Managing COPD – Medications

You can prevent or ease your COPD symptoms, like shortness of breath, cough, mucus build-up and tiredness by taking your prescribed medication. Different types of medications treat different symptoms. Sometimes, you may have a flare-up where your symptoms get worse and your doctor may prescribe extra medications to help you feel better.

To get the full benefit from your medication, you must follow the doctor’s instructions and take the medications exactly as prescribed. Some medications need to be taken only when you need them, like a quick-relief bronchodilator. Others need to be taken regularly. If you are unsure when or how to take your medications or use your devices, ask your doctor, respiratory educator, pharmacist, or other healthcare provider.

Keep a list of all of the medications you take and show it to your doctor and pharmacist, so they can check for drug interactions.

Types of Medications

There are many types of medications and treatments available to make your life with COPD easier. These include inhalers, oral medications, and other treatments.

Inhalers

  • Bronchodilator inhalers 
  • Combination corticosteroid and bronchodilator inhalers

Oral Medications

  • Antibiotics
  • Phosphodiesterase-4 Inhibitors
  • Mucolytics

Other Treatments

  • Home oxygen
  • Vaccines

Inhalers


The main medication treatment for COPD comes in inhalers (sometimes, these are called puffers). There are many types of inhalers and devices.

1. Bronchodilator Inhalers

Bronchodilators open up the airways in the lungs, making it easier to breathe. Some can even help prevent flare-ups or worsening of COPD. Often people with COPD start off on short-acting inhalers and as their symptoms worsen, such as shortness of breath or cough, long-acting medications will be added. If you were to continue to experience worsening of symptoms, a second long-acting inhaler or combination inhaler would be the next step. 

Bronchodilators are the main medication for COPD. There are two main groups of bronchodilators: beta2-agonists and anticholinergics.

  • Beta2-agonists
    These medications can be taken for prevention or to provide a quick relief. They are inhaled medications that can be short-acting or long-acting. Short-acting beta2-agonists are often used as a “rescue” or quick-relief medicine to open airways quickly. Long-acting beta2-agonists may also be taken regularly to prevent breathlessness.
    • Short-acting beta2-agonists (SABA)
      • Examples include Ventolin®, Bricanyl®
    • Long-acting beta2-agonist (LABA)
      • Examples include Foradil®, Onbrez®, Serevent®, Striverdi®
  • Anticholinergics
    These inhalers relieve breathlessness, but in a different way than beta2-agonists. They are also inhaled medications that are effective in treating COPD and some even prevent COPD flare-ups, especially when they are taken on a regular basis. There are short-acting and long-acting anticholinergics (aslo known as muscarinic antagonists).
    • Short-acting muscarinic antagonist (SAMA)
      • Examples include Atrovent®
    • Long-acting muscarinic antagonist (LAMA)
      • Examples include Incruse™, Spiriva®, Seebri®, Tudorza®
  • Combination bronchodilators
    There are a few newer options of inhalers that have both a beta2-agonist medication and anticholinergic medication. These medications help prevent COPD symptoms and are sometimes called ‘preventers’. These medications should be taken daily. Combination bronchodilators are available as short-acting and long-acting medications.
    • Combination short-acting muscarinic antagonist (SAMA) and short-acting beta2-agonist (SABA)
      • Examples include Combivent®
    • Comination long-acting muscarinic antagonist (LAMA) and long-acting beta2-agonist (LABA)
      • Examples include Anoro™, Duaklir®, Inspioloto®, Ultibro®

2. Combination Corticosteroid and Bronchodilator Inhalers

If you experience flare-ups or continued symptoms even with the use of your combination bronchodilator inhalers, your doctor may prescribe a combination inhaler with several medications in it. These inhalers have both a corticosteroid (anti-inflammatory) medication and long-acting bronchodilator medication to help prevent future flare-ups. These inhalers are considered “preventer” medications that need to be taken every day.

Long-acting bronchodilators will help relieve shortness of breath for longer periods of time, and if combined with an inhaled corticosteroid, will also bring down the swelling in your airways. Don’t worry - these are not the same steroids as those taken by some bodybuilders to build muscle. Over time, combination medications can help prevent COPD flare-ups.

Combination medications may not help relieve symptoms right away. If you need immediate help, take your quick-relief bronchodilator medicine.

  • Combination inhaled corticosteroid (ICS) and long-acting beta2-agonist (LABA)
    • Examples include Advair®, Breo®, Symbicort®, Wixela®
  • Combination inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA) and long-acting beta2-agonist (LABA)
    • Examples include Trelegy®

How do I use my inhalers properly?

Making sure you know how to take your medications is important and will help you best manage your COPD.  Did you know that up to 90% of people, including health professionals do not use inhalers correctly?

Watch these videos to learn how to use your inhaler properly, call our Lung Helpline, or speak to your pharmacist for more assistance.

Nebulizer Medication

A nebulizer is a device that turns medication into fine mist and delivers it into your airways, using a mouthpiece or a mask. Nebulizers can be used for those patients who have a difficult time using inhalers. Caution: Nebulizers can aerosolize and potentially spread different viruses and as a result inhalers may be prescribed.

Oral Medications

  • Corticosteroid Pills
    Corticosteroids also come as pills, most often known as prednisone. Corticosteroid pills have more side effects than the inhaled corticosteroids that are in combination medication. Corticosteroid pills are often used for short periods of time - usually when you have a COPD flare-up. If you need to take corticosteroid pills on a regular basis, your healthcare provider will work to keep you on the lowest dose necessary. You can talk with your healthcare provider about side effects of your medication.
    • Oral corticosteroids (OCS)
      • Examples include Medrol®, Pediapred®, Decadron®
  • Antibiotics
    Bacterial infections in your airways may cause some of your COPD flare-ups. Antibiotics can help in these cases. However, antibiotics will not work if your flare-up was caused by a viral infection. Sometimes people may be experiencing both bacterial and viral infections at the same time. Prednisone is often prescribed along with antibiotics. Sometimes antibiotics are prescribed on a regular basis for those patients with frequent flare-ups. Your lung specialist (respirologist) or family doctor will monitor you closely for improvements and side effects.

