Your COPD Medications Explained: How and Why They’re Used 

Your COPD medications might include those you take or inhale daily, some you take when your symptoms worsen, and vaccines you receive to help prevent certain diseases. 

Understanding why your healthcare team prescribes certain medications, when and how to take them, and potential side effects can be challenging. Another part of understanding your medications is learning how to use your inhaler or nebulizer so you get the right dose each time.

Your COPD medications can help reduce and prevent symptoms such as coughing and shortness of breath, decrease flare-ups, and help make daily activities easier.

The Food and Drug Administration (FDA) approved one of the newest medications for COPD in June 2024. Ensifentrine combines bronchodilator and nonsteroidal anti-inflammatory effects in one treatment. It’s taken through a nebulizer.

Here’s information about other COPD medications and how they work, based on guidelines from the Global Initiative for Chronic Obstructive Lung Disease 2024 GOLD Report, the American Lung Association, and the American Thoracic Society.

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Short-acting bronchodilators

Short-acting bronchodilators help open your airway, which helps you breathe more easily. Examples of these inhalers include albuterol (Proair HFA, Ventolin HFA), levalbuterol (Xopenex), and ipratropium (Atrovent).

These medications are often called “rescue inhalers.” This is because they work fast and are used when you’re experiencing sudden symptoms like shortness of breath. Short-acting medications only last 4 to 6 hours.

Long-acting bronchodilators

Long-acting bronchodilators also help improve breathing, but they work slower and help prevent symptoms longer than short-acting inhalers. Inhalers in this class include tiotropium (Spiriva), formoterol (Foradil), umeclidinium (Incruse Ellipta), and salmeterol (Serevent).

Because of how these inhalers work, they’re not used in an emergency situation where you need a fast-acting medication to treat sudden symptoms. These medications are inhaled once or twice daily.

Steroids

Steroids reduce swelling and inflammation in the lungs to help improve breathing. Steroids may be taken by mouth, injected, or inhaled.  

Steroid inhaler medication examples include budesonide (Pulmicort), beclomethasone (Qvar), and fluticasone (Flovent), which are inhaled several times a day.

If you have a COPD flare-up, your doctor may prescribe a short course of oral steroids, such as prednisone or dexamethasone, depending on your symptoms and condition.

Combination inhalers

Several COPD medications are available in a combination inhaler. These inhalers contain two long-acting medications inhaled once or twice daily to help prevent and control symptoms.

Budesonide/formoterol (Symbicort), fluticasone/salmeterol (Advair), fluticasone/vilanterol (Breo Ellipta), and umeclidinium/vilanterol (Anoro Ellipta) are a few examples. One medication, fluticasone/vilanterol/umeclidinium (Trelegy Ellipta), contains three long-acting medications.

A benefit of combination inhalers is that they reduce the number of medications you inhale each day, which may make it easier for you to remember to take your medications as your doctor prescribed. The number of times you inhale a combination medication will vary depending on the medication.

Phosphodiesterase-4 inhibitor

Roflumilast (Daliresp) is an oral medication that reduces inflammation, helping you breathe better. It’s often prescribed with long-acting inhalers to prevent symptom flare-ups.

Mucolytics

N-acetylcysteine (NAC) helps break down mucus buildup in your lungs and may decrease the number and severity of COPD flare-ups. NAC is inhaled using a nebulizer.  

Methylxanthines

Theophylline, the most well-known medication in this class, opens your airways to help you breathe more easily. It’s taken orally, and dosing will depend on immediate- or extended-release needs. Theophylline is usually used in combination with inhalers.

Antibiotics

Some antibiotics, such as azithromycin and erythromycin, may help reduce COPD flare-ups. These antibiotics are usually taken as pills but may also be given through the vein if you are admitted to the hospital.

Vaccines

Several different vaccines are recommended for people living with COPD. These include flu, pneumonia, RSV, tetanus/pertussis/diphtheria, COVID-19, and shingles. Vaccines reduce your risk of getting sick with certain infections and may help reduce future COPD flare-ups. Your doctor or pharmacist will work with you to determine which vaccines you need and also check to see which vaccines you have already received.  

Side effects

All medications have possible side effects. When taking a short- or long-acting inhaler, you may experience an increased heart rate, cough, trembling, dry mouth, runny nose, nervousness, or muscle cramping.

Oral steroids can cause trouble sleeping, as well as weight, blood sugar, blood pressure, and mood changes. Inhaled steroids may cause sore throat, a hoarse voice, and thrush (an oral yeast infection). 

You may experience upset stomach, shaking, headache, or trouble sleeping from theophylline. NAC may cause stomach pain, nausea, and vomiting.

While azithromycin and erythromycin can cause diarrhea, taking an antibiotic for too long might reduce how effective these medications are during future treatment sessions.

COPD medications taken by mouth may interact with some of the other oral medications you’re already taking. It’s important to keep an updated medication list with you whenever you visit your doctor or pharmacist. Your pharmacist and doctor will work together if an interaction is discovered.

If you notice swelling, irregular heartbeat, blurred vision, severe nausea or vomiting, or rash, stop using your medication and contact your doctor immediately. If you experience side effects, it’s important to tell your doctor right away. Some might be serious and need immediate attention.

Summary

There are many different medication options to treat COPD. Each of these medications is used for different reasons.

Your pharmacist or doctor will teach you how to correctly use your inhalers and answer any medication questions you have. It’s important to follow your doctor’s instructions on how to take each of your medications to help you manage your COPD symptoms and prevent future COPD flare-ups.