Medication for COPD

There are various kinds of bronchodilators, including beta-2 agonists and anticholinergics. These medications are usually inhaled. They relax the muscles in the bronchi, allowing the narrowed airways to open up, making it easier to breathe.

Beta-2 agonists form the basis of treatment for COPD. These medications can be divided up into two groups: short-acting beta-2 agonists and long-acting beta-2 agonists. The short-acting group includes fenoterol, salbutamol and terbutaline, and the long-acting group includes formoterol and salmeterol. The short-acting beta-2 agonists (SABAs) are used when needed, such as during acute breathing difficulties. They work fast, but the effect only lasts for four to six hours. Long-acting beta-2 agonists (LABAs) are taken regularly. It takes longer for them to start working, but the effect lasts for about 12 hours.

If the COPD is only causing mild symptoms, it is usually enough to use a short-acting beta-2 agonist as needed. Sudden shortness of breath can usually be quickly relieved by inhaling this medication. It is important to always carry the inhaler with you. If the symptoms get worse over time, using a long-acting beta-2 agonist over the long term can help. The medication is inhaled once in the morning and once in the evening. This relieves breathing problems and prevents acute episodes of shortness of breath (flare-ups or exacerbations).

Studies have shown that beta-2 agonists can improve people's lung function and quality of life.

The medications prevented flare-ups too.

• Without beta-2 agonists, 7 out of 100 people had to go to the hospital in the space of six months because of severe breathing difficulties.
• This was the case in 5 out of 100 people who took beta-2 agonists.

Normal doses of beta-2 agonists are usually well tolerated, but high doses can cause side effects such as a rapid pulse, palpitations or tremors.

Anticholinergics are about as effective as beta-2 agonists. They also come in short-acting and long-acting forms. Short-acting anticholinergics only start working after 20 to 30 minutes, but the effect then lasts up to eight hours. The effects of long-acting anticholinergics like tiotropium bromide last for about 24 hours, which is longer than most beta-2 agonists do. This means that they only need to be inhaled once a day.

Anticholinergics can also reduce the risk of flare-ups. As a result, people who use anticholinergics need to go to the hospital less often and their quality of life improves.

One possible side effect of anticholinergics is a dry mouth. They are otherwise regarded as well-tolerated.

Steroid medication is taken as needed in addition to bronchodilators. It doesn't have much of an effect on daily symptoms, but can lower the risk of flare-ups. For this reason, steroid inhalers are usually only used in the long term by people with severe COPD and frequent breathing problems. Previous research has shown that steroid inhalers are only effective at doses of over 1,000 micrograms per day. But such high doses of steroids also increase the risk of pneumonia. Within one year, inhaled steroids

• prevented one or more flare-ups in about 5 out of 100 people, and
• caused pneumonia in about 1 out of 100 people.

Another side effect of steroid inhalers is oral fungal infections, which occur in about 5 out of 100 people per year. Hoarseness also occurs in about the same number of people. So it's recommended that you rinse your mouth or brush your teeth after using the inhaler.

If severe symptoms don’t improve, steroids can also be temporarily taken in tablet form. Then it’s important to use the lowest possible dosage.

The possible side effects of taking steroid tablets over a longer period of time include weight gain, increased blood sugar levels and trouble sleeping. If the tablets are taken for a very long time, your skin, muscles, and bones may be weakened, too. So long-term treatment with steroid tablets is not recommended.

PDE4 inhibitors such as rolflumilast can be taken as tablets in addition to bronchodilators. They reduce the inflammation in the bronchi. This can make it easier to breathe and prevent flare-ups. Rolflumilast is only recommended if the symptoms suddenly get worse again and again.

Studies have shown that PDE4 inhibitors can somewhat improve breathing and quality of life:

• These medications prevented flare-ups with worse breathing difficulties in about 5 out of 100 people.
• About 5 to 10 out of 100 people had side effects such as nausea and diarrhea, loss of appetite, weight loss, sleep problems and headaches.

It is still not clear how well PDE4 inhibitors work compared to steroids, so they are currently rarely used.

Yes. Depending on the stage of the COPD it can be helpful to combine two bronchodilators (like a beta-2 agonist and an anticholinergic). These kinds of combinations are often more effective and have fewer side effects than a higher dose of one of the medications alone. If there are still frequent exacerbations, then a triple combination with a steroid or with roflumilast is possible.

Mucolytics are supposed to dissolve the phlegm in the airways, making it easier to cough it up. Studies have shown that mucolytics lower the risk of flare-ups with worse breathing difficulties in people who have a cough with a lot of phlegm. Mucolytics prevented flare-ups in about 52 out of 100 people.

But they do not improve breathing otherwise. They are not often used in the treatment of COPD.

People who have COPD are especially susceptible to complications caused by the flu. They can get a flu vaccine every year in the fall. Studies have shown that this vaccination decreases the risk of COPD flare-ups and respiratory infections such as bronchitis or pneumonia.

The flu vaccine is given as an injection. The most common side effects are redness and swelling where the vaccine was injected. Temporary tiredness, headaches and a mild fever are possible too.

Vaccinating against pneumococcus bacteria is also an option. These germs can cause inflammations in the lungs, the middle ear, the sinuses and other places. People with COPD are more likely than others to get pneumonia and have acute breathing problems if they are infected with pneumococcus bacteria. The pneumococcal vaccine can lower this risk somewhat. The vaccine has a protective effect for about five years and then it needs to given again ("booster shot").

Experts also recommend getting a COVID-19 vaccination.

Respiratory infections can cause acute shortness of breath in people with COPD. If the infection was caused by bacteria and the symptoms are very severe, antibiotics can help. One sign of a bacterial infection is sputum that is greenish-yellow in color or contains pus.

Antibiotics won't help if the infection is caused by viruses. They may also cause diarrhea and other side effects.

In rare cases antibiotics may be considered as a preventive measure to lower the number of exacerbations.