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There is currently no cure for COPD. There are two main goals of treatment. The first is to help control your symptoms and improve exercise tolerance, so you can carry on with your daily activities and improve your overall health status. The second goal is to reduce the risk of complications by slowing down the disease progression and by preventing and treating COPD flare-ups.
Your healthcare provider will work with you to review your symptoms and to adjust your treatment plan accordingly. If you want to keep an overview of how well your symptoms are under control, you may want to keep a symptom diary at home.
Even though this symptom diary hasn’t been formally studied in research, it may still help you remember how you felt at different times and make it easier to discuss your COPD with your doctor.
Examples of these documents are free to download here for personal use (permission to distribute for personal use only!).
If you haven’t already, then the most essential step in your treatment plan for COPD will be to quit smoking. Although you cannot reverse the damage to your lungs, quitting smoking will prevent further loss of lung function. No matter how long you have had COPD, quitting smoking can help slow the progression of the disease. Your symptoms, like breathlessness, coughing, and phlegm, will improve, and you will be less likely to experience COPD flare-ups. Find out more about quitting smoking in our Lifestyle and Prevention module.
Most people take COPD medicines using an inhaler. These small, hand-held devices deliver the medicine directly into the lungs, so it doesn’t need to travel through the bloodstream to reach its target.
Some medicines are taken using a nebuliser, a machine that turns liquid medicine into a fine mist for you to breathe in through a mask or mouthpiece. Healthcare providers mainly use nebulisers in hospitals during severe flare-ups to deliver higher doses of medicine. In some cases, healthcare providers may also recommend a nebuliser for home use if you have more advanced COPD, especially when inhalers no longer work well or are too difficult to use.
Bronchodilators are medicines to help open up your airways. Healthcare providers consider these medicines the cornerstone of COPD treatment and classify them according to how long their effects last.
Short-acting bronchodilators work within a few minutes to relax the muscles in your airways and relieve your symptoms. Healthcare providers prescribe these medicines for use as needed when symptoms flare up.
There are two types of short-acting bronchodilators:
Your healthcare provider may prescribe a combination of a SABA and a SAMA, depending on the severity and frequency of your symptoms.
If you experience breathlessness on a daily basis, your doctor will probably prescribe a long-acting bronchodilator. These medicines help relax and open up the muscles in your airways, making it easier to breathe. They act more slowly than short-acting bronchodilators, but their effects last much longer, usually between 12 and 24 hours. When taken regularly, they help keep your airways open and support your breathing throughout the day.
There are two types of long-acting bronchodilators:
Many people with COPD who experience breathlessness use a combination of two long-acting medicines: a LABA and a LAMA. Your healthcare provider can prescribe you two separate inhalers or a single combination inhaler, which is often more convenient and more effective than multiple inhalers, but sometimes a bit more expensive. Expected side effects are those of the separate medicines.
Steroids, also called corticosteroids, are medicines that help reduce inflammation. When inhaled, they act directly in the lungs to decrease swelling and irritation. Not everyone with COPD needs inhaled steroids (ICS). Healthcare providers usually prescribe these inhalers for people who have frequent COPD flare-ups or higher levels of a type of white blood cell called eosinophils. They also recommend these inhalers for people who have both COPD and asthma. Inhaled steroids only work properly when you use them regularly, so it is important to use them as your healthcare provider recommends. It is also important to know that this treatment mainly helps reduce the number of flare-ups, but it has less effect on day-to-day symptoms compared with other inhalers such as LAMA or LABA.
In terms of expected side effects, it is important to know that inhaled steroids work locally in the airways, at the site of the inflammation. Hence, only a little enters the bloodstream, leading to few side effects. Oral thrush (a yeast infection in the mouth) is the most common side effect, which you can help prevent by rinsing and gargling with water after using your inhaler. Hoarseness or a sore throat can also occur, but is less common. In people with more severe COPD, there may be a slightly higher risk of developing a chest infection called pneumonia. If your doctor prescribes an inhaled steroid, it will usually be as part of a combination inhaler that also includes a bronchodilator, sometimes even a triple combination with a LABA, LAMA, and ICS. If you are ever concerned about side effects, talk to your doctor.
Ensifentrine is a relatively new treatment for COPD that helps both to reduce inflammation in the lungs and to open up the airways (a bronchodilator effect). You take this medicine by inhalation. It can help improve your breathing and reduce the number of COPD flare-ups.
