improving your symptoms enough.

2. Corticosteroids

Corticosteroids help by reducing inflammation and swelling in the airways. Healthcare professionals prescribe them as inhalable steroids for the long-term management of COPD symptoms.

Side effects of inhaled corticosteroids are less severe than oral steroids, but may still include:

• a sore mouth or throat
• a hoarse voice
• oral thrush
• nosebleeds

Examples of inhaled corticosteroids include:

• beclomethasone (Qvar RediHaler)
• fluticasone (Flovent)
• ciclesonide (Alvesco)
• budesonide (Pulmicort Flexhaler)
• mometasone (Asmanex)

3. Macrolides

Macrolides are a type of antibiotic that, when taken long-term, can help:

• reduce inflammation
• make sputum (a mix of saliva and mucus) less sticky
• promote the production of helpful antimicrobials
• inhibit the growth of harmful pathogens in your lungs

Examples of macrolides include:

• clarithromycin (Biaxin)
• erythromycin (Erythrocin)
• azithromycin (Zithromax)

4. Mucolytics

Mucolytics make sputum less sticky, making it easier for you to clear it from your lungs by coughing. They also have antioxidant and anti-inflammatory effects.

Mucolytic medications have a low risk of side effects, but there is some doubt about how effective they are for COPD. Some research suggests harmful or mixed results in clinical trials.

N-acetylcysteine (Mucomyst) is an example of a mucolytic.

5. Combination therapies

You can use medications for COPD together, as well as individually. They sometimes come as one formulation to make double or triple inhalers that combine different types of bronchodilators. These may also include steroids.

Here are some examples of combination inhalers:

• Double inhalers:
  • Symbicort contains formoterol and budesonide (LABA + steroid)
  • Bevespi Aerosphere contains formoterol and glycopyrrolate (LABA + LAMA)

• Triple inhaler:
  • Trelegy Ellipta contains fluticasone, umeclidinium, and vilanterol (steroid + LAMA + LABA)

6. Medications for acute exacerbations

Antibiotics

Antibiotics help manage infection.

Bacterial infections appear to be the primary cause of acute exacerbations, so a doctor might prescribe a course of antibiotics if your symptoms worsen.

Examples of antibiotics used for acute exacerbations of COPD include:

• amoxicillin (Amoxil, Trimox, Wymox)
• doxycycline (Monodox, Vibra-tabs)
• azithromycin (Zithromax)

Oral steroids

Oral steroids are more effective at reducing inflammation than inhaled steroids, but they are not appropriate for long-term use because of their side effects. Doctors usually only prescribe them for COPD during acute exacerbations.

If you are taking oral steroids, it’s important to understand the range of side effects, as some of them can be very serious and require emergency treatment.

Examples of oral steroids include:

• prednisone (Rayos, Prednisone Intensol)
• prednisolone (Prelone)
• dexamethasone (Dexamethasone Intensol)

Over-the-counter (OTC) medications for COPD

Although some OTC medications help people who have a cough or are a little short of breath, none are suitable for treating COPD.

Summary

Over the last decade, there has been a great deal of research into COPD medication, and the outlook for people with COPD is improving at an encouraging rate.

If a doctor has prescribed you medication for COPD, taking it as instructed can reduce the likelihood of severe exacerbations by 44%.

Finding the right medical treatment can greatly improve your quality of life.

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