Treatments for Moderate to Severe COPD

There’s no cure for chronic obstructive pulmonary disease (COPD). But there are things you can do to stay active, breathe easier, and live longer — even if your condition is more advanced.

Ask your doctor about all of your treatment choices. You might need medicine, pulmonary rehab, oxygen therapy, or lifestyle changes. Your health care team will work with you to figure out what’s best.

What Lifestyle Changes Should I Make?

If you smoke, quit. “There’s nothing that we can do, medically or surgically, that is going to be as beneficial to managing and improving your COPD as stopping smoking,” says Benjamin Seides, MD, medical director of interventional pulmonology at Northwestern Medicine Central DuPage Hospital. 

He says you’ll also want to do the following:

Avoid lung irritants at home and work.Eat healthy and stay active.Get vaccines for flu, COVID-19, and pneumococcal diseases. 

Which Medicines Help?

Your treatment depends on your symptoms. Tell your doctor how often you have flare-ups. Here are some common medications they might give you:

Bronchodilator. This is a drug that relaxes the muscles around your airways. You usually breathe it in through an inhaler.

You may need a short-acting version, or “rescue” inhaler, to ease shortness of breath when you have a flare-up. Each dose lasts about 4 to 6 hours. 

If you have symptoms a lot, a long-acting bronchodilator is a better choice. This drug lasts for about 12 hours. You may need to try more than class, or type, to find what works best.

When choosing the right bronchodilator, Carolyn Rochester, MD, medical director of the Yale COPD Program, says there are several things to consider. That includes the following: 

Your other health problemsUnwanted side effectsDrug availabilityHow well you breathe in medicine (peak inspiratory flow rate)What your health insurance will pay for

Tell your doctor if there’s something you don’t like about your treatment. They want to make sure your medicine is easy to use and it works as well as it should. “It’s something that has to be constantly assessed and reassessed at every visit,” Rochester says.

Combination therapy. You might need to use more than one bronchodilator at the same time. “Sometimes up to three inhalers,” Seides says. Each type treats COPD in a different way.

Your doctor might suggest a bronchodilator along with an inhaled steroid. Those are drugs that ease inflammation in your airways. Rochester says steroids aren’t right for everyone. But you might benefit from this kind of combination therapy if:

You have a lot of a lot of flare-ups.You also have asthma.You also have peripheral blood eosinophilia.

Antibiotics. Viral or bacterial infections can make it even harder to breathe. Your airways might swell and fill with mucus. But antibiotics can help you get better. You might feel better before you finish all your pills. But take these drugs exactly how your doctor tells you to. That’ll lower the odds of the infection coming back.

Other drugs. Less commonly, some oral medications are used to treat symptoms of COPD. That includes roflumilast and theophylline. Because of their side effects, Seides says, “They’re really held in reserve except in cases of really severe COPD.”

What Is Pulmonary Rehabilitation?

It’s a “medically prescribed exercise program” for people with COPD, Seides says. It’s designed to help you breathe easier while you do everyday things. But it can also improve your overall quality of life. 

Pulmonary rehab is helpful if you have stable disease, Rochester says. But if you try it within 3 months of a hospitalization for a COPD exacerbation, there’s evidence it can boost your odds of living longer and lessen the chances you’ll end up back in the hospital within a year.

You’ll get lots of good things from pulmonary rehab. But a big one is that it builds up the muscles that help you breathe, Seides says.

Here are some other things you’ll learn:  

Breathing techniquesInfo about your COPDNutrition tipsHow to manage anxiety and depression

You’ll work with a team of health care professionals. That might include the following: 

Pulmonary doctorsPhysical and respiratory therapistsExercise specialistsDietitians

You can also find other people with the same condition through pulmonary rehab. You might feel more comfortable exercising and learning about COPD around people who know exactly what you’re going through.

Should You Try Oxygen Therapy?

COPD can lower the amount of oxygen in your blood. “It puts a strain on your body — your brain, your heart, other organs of the body — when there is inadequate oxygen in the blood,” Seides says. 

Oxygen therapy flows through nasal prongs or a face mask. It’s something you can use on your own. But your doctor will tell you how often to wear it and what kind of device to get.

Supplemental oxygen might help: 

Lessen your breathing problems when you’re activeEase strain on your heart and other organsImprove your sleep and daytime tiredness

Rochester says that long-term oxygen therapy, used for about 15 hours a day, can help people with low blood oxygen live longer. She says short-term use, such as when you exercise, may improve symptoms for some people, but it hasn’t been linked with longer life.

Keep in mind that extra oxygen isn’t always necessary. In general, Seides says it’s not going to make your COPD symptoms better or improve your lifespan if your blood oxygen levels are naturally at 88% or above. But that’s something you can talk to your doctor about.

When Is Surgery Needed?

If nothing else helps, you may need lung surgery to breathe better. But these kinds of procedures don’t work for everyone. Your doctor will help you decide what’s right for you.

Here are two common types of surgery for COPD: 

Lung volume reduction (LVRS). Your doctor will cut out or deflate damaged lung tissue. That allows your healthy lung tissue to work better. It’s not a cure for COPD. But it can boost your lung capacity and make breathing easier.Bullectomy. Your doctor can take out big air sacs that don’t work anymore. This gives more space for the good parts of your lungs to work.

You may need a lung transplant. You can get healthy lung tissue from a donor. This might be an option if you have severe COPD and there’s nothing else your doctor can do to fix your lungs. A successful transplant can be lifesaving, Seides says, but it’s a major surgery. Your health care team can go over the pros and cons with you.

Ask About Clinical Trials

There’s ongoing research into COPD treatment. Let your doctor know if you’re interested in joining a clinical trial. Those are studies where you can test out new drugs and therapies.

Seides says there are new minimally invasive treatments in the pipeline. Some examples include:

Targeted lung denervationTargeted drug therapyTherapies that affect mucus glands in the lung

Be cautious of commercially advertised treatments, such as stem cell therapies. “These are not of any proven benefit,” Rochester says. “And in some cases, they could lead to risk of harm, including infections.”

Photo Credit: JadeThaiCatwalk / Getty Images

SOURCES:

Carolyn Rochester, MD, medical director, Yale COPD Program; medical director, Pulmonary Rehabilitation Program, VA Connecticut Healthcare System.

Benjamin J. Seides, MD, medical director, interventional pulmonology, Northwestern Medicine Central DuPage Hospital.

Journal of Aerosol Medicine and Pulmonary Drug Delivery: “Peak Inspiratory Flow Rate in Chronic Obstructive Pulmonary Disease: Implications for Dry Powder Inhalers.”

National Heart, Lung, and Blood Institute: “COPD,” “Pulmonary Rehabilitation.”

UpToDate: “Stable COPD: Initial pharmacologic management.”

American Lung Association: “Managing Your COPD Medications,” “The Basics of Pulmonary Rehabilitation,” “Surgery for COPD.”  

Respiratory Care: “Significance of Pulmonary Rehabilitation in Improving Quality of Life for Subjects With COPD,” “Oxygen Therapy in COPD.” 

JAMA: “Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-Year Survival Among Medicare Beneficiaries.”

BMJ: “Targeted lung denervation for moderate to severe COPD: a pilot study.”

Signal Transduction and Targeted Therapy: “Progress in the mechanism and targeted drug therapy for COPD.”

International Journal of Chronic Obstructive Pulmonary Disease: “Clinical issues of mucus accumulation in COPD.”

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