Chronic obstructive pulmonary disease (COPD) is an irreversible respiratory disease, which progresses in stages. With each advancing stage, the prognosis worsens and mortality rate increases. COPD treatment offers no cure but gives symptomatic relief and slows the progression of the disease. Each stage qualifies for a different degree of treatment, which becomes more aggressive with each advancing stage.
The list of COPD medicines is long, what with one drug for an emergency situation and another for a non-emergency one and each with its own duration of use and effectiveness.
Another thing that the COPD treatment does is, it improves the prognosis of the disease, prolongs the lifespan, and reduces the mortality rate in the patient.
The goals of the COPD treatment are:
- To slow the progression of the disease by advising the patient to stop smoking and avoid other trigger factors
- Control the symptoms with medicines
- Prevent and treat flare-ups (exacerbations)
- Prevent and treat complications
- Improve the overall health of the patient with proper nutrition and exercise
- Improve exercise capacity or endurance
The COPD symptoms present at about the age of 35 to 40 years, when considerable lung damage (about 50%) has already taken place. The patient usually presents himself to the doctor in stage 2 of the disease when the symptoms such as cough and breathlessness start bothering him.
The family doctor may refer him to the lung specialist (pulmonologist) who will get him investigated with spirometry and other tests. This will help confirm the COPD diagnosis and start treatment.
There forms a management plan to improve the condition of the patient with lifestyle advice, proper diet and exercises and a treatment plan with medications to control the symptom and slow down the progression of the disease.
COPD treatment guidelines and recommendations
The recommendations for treating COPD have come from reputed institutions:
- The Global Initiative for Chronic Obstructive Lung Disease (GOLD)
- The British Thoracic Society (BTS)
- The National Institute for Health And Care Excellence (NICE)
- And more.
Their recommendations have all been incorporated in a brief manner and produced here with further clarifications.
COPD treatment with medications
Your doctor will use various medicines as required to control your symptoms, fight exacerbations and improve your health. Some will be temporary on an as required basis, while others will have to be taken routinely.
Bronchodilators form the mainstay of COPD treatment with medications. You use them with an inhaler or a nebulizer. This helps the medication to act directly at the site of the problem, which is the airways.
Not much of the inhaled medicine is absorbed in the blood and you need a much smaller dose than if you took the medicine as a tablet or liquid by mouth. Secondly, another advantage is that the action of inhaled bronchodilators starts within minutes.
If you are aware of the COPD pathophysiological changes in the lungs, you will know that the airways (bronchi) in the lungs are narrowed due to inflammation making breathing difficult and causing breathlessness. Bronchodilators act directly on the muscles in the bronchial walls relaxing them. This helps to widen the lumen of the airways and make breathing easier.
Bronchodilators are available in two types: short-acting and long-acting. At times, your doctor will prescribe both together in moderate and severe cases.
It is important to know that not all people react to these medicines in the same way. The onset of action may vary and so may the duration of action.
Short-acting bronchodilators, also called fast-acting bronchodilators, have a shorter duration of action, which lasts for 4 to 6 hours. They are given to relieve an existing bout of breathlessness (SOS basis) and before exercise to prevent exercise-induced dyspnea (breathlessness).
Examples of short-acting bronchodilators include:
- albuterol (Vospire ER)
- levalbuterol (Xopenex)
- ipratropium (Atrovent)
- albuterol/ipratropium (Combivent)
You use long-acting bronchodilators on a regular basis to prevent bouts of breathlessness. Their duration of action lasts for about 12 hours and your doctor may prescribe them for use once or twice a day.
Their onset of action is gradual as compared to the short-acting variety and, therefore, you don’t use them as SOS medicines but only as a preventive measure.
Examples of long-acting bronchodilators include:
- tiotropium (Spiriva)
- salmeterol (Serevent)
- formoterol (Foradil, Perforomist)
- arformoterol (Brovana)
- indacaterol (Arcapta)
- aclidinium (Tudorza)
Side effects include a dry mouth, dizziness, tremors, running nose, blurry vision, and an allergic rash.
Corticosteroids are powerful anti-inflammatory drugs and reduce the inflammation in the airways of the lungs. This increases the lumen size facilitating better air entry and easier breathing.
They are available as intramuscular and intravenous injections, tablets and inhalable forms. The injectable and the oral varieties are used when the symptoms suddenly flare-up.
Generally, your doctor may not order inhaled steroids alone but with an inhalable bronchodilator. Such combinations are mostly used in people with frequent exacerbations.
Examples of commonly used inhaled steroids for COPD include prednisolone, Fluticasone (Flovent) and Budesonide (Pulmicort).
In moderate or severe acute exacerbation (GOLD stage 3 and 4), a short duration course of oral steroids is prescribed for five days to prevent the further worsening of the disease.
A single COPD drug with a combination of two long-acting bronchodilators or a combination of one long-acting one and one inhaled corticosteroid is available with several brand names.
Combinations of two long-acting bronchodilators include:
- glycopyrrolate/formoterol (Bevespi Aerosphere)
- glycopyrrolate/indacaterol (Utibron Neohaler)
- tiotropium/olodaterol (Stiolto Respimat)
- umeclidinium/vilanterol (Anoro Ellipta)
Combinations of an inhaled corticosteroid and a long-acting bronchodilator include:
- budesonide/formoterol (Symbicort)
- fluticasone/salmeterol (Advair)
- fluticasone/vilanterol (Breo Ellipta)
Combination drugs are used in COPD to control the breathlessness symptom when one drug cannot do it on its own.