Working with your COPD team on a COPD action plan will ensure you have clear directions on what to do and what medicine to take if you have a flare-up.

  • Phosphodiesterase-4 Inhibitors
    Phosphodiesterase-4 Inhibitors (PDE-4) medications are a type of oral medication that decreases inflammation in the lungs. This pill is used for patients with a history of frequent flare-ups and chronic cough with mucus (phlegm). It can prevent flare-ups and should be used along with regular inhalers.
    • Examples include ™Daxas
  • Mucolytics
    Mucolytics help to remove secretions (unwanted contents like phlegm) from the lung by thinning mucus so it is easier to cough up. These medications are for patients with frequent flare-ups. Example: Mucomyst (N-acetylcysteine – NAC), may prevent flare-ups.
    • Examples include Mucomyst

Other Treatments

  • Oxygen
    Not everyone who has COPD needs to “be on oxygen.” However, if you have lung damage from COPD and have low oxygen levels in your blood, you may need supplemental oxygen to keep your oxygen levels up. Home oxygen, like other treatments for COPD, is not a cure but it can help improve your quality of life and help you live longer. If your doctor prescribes you home oxygen, it is very important to treat it like any other medication prescription. This means that you must use your home oxygen as your doctor prescribes and use the flow rate and frequency he or she recommends. For some people, this might mean using oxygen all day, for others it might mean using oxygen only at night or while exerting yourself (like when you’re walking or moving a lot).

    Home oxygen does not replace other treatments you may have been prescribed. It is an additional treatment to your other prescriptions of inhalers and/or pulmonary rehabilitation. It means your home oxygen & other prescriptions go hand-in-hand. If it is determined that you need home oxygen to improve your blood-oxygen levels, you will need to talk to a home oxygen company’s health care professional to determine what equipment is best for you. Oxygen therapy is generally delivered as a gas from a cylinder or concentrator. Most often you will be on oxygen through small nasal prongs that fit into your nostrils, but sometimes you may need to use a mask that covers your mouth and nose. Breathing in this extra oxygen raises low blood-oxygen levels, eases the strain on your body and makes breathing easier.

    Your body cannot store oxygen, so the therapy works only while you use it. If you take off your oxygen mask or remove the prongs, your blood oxygen level will drop within a few minutes. Like any other prescription medicine, oxygen must be used carefully and properly. You need to follow instructions and follow all the safety precautions. If you have any questions about proper use of your inhalers or other treatments, be sure you ask someone from your COPD team.

    Saskatchewan residents who meet specific criteria for home oxygen may have oxygen funded through the Saskatchewan Aids to Independent Living (SAIL) government program. To learn more about Saskatchewan’ oxygen funding, visit our Lung Health Materials to download the Home Oxygen Brochure.

    People with Treaty Status in Saskatchewan have oxygen funding covered through the Non-Insured Health Benefits (NIHB) program through the Federal government.
     
  • Vaccines
    Vaccines (shots) for flu and pneumonia help protect you against these illnesses and lower your chance of a flare-up. You need to get a flu shot every year. Most people only need the pneumonia shot once, but some might need a booster (a second dose). Ask your doctor if you need a booster.
    • Examples of pneumonia vaccines include Pneumovax 23, Prevnar® 13

The COVID-19 vaccine is also recommended for people with COPD to protect yourself. Check with your health care provider or local public health office to determine when you should be receiving these vaccines.

COPD medications come in various forms

•Diskus® • MDI (metered dose inhaler) • Ellipta® • nebulizer • oral inhalation • Turbuhaler® • Respimat® • Genuair® • Aerolizer® • Breezhaler® • Handihaler® • 

Watch these videos.


Products used to treat COPD include

AAdvair® Diskus® •Airomir® MDI •Anoro® Ellipta®  •Apo-Ipravent inhalation solution •Apo-Salvent MDI •Atrovent® HFA •BBaca Respiclick™ •Breo® Ellipta® •Bricanyl® Turbuhaler® •CCombivent® Respimat® •DDuaklir® Genuair® •FForadil® Aerolizer® •IIncruse® Ellipta® •Inspiolto® Respimat® •OOnbrez® Breezhaler® •PPMS-Fluticasone Propionate/ Salmeterol DPI •PMS-Ipratropium inhalation solution •SSanis-Salbutamol Inhaler HFA •Seebri® Breezhaler® •Serevent® Diskus® •Spiriva® Handihaler® •Spiriva® Respimat® •Striverdi® Respimat® •Symbicort® Turbuhaler® •TTeva-Combo Sterinebs •Teva-Ipratropium Sterineb •Teva-Salbutamol SteriNeb •Trelegy® Ellipta® •Tudorza® Genuair® •UUltibro® Breezhaler® •VVentolin® Diskus® •Ventolin® HFA •Ventolin® inhalation solution •WWixela® Inhub® •

Active ingredients used to treat COPD include

aaclidinium bromide • amoxicillin • cclavulanic acid • fformoterol fumarate • gglycopyrronium bromide • guaifenesin • iindacaterol maleate • ipratropium bromide • oolodaterol hydrochloride • oxtriphylline • pprednisone • rroflumilast • ssalbutamol sulphate • salmeterol xinafoate • tterbutaline sulfate • theophylline • tiotropium bromide monohydrate • uumeclidinium bromide • vvilanterol trifenatate • 

Resources

Page Last Updated: 10/06/2021