Medication Overview

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Medications are a key part of any patient’s treatment plan for chronic obstructive pulmonary disease (COPD). Patients and their healthcare providers work together to find the right combination of medicines to treat different aspects of the patient’s disease, in the best way possible.

Some drugs for COPD are called “maintenance” medicines. This means that they are used to help control and prevent the symptoms of stable COPD, which are symptoms the patient has all or most of the time. Some medicines are used to treat symptoms that suddenly get worse during COPD flare-ups. Others are not used to treat the symptoms of the disease itself, but to treat related conditions that people with COPD often have.

These types of medicines can all play a role in a COPD treatment plan:

What are bronchodilators?

Bronchodilators are a central part of the COPD treatment plan for most patients. During a “bronchospasm,” the muscles that surround the airways tighten up and make the airways too narrow for enough air to pass through. This can make it hard to breathe.

Bronchodilators are inhaled drugs that can help to relieve and prevent bronchospasms by helping the muscles around the airways to relax. This opens up the airways and makes breathing easier.

There are several types of bronchodilator medicines:

Short-acting beta-agonist bronchodilators are called “SABAs” for short. SABAs are sometimes called “rescue” inhalers, because they can provide very quick relief for sudden or severe breathing symptoms. They usually contain a medicine called albuterol. Common brands names for SABA albuterol inhalers are:

  • ProAir HFA
  • Proventil HFA
  • ReliOn Ventolin HFA
  • AccuNeb

Long-acting beta-agonist bronchodilators are called “LABAs” for short. Common brand names of LABA drugs include:

  • Foradil Aerolizer (formoterol fumarate)
  • Brovana (arformoterol tartrate)
  • Serevent Diskus (salmeterol xinafoate)

Short-acting anticholinergic bronchodilators take a bit longer to start working than SABAs do. Currently, Atrovent HFA (ipratropium bromide) is the only bronchodilator of this type that is available.

Long-acting anticholinergic bronchodilators include:

  • Spiriva HandiHaler and Spiriva Respimat (tiotropium bromide)
  • Tudorza Pressair (aclidinium bromide)

What are corticosteroids?

Corticosteroids are another type of medicine commonly used to help control COPD symptoms. They work by helping to reduce the amount of swelling in the airways and make it easier for a patient to breathe. Corticosteroids can be inhaled, or they can be taking orally in a tablet or liquid.

Types of inhaled corticosteroids include:

  • Beclomethsone (brand names: Qvar, Beclovent)
  • Budesonide (brand name: Pulmicort)
  • Flunisolide (brand name: AeroBid)
  • Fluticasone (brand name: Flovent)
  • Triamcinolone (brand name: Azmacort)

Types of oral corticosteroids include:

  • Prednisolone (brand name: Prelone)
  • Prednisone (brand name: Deltasone)
  • Methylprednisolone (brand name: Medrol)

Corticosteroids are used daily as part of COPD maintenance therapy for some patients, especially patients with more severe disease. In other cases, corticosteroids are used to help treat a COPD flare-up and keep it from getting worse.

What are combination therapies?

Combination therapies for COPD contain two different types of medicines delivered in a single dose. For many patients, the combined drugs are an effective and convenient way to manage their symptoms.

Several types of combination therapies are currently available for treating COPD patients.
Combivent Respimat (albuterol + ipratropium) contains a SABA bronchodilator plus a short-acting anticholinergic bronchodilator. Anoro Ellipta (vilanterol + umeclidinium) contains a LABA bronchodilator plus a long-acting anticholinergic bronchodilator:

There are also three medications that contain a LABA bronchodilator plus an inhaled corticosteroid:

  • Advair Diskus (salmeterol + fluticasone propionate)
  • Breo Ellipta (vilanterol + fluticasone furoate)
  • Symbicort (budesonide + formoterol fumarate)

What are phosphodiesterase-4 inhibitors?

Phosphodiesterase-4 inhibitors are a treatment option for certain patients with COPD. Daliresp (roflumilast) is the only drug of this type that is currently available in the US. For patients with severe COPD, Daliresp is taken every day to help to reduce the number of moderate and severe COPD flare-ups that a patient has per year.

What are methylxanthines?

Methylxanthines are an older type of bronchodilator for treating COPD. They work by reducing swelling in the airways and relaxing the muscles that surround them. Methylxanthines are not used as often as other types of bronchodilators, because they can cause serious side effects. The most common type of methylxanthine is called “theophylline.”

What are antibiotics?

For COPD patients, antibiotics are frequently used to treat respiratory infections that are caused by bacteria. Respiratory infections very often cause COPD flare-ups, so it is important to treat the infection with antibiotics as quickly as possible.

Antibiotics include drugs such as:

  • Amoxicillin
  • Ampicillin
  • Amoxicillin-clavulanate
  • Azithromycin
  • Doxycycline
  • Tetracycline
  • Trimethoprim/sulfamethoxazole

What are mucolytic drugs?

Some COPD patients use mucolytic drugs to help thin and loosen the mucus produced by their lungs. When the mucus produced by the lungs is too thick, it can clog the airways and become hard to clear out by coughing. Mucolytic drugs can make it easier to cough up the mucus, which clears the airways and makes breathing easier.

Common types of mucolytic drugs for COPD are:

  • N-acetylcysteine
  • Carbocisteine
  • Erdosteine
  • Mecysteine

What are opioids?

Opioid medicines are a type of very strong pain reliever. For some patients with very severe COPD, opioids can provide some relief for severe breathlessness as well. Common opioids are:

  • Morphine
  • Oxycodone
  • Hydrocodone

What medications can help a person stop smoking?

Two types of medications are available that can help a patient with COPD to stop smoking for good. Nicotine replacement products deliver a small amount of nicotine into the body that can help make it easier to quit smoking. These include gum, patches, inhalers, and lozenges.

Prescription medicines can decrease a person’s urge to smoke without delivering any nicotine at all. These include:

  • Chantix (varencline)
  • Wellbutrin and Zyban (both contain bupropion)
  • Pamelor (nortriptyline)

What are antidepressants and anti-anxiety medicines?

Many COPD patients will experience anxiety or depression (or both) at some point during the disease. Antidepressants and anti-anxiety medicines can be helpful in treating these conditions and improving a patient’s quality of life.

Some of the antidepressants and anti-anxiety medications that can be used to treat COPD patients are:

  • Zoloft and Lustral (sertraline)
  • Celexa (citalopram)
  • Lexapro (escitalopram)
  • Effexor (venlafaxine)
  • Buspar (buspirone)
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