If you are coughing out a lot of mucus, which you are finding difficult to expectorate, your doctor may prescribe you a drug called a mucolytic. It comes in a tablet or liquid form and makes the mucus thin and easy to cough out. It is a good drug for treating excessive mucus in any respiratory illness.
Theophylline belongs to a class of drugs called methylxanthines. Some doctors may prescribe theophylline as the first line of treatment in severe cases of COPD where the rapid-acting bronchodilators and steroids do not work.
It comes in the pill or liquid form for oral use. It widens the lumen of the airways by its anti-inflammatory action to relieve breathlessness.
Due to its serious side effects, its use is restricted.
Short course antibiotics
The doctor prescribes antibiotics when there is a superadded bacterial infection. This can happen when COPD complications set in or during an exacerbation. They are not used to prevent such situations but only as treatment. Azithromycin is the antibiotic of choice due to its powerful antibacterial and anti-inflammatory effect.
Oxygen therapy in COPD
COPD and low oxygen blood levels indicate the use of oxygen therapy with certain guidelines. Oxygen therapy is indicated when the oxygen saturation as shown by the pulse oximeter is less than 88 percent.
Several devices to deliver oxygen to your lungs are available including lightweight portable units you can carry home for use. You can use a nasal cannula or an oxygen mask.
The need for oxygen therapy varies in different COPD patients. Some may require it during physical activity, some before going to bed and others with severe COPD may require it all the time.
Oxygen therapy helps to:
- increase range of physical activity
- helps with proper sleep
- increase life span
- supply enough oxygen to the body organs such as the heart keeping them healthy
Surgery for COPD
Lung volume reduction surgery
In this type of lung surgery, the surgeon removes parts of damaged lung tissue making more room for the healthy part of the lung to expand.
Due to advanced emphysematous changes, the walls of the adjacent alveoli get damaged giving rise to large air spaces called bullae. This can cause great breathing difficulty. Surgical removal of these bullae improves air flow in the lungs.
This is the ultimate surgical step in the COPD treatmrent for severely damaged lungs. It will improve breathing and life quality. However, there are major risks such as organ rejection.
Capping it up
As you can see, the COPD treatment guidelines run a long line and the duration of each drug varies depending on the accompanying symptoms and complications.
There are drugs to handle emergency situations and some drugs to be taken for a long duration as preventive aids, each adding to the effectiveness of the treatment.
Lifestyle management to reduce COPD symptoms
The COPD treatment has to be accompanied by a motivated COPD lifestyle management plan. This solely depends on you and you are responsible for its success or failure. Do not underestimate its importance. COPD lifestyle modifications are meant to get rid of your old unhealthy habits and incorporate new healthy ones.
These lifestyle changes will help to reduce and control your symptoms, improve your failing health, and slow down the progressive damage to the lungs.
The pulmonary rehabilitation program, as this management program is also called, involves a group of specialists who provide nutrition advice, help with breathing and physical exercises. They include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians.
Stop Smoking and avoid other lung irritants
First and foremost, your doctor will advise you to stop smoking. This is imperative because smoking is the leading cause of COPD. 90% of COPD people are or were smokers.
You will have to exert full control of mind and fight the temptation to smoke. Think of the complications that can make your life miserable and can even end your life.
If necessary, to fight nicotine withdrawal symptoms, take medical help. There are behavioral and motivational therapies that you can adopt to fight your cravings to smoke.
You should avoid other risk factors that can trigger a COPD flare–up such as a polluted atmosphere, inhaling second-hand smoke, biogas pollution in the kitchens, etc.
Nothing could be more important for the COPD patients than maintaining a proper weight and staying well nourished.
Being overweight will make you more breathless and limit your activity because you have to carry more of your weight around, which requires more effort. Again, obesity is associated with a decreased lung function.
Staying underweight is probably worse because it is associated with malnutrition and a reduced energy output.
The COPD patient should stick to a diet that gives all round nutrition and should consist of whole grains, fresh fruits, vegetables, and lean proteins. This ensures a good supply of vitamins, especially vitamins C, E, and D, minerals, and fiber. Proper nutrition helps with a better overall outcome in COPD patients.
Maintain your calorie intake as required by your weight status. If you are overweight, limit your calorie intake and if you are underweight, increase your calorie intake. Take the advice of your doctor and dietician on this.
Breathing exercises and physical activity both form an essential routine for COPD patients. They improve your breathing, make you feel overall better and help to reduce your anxiety.
COPD breathing exercises include
- Pursed-lip breathing
- Diaphragmatic breathing
- Deep breathing techniques
Physical activity includes:
- Stretching and strength training exercises
- Aerobic exercises
Everyday health explains them all with images.
With damaged lungs and sensitive airways, the COPD patients are very prone to catch influenza and then suffer from its complications such as pneumonia.
The Centers for Disease Control and Prevention (CDC) recommends that all COPD patients take the flu shot every year and the pneumococcal vaccine once as an adult before the age of 65 years and then and then two more at 65 years or older.