Antibiotics, Mucolytics, and Opioids

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Some types of drugs are commonly used to treat chronic obstructive pulmonary disease (COPD). One of these is called a bronchodilator. Bronchodilators include drugs called short-acting beta-agonists (SABAs), long-acting beta-agonists (LABAs), and long-acting muscarinic antagonists (LAMAs). These drugs are the main backbone of COPD treatment.1-4

Inhaled corticosteroid (steroids) drugs are also a common treatment for COPD. They are used in people who have frequent flare-ups or who need to be in the hospital during a flare-up. Flare-ups are times when COPD symptoms quickly get worse. They are also called exacerbations.1-3

However, these are not the only drugs used to treat COPD. The decision about which treatments to use and when is based on how severe and frequent your symptoms are. Each person’s case will be different. Other drugs used to treat COPD include:5-7

  • Antibiotics
  • Mucolytics
  • Opioids

What are antibiotics?

People with COPD have inflammation and mucus in their airways. This can increase the risk of getting a lung infection. Antibiotics are drugs that these infections by attacking the germs that cause them.8

Infections can lead to COPD flare-ups. Because of this, preventing and treating infections is important in managing COPD. Which antibiotic to use depends on common germs in the area, side effects, past infections you have had, and more.5

When are antibiotics used to treat COPD?

Your doctor may prescribe antibiotics during an active flare-up if they suspect that an infection is part of the cause. Common signs that an antibiotic drug may need to be added to your regular treatment during a flare-up include:5

  • Worsening shortness of breath
  • Thickened mucus or more mucus production
  • Mucus that has yellow or green pus in it (also called purulence)
  • Symptoms that are severe enough to be treated in a hospital

In other cases, antibiotics are taken regularly, even when there is not an active infection. This is done to prevent an infection from occurring and causing a flare-up. Using antibiotics in this way is called prophylaxis. Antibiotic prophylaxis is used only in people who continue to have flare-ups even when using all other treatment options.1,2,5

What are the possible side effects of antibiotics?

Like all drugs, antibiotics have side effects and risks. Common side effects of antibiotics include:8

  • Allergic reactions
  • Antibiotic resistance – This is when germs develop the ability to escape a drug’s effects and become harder to target.
  • Changes to gut bacteria that can lead to severe diarrhea – These changes are caused by an overgrowth of a bacteria called C. difficile.

Side effects can vary depending on the specific treatment/drug you are taking. For example, macrolides are one of the most common antibiotics used for COPD. They can increase the risk of:1,2,9

  • Nausea or vomiting
  • Belly pain
  • Diarrhea
  • Changes in the way the heart beats, which can increase the risk of severe heart issues
  • Trouble hearing

What are mucolytics?

Mucolytic drugs are used to treat conditions that involve a buildup of mucus in the lungs, including COPD, asthma, and cystic fibrosis. Mucolytic drugs help thin out and break up this mucus.6,10

Mucus traps irritants and germs in your airway and lungs. Mucus that is broken up can be cleared from the lungs easier. When mucus is not cleared normally, the risk of inflammation and infection increases. This can lead to COPD flare-ups.6,10

These drugs are typically taken orally or inhaled as a mist or aerosol. They may be prescribed alongside other COPD treatments.6,10

When are mucolytics used to treat COPD?

Mucolytics are not first-line drugs like bronchodilators are. However, some research has shown that mucolytics may help reduce flare-ups and hospital stays. They may also decrease the number of days when a person cannot do their normal activities due to COPD symptoms.6,11

Some common mucolytics used in COPD are:6,10,11

  • Acetylcysteine
  • Carbocisteine
  • Ambroxol
  • Erdosteine

Mucolytics are not suitable for everyone with COPD. Their use should be determined by a healthcare professional based on an individual's specific condition and needs. You and your doctor will work together to decide whether mucolytics are right for you.6,10

What are the possible side effects of mucolytics?

Mucolytics are generally safe to use, but they can have side effects. Common side effects of mucolytics include:10

  • Diarrhea
  • Nausea and vomiting
  • Sore throat or loss of voice
  • Trouble breathing
  • Chest pain
  • Rash

What are opioids?

Opioids are drugs prescribed to treat severe pain. Opioids are also called narcotics. Some common opioid drugs are:12

  • Oxycodone
  • Oxymorphone
  • Morphine
  • Fentanyl
  • Hydrocodone

Opioids can be habit-forming, so doctors use caution when prescribing these drugs. But opioids can be safe and effective when used correctly. These drugs come in different strengths and forms. They can be taken as pills, placed on the skin in patches, or injected into the body.12

When are opioids used to treat COPD?

In addition to pain relief, opioids may help reduce the feeling of breathlessness in people with severe COPD. But research on how effective they are for those with COPD is mixed. In fact, opioids can decrease breathing rate and make it harder to breathe for some people.12-14

Opioids for use in COPD is generally reserved for severe cases where other treatments have not worked. Opioids should always be prescribed and given by a doctor after a thorough evaluation. You and your doctor will weigh the benefits and risks of adding an opioid to your treatment plan.12-14

What are the possible side effects of opioids?

Opioids can cause a variety of side effects. The most common side effects include:12

  • Constipation
  • Nausea
  • Shallow and slowed breathing
  • Lower heart rate
  • Loss of consciousness, grogginess, or confusion
  • Sleepiness
  • Jitteriness or trouble sleeping when stopped too quickly

Taking opioids inappropriately can be dangerous. Follow your doctor's exact instructions for how to take these drugs. Also, only take them when you need them. These measures can help reduce side effects.12

All opioid drugs have a boxed warning, the strictest warning from the US Food and Drug Administration (FDA). They have this warning because they present a risk of addiction, abuse, or misuse. These issues can lead to a life-threatening overdose. Opioids also may cause serious breathing problems. Finally, they can have life-threatening effects when combined with certain other drugs.15

Other things to know

These are not all the possible side effects of antibiotics, mucolytics, or opioids. Talk to your doctor about what to expect when taking these types of drugs. You also should call your doctor if you have any changes that concern you when taking an antibiotic, mucolytic, or opioid.

Before beginning treatment for COPD, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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