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Treatment of COPD

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What are the treatments for COPD?

Stopping smoking is the most important treatment for COPD. No other treatment may be needed if the disease is in the early stage and symptoms are mild.

If symptoms become troublesome, one or more of the following treatments may be advised by your health professional. Unfortunately,  treatments cannot cure COPD but only help with disease management by easing symptoms. Also, some treatments may prevent some flare-ups of symptoms and reduce the risk of exacerbations.

Short acting bronchodilator inhalersInhaler

This medicine relaxes the muscles in the airways (bronchi) to open them up (dilate them) as wide as possible. They include:

  • Beta agonist inhalers. For example, salbutamol and terbutaline.
  • Antimuscarinic inhalers. For example, ipratropium.  

These inhalers work well for some people, but not so well in others. Typically, symptoms of wheeze and breathlessness improve should improve within 5-15 minutes with a beta agonist inhaler, and within 30-40 minutes with an antimuscarinic inhaler. The effect from these medicines usually last for 3-6 hours Some people with mild or intermittent symptoms, such as asthma, may only need an inhaler 'as required' for when breathlessness or wheeze occur. Some people need to use an inhaler regularly. The beta agonist and antimuscarinic inhalers work in different ways. Using two, one of each type, may help some people better than one type alone.

Long acting bronchodilator inhalers

These include the beta agonists called formoterol and salmeterol, and the antimuscarinic called tiotropium. They work in a similar way to the short acting inhalers, but each dose lasts at least 12 hours. One may be an option if symptoms remain troublesome despite taking a short acting bronchodilator.

Sometimes a combination of a short acting and a long acting inhaler is used. Sometimes a combination of both types of long acting inhaler is used. This is mainly used for people with more severe symptoms, or for people who have frequent flare-ups of symptoms.

Steroid inhaler

A steroid inhaler may help in addition to a bronchodilator inhaler if you have more severe COPD or regular flare-ups (exacerbations) of symptoms. Steroids reduce inflammation. There are several brands of steroid inhaler. A steroid inhaler may not have much effect on your 'usual' symptoms, but may help to prevent flare-ups.

Bronchodilator tablets

These contain medicines such as theophylline that 'open the airways'. Side-effects are quite common and inhalers are usually better. However, some people find inhalers difficult to use, and tablets are an alternative. They may also be added in to the above treatments in severe cases.

Steroid tablets

A short course of steroid tablets is sometimes prescribed if you have a bad flare-up of wheeze and breathlessness (often during a chest infection). They help by reducing the extra inflammation in the airways caused by infections. Taking steroid tablets long-term is not usually advised due to the serious side-effects which can develop.

Mucolytic medicines

A mucolytic medicine such as carbocisteine or mecysteine makes the sputum less thick and easier to cough up. This may also have a knock-on effect of making it less easy for bacteria (germs) to infect the mucus and cause chest infections. The number of flare-ups of symptoms (exacerbations) tends to be less in people who take a mucolytic. It needs to be taken regularly, and is most likely to help if you have moderate or severe COPD and have frequent or bad flare-ups.

Antibiotics

A short course of antibiotics is commonly prescribed if you have a chest infection, or if you have a flare-up of symptoms which may be triggered by a chest infection.

Oxygen

This may help some people with severe symptoms. It does not help in all cases. A specialist usually does some breathing tests to assess whether oxygen will help. If found to help, oxygen needs to be taken for at least 15-20 hours a day to be of benefit. Normally, you will only be considered for oxygen if you do not smoke. There is a serious fire risk when using oxygen if you smoke.

Surgery

This is an option in a very small number of cases. For example, removing a section of lung that has become useless may improve symptoms. Lung transplantation is being studied, but is not a realistic option in most cases.

Treatment of flare-ups (exacerbations) of symptoms

If you have a flare-up of symptoms, you may be advised to increase the dose of your usual treatments, and/or to add in some other treatments for the duration of the flare-up. For example, an increase in the dose of your usual inhaler or perhaps adding in another inhaler type for the duration of the flare-up. Also, commonly, a short course of antibiotics and/or steroid tablets are used as part of the treatment for a flare-up of symptoms.

If you have frequent flare-ups then your doctor may advise on a 'self-management plan'. This is a written plan of action agreed by you and your doctor on what to do as soon as possible after a flare-up starts to develop. For example, you may be given advice on how to increase the dose of your inhalers when needed. You may also be given some steroid tablets and/or antibiotics to have 'on standby' so that you can start these as soon as possible when a flare-up first develops.