It is currently only available in the United States.
Taking your medicines the right way is just as important as taking them regularly. For your inhaled treatment to work properly, it needs to reach the lungs. Take your time to watch an inhaler technique video that matches your inhaler device and review any materials your doctor has provided about using your medicines correctly. Remember to bring your inhalers to every doctor’s appointment so your healthcare provider can check your inhaler technique regularly. Your pharmacist can also support you in making sure you’re using your inhalers correctly.
Steroids are medicines that help reduce inflammation. You take oral steroids by mouth to treat COPD flare-ups over a short period. Healthcare providers do not recommend long-term use because these medicines only help for a short time and can cause more harm than benefit when you use them regularly.
During a short course of oral steroids, you might experience side effects such as increased appetite, difficulty sleeping, or mood changes like irritability or anxiety. When taken regularly or over a longer period of time, oral steroids can also lead to other side effects, including weight gain, osteoporosis, or diabetes.
Oral steroids are sometimes prescribed as part of a so-called ‘rescue-pack’. This is a set of medications you keep at home to use if you experience a COPD flare-up. You should only start the medicines in your rescue pack in accordance with the instructions in your COPD action plan. After using your rescue pack, it is important to get in touch with your doctor. This way, they can check your recovery, review your COPD action plan if needed, and renew your prescriptions.
Mucolytics (for example, carbocysteine or N-acetylcysteine) are medicines that help reduce cough and thin phlegm, which makes it easier to cough up. It is sometimes prescribed as an additional treatment to help prevent COPD flare-ups.
Antibiotics are medicines used to treat chest infections caused by bacteria. Signs of a chest infection are a change in the colour of your phlegm, increased coughing, and being more breathless than usual. You may even develop a fever (body temperature of 38°C/100.4°F or more). Antibiotics are sometimes prescribed as part of a so-called ‘rescue pack’. This is a set of medications you keep at home to use if you experience a COPD flare-up. You should only start the medicines in your rescue pack in accordance with the instructions in your COPD action plan. After using your rescue pack, it is important to get in touch with your doctor. This way, they can check your recovery, review your COPD action plan if needed, and renew your prescriptions.
Some people with COPD have frequent flare-ups. In these cases, your doctor may propose adding regular antibiotics (such as azithromycin) to your treatment plan. This treatment may help reduce how often COPD flare-ups occur. This treatment is only prescribed and monitored by a COPD specialist.
When you’re prescribed antibiotics, it is important to take them exactly as directed by your healthcare provider. Side effects can vary depending on the type of antibiotic, but the most common ones include diarrhoea and nausea (feeling sick).
Roflumilast is a tablet that reduces the risk of COPD flare-ups. Availability may differ from country to country. Your healthcare provider may prescribe roflumilast if you have chronic bronchitis, severe or very severe COPD, and frequent flare-ups. You take it in addition to your regular COPD medicines, not instead of them. Common side effects include nausea (feeling sick), diarrhoea, and weight loss. Roflumilast can also cause mood changes in some people, such as feeling agitated or depressed. If you or someone close to you notices any changes in your mood, tell your doctor right away.
Healthcare providers sometimes prescribe theophylline tablets to help relieve shortness of breath. However, they are generally less effective and cause more side effects than other COPD treatments. For this reason, healthcare providers prescribe them less often today. In some countries, however, theophylline remains more widely used because inhalers are difficult to access or too expensive.
For some patients with more severe cases of COPD who also have higher levels of eosinophils (a type of white blood cell), the COPD specialist might consider adding biologics to the treatment plan. This is a type of medication that is provided by injection. Biologics reduce the frequency of flare-ups and improve lung function overall.
The use of biologic treatments in COPD is still relatively new compared with their use in conditions like asthma. However, some biologics have been shown in clinical studies to help reduce the number of flare-ups. At this time, they have not been shown to slow down the overall progression of the disease.
Availability and reimbursement policies differ from country to country. While effective, this treatment can be expensive, and it is used in addition to other COPD treatments, including inhalers. So it is often considered when other options are no longer sufficient.
How to self-administer a biologic?
