Even though COPD cannot be cured, it can be treated. COPD treatment is aimed at reducing symptoms, preventing the disease from getting worse, improving the ability to exercise, preventing and treating complications, and preventing and treating exacerbations.
Almost every person with COPD will be prescribed a short-acting bronchodilator (either a beta-agonist, an anticholinergic, or a combination of both) to use as needed to relieve shortness of breath, coughing, wheezing, and other symptoms. Some people also will need long-acting bronchodilators and/or an anti-inflammatory drug. Your doctor will work with you to figure out the right drugs and combinations of drugs to relieve your symptoms, and you also should get immunized against influenza and pneumonia.
One thing you should avoid using is over-the-counter cough medications, such as guaifenesin (Robitussin, Mucinex), since there is little evidence to show that these are helpful for people with COPD. Although coughing can be bothersome, it has the important function of helping to clear mucus. This means that suppressing a cough may increase the risk of lung infection.
Mild COPD Treatment
For a person with mild COPD who has occasional symptoms, a short-acting bronchodilator alone may be sufficient to manage the condition. Two short-acting bronchodilators—a beta-agonist plus an anticholinergic—also may be prescribed. To simplify this regimen, a combination of a short-acting beta-agonist plus a short-acting anticholinergic is available in a single inhaler. If more symptoms develop over time, additional medications will likely be necessary.
Moderate-to-Severe COPD Treatment
For people with moderate-to-severe COPD who tend to experience symptoms more frequently, one or more long-acting bronchodilators will be added to the regimen. These drugs will be taken regularly every 12 or 24 hours. If acute episodes of breathlessness or coughing occur while taking these medications, a short-acting bronchodilator such as albuterol can be used to quell the episodes.
Inhaled corticosteroids are recommended for people with moderate-to- severe COPD who do not get sufficient relief from bronchodilators alone, or who experience frequent exacerbations of symptoms. Inhaled corticosteroids have been shown to reduce flare-ups. However, some studies have found that using inhaled corticosteroids, with or without a bronchodilator, increases the risk of developing pneumonia. Nevertheless, because inhaled corticosteroids may decrease the risk of dying, they often are added when bronchodilators alone are insufficient. Hopefully further research will clarify the role of inhaled steroids in COPD. Patients should discuss any concerns they have with their physician.
For people prescribed long-term use of both a long-acting bronchodilator and a corticosteroid, combinations of both in a single inhaler are available.
Severe COPD Treatment
For patients with more severe COPD, combinations of two long-acting bronchodilators are generally used. These often are combined in a single inhaler.
For people with obstructive airway diseases, flu or pneumonia can be very serious and even life threatening. Fortunately, vaccines are available to protect against influenza and some forms of pneumonia. It is extremely important that everyone with obstructive airway disease follow the recommended vaccination schedule, or their doctor’s advice.
People with COPD or other lung problems should receive an influenza vaccination once a year. The ideal time to get a flu shot is in October or November, as flu season runs from November to March.
The pneumococcal vaccine protects against the bacteria that is the most common cause of pneumonia, Streptococcus pneumoniae. There are now two forms of pneumococcal vaccine, the Pneumovax and the Prevnar 13. It is recommended that all adults over age 65 receive a pneumococcal vaccination. Unlike the flu shot, which must be given every year in the fall, pneumococcal vaccination provides protection for at least five years. It can be given at any time of the year.
The pneumococcal vaccine is advised for all people with COPD age 65 and older. It also may be given to people with COPD who are younger than age 65 and have severe or very severe disease (FEV1 less than 40 percent of predicted), and recommended for people with asthma who are younger than age 65.
Treating COPD Exacerbations
The most common cause of an exacerbation is a lung infection that may increase mucus production. In these cases, antibiotics may be used. Before prescribing an antibiotic, the doctor may send a sample of the sputum for analysis to determine whether the infection is bacterial or viral, since antibiotics are only effective against bacteria. Studies have shown that a short course (five days) of antibiotics is just as effective as taking antibiotics for longer than five days.
In 2017, the American Thoracic Society and European Respiratory Society issued joined guidelines on the management of COPD exacerbations. Their recommendations included:
- For ambulatory patients with an exacerbation of COPD, a short course of oral corticosteroids plus antibiotics.
- For patients hospitalized with an exacerbation, oral corticosteroids rather than intravenous corticosteroids, if possible.
- For patients hospitalized with an exacerbation causing respiratory failure, noninvasive mechanical ventilation.
- After being discharged for an exacerbation, pulmonary rehabilitation should begin within three weeks. It should not be started during hospitalization.
A recent study found that engaging in any amount of regular exercise following hospitalization for a COPD exacerbation actually reduces the risk of dying.
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