Chronic Obstructive Pulmonary Disease (COPD)

Treatment Overview

Although chronic obstructive pulmonary disease (COPD) cannot be cured, it can be managed. Treatment for COPD focuses on:

• Slowing the progression of the disease by avoiding tobacco smoke and other environmental factors, such as air pollution.
• Reducing and controlling symptoms, such as shortness of breath.
• Increasing your activity level.
• Improving your overall health.
• Preventing and treating a COPD exacerbation—a rapid and sudden increase in your cough, amount of mucus, and/or shortness of breath—and other complications.

Following your treatment plan may reduce symptoms enough to allow you to participate in hobbies, daily activities, and family events.

Because people are diagnosed at different stages of COPD, your initial treatment will depend on the severity of your COPD and your associated symptoms.

Initial treatment

Initial treatment for chronic obstructive pulmonary disease (COPD) helps you breathe better and slow the disease. It includes:

• Quitting smoking. This is the most important step you can take to prevent or slow damage to your lungs—it is never too late to stop smoking. No matter how long you have had COPD or how serious it is, quitting smoking will help slow the progression of the disease and improve your quality of life. Nicotine replacement therapy, use of the medication bupropion (Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting.⁵ For more information, see the topic Quitting Tobacco Use.
• Doing all you can to make breathing easier.
  • Avoid conditions that may irritate your lungs, such as indoor and outdoor air pollution, smog, cold dry air, hot humid air, or high altitudes.

    Avoiding triggers for COPD

  • Take rest breaks. Schedule rest breaks when doing household chores and other activities. An occupational or physical therapist can help you find ways to do everyday activities with less effort.
  • Learn breath training techniques to improve airflow in and out of your lungs.

    Breath training for COPD

  • Learn ways to clear your lungs that can help you save energy and oxygen.

    Clearing your lungs when you have COPD

• Staying as active as possible and getting regular exercise. Exercise improves shortness of breath and will help you be more active. If you stay active, you may develop fewer complications, have a better attitude about your life and the disease, and be less likely to feel depressed or isolated from friends and family. For more information on exercising with COPD, see:

  Exercises for chronic obstructive pulmonary disease.

• Assessing the need for oxygen treatment, which is mainly used to prevent or slow the worsening of right-sided heart failure and to prevent premature death. For more information, see:

  Using oxygen at home.

• Avoiding respiratory illnesses, such as the flu (influenza) and pneumonia. Avoiding these illnesses can help prevent COPD getting worse. Talk with your health professional about getting a yearly flu shot and the pneumococcal vaccine (which can help protect against complications of pneumonia). Usually, people need only one dose of the pneumococcal vaccine. But doctors sometimes recommend a second dose for some people, especially if they have a long-term disease. Talk with your doctor about whether you need a second dose.
• Eating regularly and well. Problems with muscle weakness and weight loss are frequent with COPD. For more information, see:

  Eating well when you have COPD.

  Avoiding weight loss when you have COPD.

Medications can help relieve shortness of breath and prevent a rapid, sometimes sudden, and prolonged worsening cough, amount of mucus, and/or shortness of breath (COPD exacerbation). Medications include:

• Bronchodilators. Bronchodilators open the airways of the lung (bronchial tubes) so you can breathe more easily. Bronchodilators are either short-acting to relieve symptoms or long-acting to help prevent breathing problems. The two main types of bronchodilators are:
  • Anticholinergics (such as ipratropium and tiotropium).
  • Beta2-agonists (such as albuterol and metaproterenol).
• Anti-inflammatory medications such as corticosteroids may be taken orally, such as prednisone, or inhaled, such as beclomethasone dipropionate or fluticasone propionate. Inhaled medications are used with an inhaler, which delivers more medication directly to the lungs. If you use a metered-dose inhaler (MDI), be certain you know how to use it properly. For more information, see:

  Using a metered-dose inhaler.

  Using a dry powder inhaler.

