Treatment for COPD
COPD can be treated. Current treatments for COPD cannot repair the damage to your lungs. However, some treatments may reduce your risk of exacerbations (x-saa-cer-bay-shun) (flare-ups). This makes it easier for you to breathe and feel better.
If you were asked what your inhalers do, you’d probably say, "they open up my lungs." Yes, that’s true, but what’s important to know – and really understand – about COPD medications is that there are different types of medications that open your airways in different ways. If you’ve graduated from pulmonary rehabilitation (pull mon air ree re ha bill ii tay shun), you should have the information you need. Work with your health care team and take your COPD medications as directed to get as much out of them as possible.
Taking medicines can improve your COPD symptoms. They must be taken as directed by your doctor. COPD medicines work in different ways. Using medicines from different groups may help:
- Relax the muscles around the lungs’ breathing tubes
- Reduce swelling in the breathing tubes
- Reduce mucus production
All of which makes breathing easier.
Controller and Rescue Medications
There are two basic ways that medications open up the airways in your lungs: They act as controllers (maintenance or preventers) or relievers (rescue). Here we’ll refer to them as either controllers or rescue relievers. An easy way to understand how these medications work is to look at this in the same way we look at fire.
Controllers (Maintenance-Prevention): As a responsible person, you do your best to prevent fires by maintaining your home, keeping the electrical wires operating safely, turning off the stove when you’re not using it and putting hot matches in a fireproof container or in water. All these things prevent a fire from starting. If you are not careful, what might happen? A fire could start, and even if it starts slow and small, it could quickly become a raging inferno. As we all know, it makes a lot more sense to prevent a fire than allow one to start!
Rescue Relievers: If and when a fire does start, however, you have (or should have) a fire extinguisher handy. We also have the 911-system to call for help. Again, if you can prevent a fire from starting – even knowing that you have help to put it out – you would do it.
Think of the medicines for your lungs in the same way. Use your controller medications as directed to be as effective as possible to keep your airways from swelling up, having spasms and getting tight. If, however, you do all you can to prevent airway tightness and increased shortness of breath and you still run into problems, that’s the time to reach for your rescue reliever medication!
Keep track of how long your inhalers last, and refill your prescriptions with time to spare so you don’t run out. Show a respiratory health professional how you use your inhaler, and learn the best techniques so you get the most benefit from your inhaled medications.
Short-acting Anticholinergic Bronchodilators (Controller)
Recent studies reveal inferior control of symptoms compared to long-acting anticholinergic agents.
Long-acting Anticholinergic (an-tee-coe-luh-nur jick) Bronchodilators (brawn-coe-die-lay-ters) (Controller)
Inside our bodies, there is a constant stream of messages being sent to keep us safe and well. This is the job of the parasympathetic nervous system. If you touch something hot, a message is sent through your nerves to pull your hand away. If you have an infection, a message is sent to your white blood cells to go to that part of your body and fight it. How does this work in the lungs? Messages are sent to squeeze down the airways to prevent bad air from coming inside the lungs. This causes symptoms of chest tightness and shortness of breath. Anticholinergic medications block this message from getting through and keep your airways open before they even start to squeeze shut. Yes, this is pretty amazing!
Long-acting Beta-agonist (bay-ta aa-go-nists) Bronchodilators (Controller)
These medicines also work to relax the muscles in your airways and keep them from squeezing. Yes, they do the same thing that the rescue reliever medications do – but this long-acting type lasts for 12 hours or more. So, if you take it every day as prescribed you should have around the clock coverage for preventing those muscles from acting up and squeezing your airways. These work very well, especially for people with night-time symptoms.
Corticosteroids (kort-te-coe-stair-royds) (Controller):
Corticosteroids work to reduce inflammation (swelling) on the inside of your airways. Like all controller medicines, you must take them as prescribed every day in order for them to give you protection against flare-ups, commonly referred to as an exacerbation (x-saa-cer-bay-shun) of COPD.
Combination Corticosteroids and Long-acting Beta-agonists (Controller)
There are many folks (but not all) who have COPD with frequent exacerbations, flare-ups. These folks benefit from both an inhaled corticosteroid and a long-acting bronchodilator for 12 hours of relief or more. This is such a common combination, and it works so well, it makes sense to put these two medications into one inhaler.
Combination Long-acting Anticholinergics and Long-acting Beta-agonists (Controller)
For the first time ever, we have a new medication that combines two long-acting bronchodilators into one inhaler. This medication blocks the messages for airways to close and keeps muscles around the airways from squeezing for 24 hours.
Phosphodiesterase-4 (fahs foe di aa stir ace) Inhibitor (PDE-4 Inhibitor, Controller)
This is a new class of controller medication that helps control airway inflammation. It has been proven to decrease COPD exacerbations (flare-ups) for patients with severe or very severe COPD, a high-risk for flare-ups and chronic bronchitis. This medicine is an oral tablet lasting 24 hours.
