Antibiotics, Mucolytics, & Opioids

Some medications for chronic obstructive pulmonary disease (COPD) are very common, such as bronchodilators and corticosteroids. Some patients will use those medicines every day as part of their treatment plan. Other medications are used only in some situations, or only for some patients. Types of medicines that are occasionally used by patients with COPD include:

  • Antibiotics
  • Mucolytic drugs
  • Opioids

How are antibiotics used to treat COPD?

A difficult part of living with COPD is dealing with acute exacerbations, which are also called COPD attacks or flare-ups. A flare-up happens when a patient’s COPD symptoms get much worse all of a sudden. If the flare-up is severe enough, it may even need to be treated in the hospital.

Respiratory infections are the cause of many COPD flare-ups. Because people with COPD already have inflamed, mucus-filled airways, they are much more susceptible to infections. A virus or bacteria in the patient’s respiratory system can cause these infections, such as:

  • Acute bronchitis
  • Flu
  • Pneumonia

A change in the amount or color of mucus produced by the lungs is a key sign of a respiratory infection. Other symptoms are increased breathlessness and coughing. Patients should contact their healthcare providers if they think they may have a respiratory infection.

Antibiotics are medicines that are used to treat respiratory infections that are caused by bacteria. Healthcare providers can determine the cause of the infection or the flare-up, and whether or not it should be treated with antibiotics.1,2

How are mucolytic drugs used to treat COPD?

Some people with COPD have lungs that produce mucus that is very thick, which makes it hard to clear out from the airways by coughing. This mucus can clog the airways and make it harder for a patient to breathe.

Mucolytic drugs work by loosening and thinning the mucus, which can make it easier to cough up and clear out the airways. Mucolytics are usually taken on a regular basis, in pill form or in liquid form that can be inhaled or taken orally.1,3

Types of mucolytic drugs used by people with COPD include (some of these drugs are not available in the US):

  • N-acetylcysteine
  • Carbocysteine
  • Erdosteine
  • Ambroxol3,4

While some patients get relief from mucolytic drugs, there is some debate among healthcare providers about whether or not they really benefit most people with COPD. For this reason, healthcare providers might not suggest them for all COPD patients.

However, there is some evidence from scientific studies suggesting that mucolytic drugs might be able to help patients reduce their risk of acute exacerbations. This seems to be more effective for patients with severe disease. Further studies in this area may change the way that mucolytics are used to treat COPD.1

How are opioids used to treat COPD?

Opioids are medications that reduce the amount of pain a person feels. Examples of opioids include:

  • Morphine
  • Oxycodone
  • Hydrocodone

For some patients with very severe COPD, opioids can provide some relief for their symptom of breathlessness. However, researchers are not sure if the side effects of opioids outweigh the benefits of them for most patients. Opioids are very strong and can be addictive, so they need to be used with caution.1,5

Written by: Anna Nicholson and Emily Downward | Last reviewed: April 2018.
View References
  1. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease, 2018 Report. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available at http://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf. Accessed 4/3/18.
  2. Sethi S. Infection as a comorbidity of COPD. Eur Respir J. 2010 Jun;35(6):1209-15. doi: 10.1183/09031936.00081409.
  3. Davies L and Calverley PMA. The evidence for the use of oral mucolytic agents in chronic obstructive pulmonary disease (COPD). Br Med Bull. 2010 Dec;93(1):217-227. https://doi.org/10.1093/bmb/ldp050
  4. Vega CP. Best evidence review: mucolytics – an update on their use in COPD. Medscape. Available at https://www.medscape.com/viewarticle/724391_2. Accessed 4/3/18.
  5. Ekström M, Nilsson F, Abernethy AA, Currow DC. Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review. Ann Am Thorac Soc. 2015 Jul;12(7):1079-92. doi: 10.1513/AnnalsATS.201501-034OC.