• Mucolytics, such as acetylcysteine (Mucomyst or Mucosil-10) or iodinated glycerol (Organidin, Iophen), which thin the mucus in the bronchial tubes and lungs, possibly making it easier to cough up mucus. They are no longer commonly used.
• Expectorants, such as guaifenesin (Fenesin, Humibid L.A.), which also may make it easier to cough up mucus. They are no longer commonly used.

Treating more than the disease and its symptoms is vital to success. Treatment should also include:

• Education. Educating yourself and your family about COPD and your treatment plan helps you and your family cope with your lung disease.
• Counseling and support groups. Shortness of breath may reduce your activity level and make you feel socially isolated because you cannot enjoy activities with your family and friends. You should be able to lead a full life and be sexually active. Counseling and support groups can help you and your family learn to live with COPD.
• Building a support network of family and friends. Learning that you have a disease that may shorten your life may trigger depression or grief. Anxiety can make respiratory symptoms worse and can trigger or prolong exacerbations. Support from family and friends can reduce anxiety and stress and make it easier to live with COPD.

Ongoing treatment

As chronic obstructive pulmonary disease (COPD) progresses, it is important to recognize and treat complications, especially a COPD exacerbation. COPD exacerbations are a sudden and prolonged increase in symptoms—shortness of breath, cough, and mucus (sputum) production. A COPD exacerbation can be life-threatening, and you may need to go to your health professional’s office or to a hospital. Treatment includes:

• Anticholinergics (ipratropium, tiotropium), oral corticosteroids (prednisone, budesonide), and beta2-agonists (albuterol, metaproterenol), which make it easier to breathe.
• Mechanical ventilation, which is a machine that helps you breathe. Ventilation is used only if medication is not helping you.
• Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of some people who have severe COPD. For more information, see:

  Using oxygen at home.

• Antibiotics, which are used when a bacterial lung infection is considered likely. People with COPD have an increased risk of pneumonia and frequent respiratory infections. Although most infections are caused by a virus, some are caused by bacteria. Most studies support the use of antibiotics. But some experts believe that since most exacerbations are caused by viruses, antibiotics should not be used unless there is a confirmed bacterial infection.

Other complications you may have include depression, which is treated through counseling and medication, and problems with muscle weakness and weight loss, which can be treated by improving your diet. For more information, see:

Eating well when you have COPD.

Avoiding weight loss when you have COPD.

Your health professional may also suggest a pulmonary rehabilitation program, which is a supervised program that includes activities such as exercise and breath training.

Breath training for COPD

Treatment if the condition gets worse

As chronic obstructive pulmonary disease (COPD) gets worse, you may experience increased shortness of breath and more COPD exacerbations, and it will become more and more difficult to perform daily activities. A pulmonary rehabilitation program, which includes activities such as exercise and breath training, can help make it possible for you to perform daily activities.

Other treatment includes:

• Using medications such as methylxanthines or oral corticosteroids.
• Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of people who have severe COPD and low oxygen levels. For more information, see:

  Using oxygen at home.

• Lung volume reduction surgery, which removes a portion of one or both lungs, making room for the remaining lung tissue to work more efficiently. This procedure is not appropriate for most people.
• A lung transplant, which is surgery to replace a diseased lung with a living lung from a person who has recently died. Lung transplants are not common.
• A bullectomy, which removes bullae from the lungs in those who mainly have emphysema. Bullae are formed when the tiny air sacs in the lungs break into larger air spaces. They sometimes can become so large that they interfere with breathing. However, they are rarely treated surgically.

Heart failure that affects the right side of the heart (cor pulmonale) frequently occurs in people with COPD. Depending on its severity, oxygen and diuretic medication may be needed.

Treatment for COPD is increasingly successful at prolonging life. However, COPD is a progressive and possibly fatal disease. You and your health professional should discuss what types of medical treatment you want to receive if sudden, life-threatening breathing problems develop, such as whether you want to receive mechanical ventilation. This discussion may include the possibility of your creating an advance directive to state your wishes if you become unable to communicate them. For more information, see the topics Writing an Advance Directive and Care at the End of Life.

What to Think About

Sticking with your treatment plan will make you feel better and make you less likely to become depressed. A self-reward system, such as a night out to eat after sticking to your medication and exercise schedule for a week, can help keep you motivated.