When starting treatment with biologics, your healthcare provider will train you to give yourself a dose via injection. After practicing a few times at the hospital, you will usually be able to do the injections by yourself at home (like insulin injections for diabetes). Since a proper technique is essential for the medicine to work and to ensure you get the full dose, we have created videos to assist you with the correct technique whenever you need it. There are two types of injections: (i) via a prefilled pen or (ii) via a prefilled syringe. Instructions depend on the device you use.
For some people with severe COPD, healthcare providers may recommend additional treatments alongside inhalers and medicines to help improve breathing. These include surgical and non-surgical options that target the most damaged areas of the lungs.
Endoscopic lung volume reduction (ELVR) is a non-surgical procedure used to treat people with severe emphysema. It can achieve similar benefits to traditional surgery but without removing lung tissue. During the procedure, performed under general anesthesia, a bronchoscope (a thin, flexible tube with a light and camera) is used to place small one-way valves into selected airways. These valves allow trapped air to escape from the most damaged parts of the lung, causing them to deflate and shrink. This helps the healthier parts of the lung to expand and function more effectively. Endoscopic lung volume reduction can be an alternative for carefully selected patients who are not suitable candidates for traditional surgery.
Surgery may be an option for some people with severe COPD. When regular COPD treatments are no longer sufficient, your healthcare provider might suggest lung surgery to help improve your breathing.
The two main types of surgery in the context of COPD are:
This surgery involves removing the most damaged parts of the lungs. It is a treatment option for people with severe emphysema. It allows the remaining healthier parts of the lung to expand more fully and work more efficiently. Your healthcare provider may order additional tests to determine whether this type of surgery could be of benefit for you. Not everyone is a suitable candidate. For some people, the risks of surgery may outweigh the benefits.
This involves replacing a damaged lung with a healthy lung from an organ donor. When successful, the transplantation can significantly improve your breathing, quality of life, and the expected course of the disease. However, it is a major operation which – like all operations – carries certain risks. After the transplant, you will need to take medicines to prevent your body from rejecting the donor lung(s). This treatment is only suitable for carefully selected patients with advanced COPD.
If COPD causes a low level of oxygen in your blood, your healthcare provider may recommend starting oxygen therapy at home. You receive oxygen through a mask or nasal tubes connected to an oxygen tank or an oxygen concentrator. Supplemental oxygen is only beneficial to people with low levels of oxygen in the blood. It is important to know that oxygen therapy is not a treatment for breathlessness — the main symptom of COPD. Breathlessness happens because it is harder for you to move air in and out of your lungs, not necessarily because your blood oxygen levels are low.
Oxygen therapy is categorized based on when it's being used:
It is important not to smoke when using oxygen. This is because oxygen is a highly flammable gas, and if you light a cigarette in proximity, it could cause a fire.
Depending on the organisation of your healthcare system, your GP or respiratory specialist may refer you to a pulmonary rehabilitation programme. This programme helps people with long-term lung conditions whose breathing problems affect their daily lives. It is a structured course of lung physiotherapy, usually offered in group sessions but tailored to your individual needs. Pulmonary rehabilitation is often multidisciplinary, meaning it also involves other specialists such as a dietitian, psychologist, and occupational therapist.
The course focuses on the following topics:
- Exercises to increase your overall fitness, which will make you feel stronger and more energized
- Specific breathing exercises that you can use in times of increased breathlessness
- General information regarding your condition, so that you know more about it and feel empowered
Pulmonary rehabilitation has proven to be beneficial for patients with COPD. It improves your ability to exercise, enhances your quality of life, and reduces the frequency of COPD flare-ups. Pulmonary rehabilitation is beneficial for most people with COPD. Even if you have severe breathlessness, you might still benefit from the rehabilitation programme.
Although it can be tempting to look for other ways to manage your cough or breathlessness, very little scientific research supports the use of over-the-counter medicines for people with COPD.
That is also why international COPD treatment guidelines do not recommend these medicines. While you might feel inclined to try cough suppressants (antitussives) or over-the-counter expectorants (medicines to help thin and loosen phlegm), their benefit in COPD is unclear. If you’re thinking about trying any alternative or complementary treatments, always talk to your healthcare provider first to make sure they are safe and suitable for you.
Taking the time to learn more about COPD is an important step toward managing your condition—well done!
Understanding your condition and knowing your treatment options can really help you feel more in control of your condition and your overall health.
Below are a few tips to help you self-manage your condition:
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