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Medications for Chronic Obstructive Pulmonary Disease (COPD)

The content below is part of the “Health Library” and is not indicative of services available at the facility.

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. As such, ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor. Make sure to follow the instructions provided. If you have further questions about benefits, usage, or side effects, contact your doctor.

Numerous medications may be prescribed to treat COPD. These medications may be taken by mouth or inhaled into the lungs. Some work by opening the airways. Others are designed to reduce inflammation, or eliminate infections. The list below is a sample of some of these medications. Doctors may often choose drugs closely related to those listed. They may also choose combinations of drugs.

Prescription Medications

  • Bronchodilators
  • Corticosteroids
  • Phosphodiesterase 4 (PDE4) inhibitors
  • Oxygen therapy
  • Antibiotics
Bronchodilators

Short-acting inhaled bronchodilators include:

  • Beta2-agonists
    • Albuterol
    • Terbutaline
    • Fenoterol
  • Anticholinergics
    • Ipatropium
    • Oxitropium

Long-acting inhaled bronchodilators include:

  • Beta2-agonists
    • Salmeterol
    • Formoterol
    • Arformoterol
    • Indacaterol
    • Olodaterol
  • Anticholinergics
    • Tiotropium
    • Aclidinium
    • Umeclidinium
    • Glycopyrronium

These drugs work by relaxing the smooth muscles of the respiratory tract. This allows the bronchial passages to open, which makes breathing easier.

Possible side effects include:

  • Fast heartbeat
  • Nervousness, trembling
  • Heartburn or nausea
  • Insomnia
  • Constipation
  • Difficulty urinating
  • Dry mouth
  • Sore throat
Corticosteroids

Common names include:

  • Beclomethasone
  • Triamcinolone
  • Budesonide
  • Flunisolide
  • Fluticasone

Corticosteroids reduce inflammation in the airway walls. They are frequently used if airway obstruction cannot be kept under control with bronchodilators. Corticosteroids are usually provided in an inhaled form. This allows them to work directly on inflamed lung tissue. Few serious side effects are associated with their use if inhaled.

Possible side effects from inhalation therapy include:

  • Dry throat or mouth
  • Hoarseness
  • Fungal infection in the mouth or throat— thrush

Systemic corticosteroids, taken by mouth or by IV, may also be used to treat sudden worsening of COPD. However, long-term use in COPD is not usually recommended.

Phosphodiesterase 4 (PDE4) Inhibitors

Common names include:

  • Roflumilast

PDE4 inhibitors reduce lung inflammation by blocking the effects of specific inflammatory substances in the body. It also makes mucus easier to clear from the lungs and reduces the number of COPD exacerbations. It is generally used in people who have severe COPD. PDE4 inhibitors are taken by mouth once a day.

Possible side effects include:

  • Nausea
  • Diarrhea
  • Weight loss
  • Headache
  • Insomnia

Side effects that affect your mental health may include new or worsening depression or anxiety. NOTE: These drugs may increase the risk of suicidal thoughts or actions. If you have these feelings, call for emergency medical services right away.

Oxygen Therapy

Supplemental oxygen may be given in the hospital or as home oxygen therapy. There are several of oxygen delivery. A nasal cannula is a two-pronged device inserted in the nostrils. It is connected to a tube carrying the oxygen. The tube can rest on the ears, or be attached to the frame of eyeglasses. People who need a high flow of oxygen may use a mask.

Oxygen therapy raises low blood oxygen levels. This enhances your ability to tolerate exercise, and improves mental function. It also improves heart function and helps to prevent some of the heart complications of COPD. You may require oxygen only during waking hours, or you may need it at all times throughout the day. Make sure that you understand how many hours a day you should be using oxygen. It is important to follow the prescription closely.

If you are using supplemental oxygen, it is extremely important that you do not smoke cigarettes. You should also avoid all other sources of fire or flame, such as candles or gas stoves. These could produce an explosive reaction. You should also avoid drinking alcohol or sedatives, since these can slow your breathing rate.

While on supplemental oxygen therapy, contact your doctor if:

  • You develop a headache, blue lips, confusion, or agitation
  • Your breathing becomes very shallow
  • You are still very tired following slight exertion
Antibiotics
  • Tetracycline
  • Doxycycline
  • Ampicillin
  • Amoxicillin
  • Trimethoprim-sulfamethoxazole
  • Clarithromycin
  • Azithromycin
  • Erythromycin
  • Cephalosporins
  • Quinolones

Antibiotics are used to treat bacterial infections that could further limit breathing. They are frequently prescribed at the first sign of a respiratory infection, such as increased production of green or yellow sputum or fever. Usually, they are taken for 3-7 days. Your doctor may advise you to take them for a longer period to prevent flare-ups. Some are taken with food or on an empty stomach. It is usually best to avoid alcohol while taking antibiotics.

Some of the more likely side effects include:

  • Diarrhea
  • Abdominal pain
  • Sore mouth or tongue
  • Vaginal itching due to growth of fungus or yeast
  • Increased sensitivity to sunlight with tetracycline
  • Rash

Special Considerations

Talk to your doctor before using any over-the-counter medications if you have COPD.

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

When to Contact Your Doctor

Contact your doctor if you:

  • Have serious side effects, such as increased shortness of breath or signs of an allergic reaction, including swelling of the face, lips, or eyelids
  • Have prolonged nausea, vomiting, or diarrhea
  • Develop white spots in your mouth
  • Develop vaginal itching
  • Have severe or prolonged muscle cramps or heart palpitations

Revision Information

  • Beghè B, Rabe KF, Fabbri LM. Phosphodiesterase-4 inhibitor therapy for lung diseases. Am J Respir Crit Care Med. 2013;188(3):271-278.

  • Bronchodilators for COPD. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901285/Bronchodilators-for-COPD. Updated February 9, 2017. Accessed February 22, 2017.

  • Brown WM. Treating COPD with PDE 4 inhibitors. Int J Chron Obstruc Pulmon Dis. 2007;2(4):517-533.

  • COPD. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115557/COPD. Updated February 9, 2017. Accessed February 22, 2017.

  • Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017. Global Initiative for Chronic Obstructive Lung Disease website. Available at: http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd. Accessed February 22, 2017.

  • How is COPD treated? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/treatment. Updated July 23, 2013. Accessed February 22, 2017.

  • Inhaled corticosteroids for COPD. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T161710/Inhaled-corticosteroids-for-COPD. Updated February 9, 2017. Accessed February 22, 2017.

  • Managing your COPD medications. American Lung Association website. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/managing-your-copd-medications.html. Updated November 15, 2016. Accessed February 22, 2017.

  • Supplemental oxygen. American Lung Association website. Available at: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/diagnosing-and-treating/supplemental-oxygen.html. Updated November 15, 2016. Accessed February 22, 2017.

  • 1/13/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115557/COPD: Herath SC, Poole P. Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev. 2013;(11):CD009764.