Medications to Reduce COPD Symptoms
Despite their fixed lung obstruction, many people with COPD also have some reversible airway obstruction that may respond somewhat to bronchodilators. A short-acting bronchodilator may be prescribed for occasional symptoms, while more frequent symptoms may call for a long-acting bronchodilator. The beta2 agonists and anticholinergics are used most often. The methylxanthine derivative theophylline is less effective than beta2 agonists, but it eases symptoms in some people with COPD.
If bronchodilators fail to relieve airway obstruction adequately, corticosteroids (both oral and inhaled) may diminish inflammation in some people. Corticosteroids are less effective for COPD than for asthma, however. In addition, the side effects of corticosteroids may be more severe in older people.
Because of the difficulty in predicting who will respond to corticosteroid therapy, it is common to institute a two- to three-week trial period of oral corticosteroids, used under careful monitoring and discontinued immediately if they show no benefit. For people who show improvement, the medications are tapered to the lowest effective dose.
The long-acting beta2 agonist Advair (salmeterol and fluticasone) has demonstrated mixed results for the treatment of COPD. Symbicort, a long-acting beta2 agonist that contains budesonide and formoterol, is also now available. Symbicort has been approved for the maintenance treatment of COPD. Both Advair and Symbicort are currently recommended only for individuals with severe COPD who experience frequent flare-ups.
In 2011, the FDA approved Daliresp (roflumilast), an oral medication taken once daily, to reduce the risk of COPD flare ups in people with severe chronic bronchitis with a history of exacerbations. It is intended to treat the symptoms of cough and excess mucus linked to bronchitis. It is not intended for treatment of emphysema.
Daliresp belongs to a class of drugs known as phosphodiesterase (PDE)-4 inhibitors. PDE-4 is an inflammation-causing enzyme that is thought to be overproduced in individuals with chronic bronchitis. Daliresp should be considered when first-line therapies are not tolerated or are not providing adequate benefit.
Expectorants (such as guaifenesin, found in Mucinex, Robitussin and other medications) may help loosen mucus secretions in the airways of some people; however, the objective evidence of their benefit is weak.
Although many COPD exacerbations are caused by viruses, antibiotics (such as azithromycin, tetracycline, ampicillin, erythromycin, and combinations of trimethoprim and sulfamethoxazole) are commonly prescribed when increased production of yellow or green phlegm signals a respiratory infection, which can aggravate COPD.
Although moderate worsening of symptoms can be treated at home, severe episodes require hospitalization. Recent evidence suggests that long-term use of a class of antibiotics known as macrolides may help prevent flares.