Chronic Obstructive Pulmonary Disease (COPD)

Medicine for chronic obstructive pulmonary disease (COPD) is used to reduce shortness of breath, control coughing and wheezing, and prevent and reduce a rapid, sometimes sudden, and prolonged increase in coughing, amount of mucus, and/or shortness of breath (COPD exacerbation). Most people with COPD find that medicines make breathing easier.

Bronchodilators and inhaled corticosteroids are often used with a metered-dose inhaler (MDI), a dry powder inhaler (DPI), or through a mouthpiece or mask (nebulizer). Most doctors recommend that everyone using an MDI also use a spacer, which efficiently delivers medicine to the lungs and makes it easier to control the dose. Use of a spacer is especially important when using an inhaler containing a corticosteroid medicine. Do not use a spacer with a dry powder inhaler (DPI).

Many people use an MDI incorrectly and do not get the full benefit from the medicine. For more information, see:

Using a metered-dose inhaler.

For information on how to use a dry powder inhaler, see:

Using a dry powder inhaler.

Medication Choices

Bronchodilators are used to open or relax the airways of the lung (bronchial tubes) and relieve shortness of breath. Bronchodilators are either short-acting to relieve symptoms or long-acting to help prevent breathing problems.

• Short-acting bronchodilators are considered a first-line therapy for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). Short-acting bronchodilators include:
  • Anticholinergics (such as ipratropium).
  • Beta2-agonists (such as albuterol and levalbuterol).
  • A combination medicine that contains an anticholinergic and a beta2-agonist (such as Combivent, which contains albuterol and ipratropium).
• Long-acting bronchodilators are effective and convenient for treating COPD in a person whose symptoms do not go away (persistent symptoms). Long-acting bronchodilators include:
  • Anticholinergics (such as tiotropium).
  • Beta2-agonists (such as salmeterol and arformoterol).

Oral corticosteroids (prednisone) may be used in pill form for a COPD exacerbation or in an inhaled form to prevent COPD exacerbations. They are often used if you also have asthma.

Other medicines, which are not commonly used, include:

• Expectorants, such as guaifenesin (Mucinex), which may make it easier to cough up mucus. Their use is generally not recommended.
• Methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects and so are not usually recommended.

What to Think About

The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This does not always mean the medicine will not help. It is usually best to try the medicine for a period of time before you decide whether it is working.

Combining beta2-agonists with anticholinergics or corticosteroids provides better results than using these medicines alone.^{8, 9} It may also reduce the risk of side effects compared to increasing the dose of one medicine.¹⁰

Metered-dose inhalers (MDIs) and nebulizers deliver medicine equally well. You can carry an MDI more easily than a nebulizer. Nebulizers usually need to be plugged in.

It is important to keep track of your inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medicine but also prevents you from inhaling only propellant after the medicine has run out.