Short (fast)-acting Beta-agonist Bronchodilators (Rescue Reliever)
These medicines work to relax the muscles in your airways from squeezing. They go to work as soon as you take them and you can feel relief within minutes. This is good, but they last for only about 4-6 hours – the exception is Xopenex - which works for 6-8 hours. Remember, our goal is to keep your airways open without giving them the chance to flare-up. Use these medicines if you feel short of breath, but only as needed.
There are combination medications that contain short-acting anticholinergic and a short-acting beta-agonist.
Nebulizers and Handheld Inhalers.
There are two main ways to get inhaled medications into the lungs: nebulizers and handheld inhalers.
Nebulizers (neh bew lie zer)
A nebulizer is a device that changes liquid medication into a fine mist that can be inhaled into the lungs. This mist can be breathed in through a mouthpiece or face mask. There are two main types of nebulizers: jet and electronic nebulizers.
The jet nebulizer is the most common. In jet nebulizers, pressurized gas from a small air compressor or pressurized oxygen at the hospital is forced through a narrow opening, combining it with the liquid medication to create a mist.
Electronic nebulizers are another type of nebulizer. Two main types are ultrasonic and vibrating mesh. Electronic nebulizers work by using electrical energy to cause very fast vibrations of a mechanical part that turns the liquid medication into a mist.
There are two main types of handheld inhalers: pressurized metered-dose inhalers (pMDI) and dry-powder inhalers (DPI).
Pressurized Metered-Dose Inhalers (pMDI)
A pMDI releases medication in the form of a fine mist that can be inhaled into the lungs. Each spray has a precisely measured dose of medication mixed with a propellant. The spray comes out by pushing down on the canister to release the medication. Use a slow deep breath.
Dry-Powder Inhaler (DPI)
DPI’s also contain a precise dose of medication, but in the form of a very fine powder. DPIs do not contain a propellant, so the powder is inhaled by taking a fast, deep breath through the mouthpiece. With the DPI it is the user who provides the force to get the medication out of the device and into the lungs.
Nebulizer or Handheld Inhaler- Which is Best?
Studies have shown that respiratory medications delivered by nebulizer, metered-dose inhaler (MDI) and dry-powder inhaler (DPI) have similar results. However, these are dependent on proper technique. To decide which system is best for you, talk with your health care provider. Here are some things to consider:
Potential Nebulizer Benefits:
- Works well for patients with severe disease and frequent exacerbations
- Works well for patients who have physical and/or cognitive limitations
- Is good for inhalation drug delivery during exacerbations of COPD, especially when higher than routine drug doses are needed
- Normal breathing pattern can be used
- The medicine is delivered constantly for 10-15 minutes providing relief during a bad breathing episode
- Easier for individuals who have trouble coordinating deep inhalation with activation of medication
Potential Nebulizer Drawbacks:
- Takes more time
- Proper assembly and cleaning are required
- Less portable than inhalers
- Potential for delivery of medicine into the eyes
Potential Handheld Inhaler Benefits:
- Portable, light, compact
- Short treatment time
- Dose is exactly the same with each use
- No preparation of medications is needed
- Medication contamination is unlikely
Potential Handheld Inhaler Drawbacks:
- Multiple inhalers are available and each device requires specific instruction for use
- More dependent on proper technique including inspiratory hold and coordination of breath with device activation
- More likely to have medicine deposit into mouth and back of throat instead of getting deeper into the lungs
Severe COPD will reduce your lungs’ ability to put oxygen into your blood to be carried throughout your body. Your doctor can measure the oxygen in your blood by using a pulse oximeter (ox-im-eh-ter). This is a small device that fits snugly on your finger. It measures how many red blood cells are carrying oxygen. If the level of oxygen in your blood is too low, it can be confirmed by an arterial (are-teer-ree-uhl) blood gas test (ABG). If so, your doctor may prescribe oxygen therapy for you.
Shortness of breath does not necessarily mean you need to be on oxygen. Many patients who have severe shortness of breath do not have low oxygen levels in their blood. Also, many patients who have low oxygen levels do not always feel breathless. Oxygen is usually ordered if the oxygen in your body or blood is low during sleep, exercise, during a 6-minute walk test and/or while you are not active.
Learn more about Oxygen Therapy
Pulmonary rehabilitation is a treatment program. It provides exercise training, education about COPD, tips on how to complete everyday activities without becoming so short of breath and advice on how to live better with your disease. Many different types of medical professionals work with you in the program. These include doctors, nurses, physical therapists, exercise specialists and dietitians. Dietitians (dye-ah-ti-shuns) are individuals who can teach you about healthy food choices. You will work with this team to create a special program for you. Pulmonary rehab programs are available in most communities and often paid for by insurance.
Learn more about Pulmonary Rehabilitation
All medicines can have side effects. Tell your health care provider about all the medicines you take so you can talk together about them.