Medications for COPD

Bronchodilators are a type of medicine you inhale, usually with an inhaler. They make breathing easier by relaxing the muscles in your airways helping them to open up.

Short-acting bronchodilator

• If you only get short of breath when you’re active, your doctor may give you a short-acting bronchodilator. This will help your breathing quickly and the effects last for four to six hours.

Long-acting bronchodilator

• If you’re breathless every day, you’ll be prescribed a long-acting bronchodilator. This may take longer to have an effect, but the effects last longer – 12 to 24 hours.
• There are two main types of long-acting drugs. They are called long-acting anti-muscarinic (LAMA) and long-acting beta agonist (LABA). Most people with COPD who are breathless will benefit from taking both kinds. Sometimes they come in separate inhalers and sometimes in combinations. You may get on better with one or another combination, but in general they are all thought to be equally effective.

If you have more than one or two flare-ups (exacerbations) of your COPD requiring treatment, you may also be given an inhaler with a small dose of steroid in it. This can help reduce inflammation and swelling in your airways. You’ll usually be given a combination inhaler – two or three medicines in one inhaler – with one or two bronchodilators and a steroid.

Steroid inhalers are also useful for people with COPD whose condition has asthma-like features: this includes varying day-to-day symptoms, a history of asthma or allergies, or higher levels of a type of white blood cell called eosinophils picked up as part of routine blood tests.

If you’re prescribed steroids for your COPD, you should always take them as prescribed. Do not stop taking your steroid inhalers just because you feel well. Not everybody with COPD needs to use inhaled steroids. Your health care professional should be able to explain to you why you are on them.

Steroid cards

If you are on a high dose of steroids, you should be given a steroid card from your GP. This is a card that lets health care professionals know you take steroids at a high dose.

For inhaled steroids, a high dose is defined as more than 1000 micrograms of beclomethasone (a steroid medicine) or equivalent. Most people, even if they are on inhaled steroids, do not require such a high dose. Ask your health care professional if you are unsure what dose you’re on.

Make sure you always carry your steroid card with you. If you have a carer, make sure they know you have a steroid card. If you lose it, you can get a replacement from your pharmacy or GP. It’s useful in emergency situations, as your body may not produce enough natural steroids to help you deal with illness or injury. In this situation, doctors will need to give you extra steroids when treating you.

If you’re given inhaled medicine to take regularly, it’s important you take it as prescribed, even if you feel well. This can also reduce the risks of a flare-up.

Inhaled medicine can be taken in different ways:

• dry powder inhalers (DPIs)– breathe in as hard as you can then hold your breath for ten seconds
• Soft mist inhalers – these produce an aerosol but use spring power instead of propellant
• pressurised metered dose inhalers (MDIs) – they produce a puff of medication like an aerosol – use a slow deep breath in and hold your breath for up to ten seconds
• with a spacer – these attach to pressurised metered dose inhalers (MDIs) to help you breathe in the drug more effectively
• nebulisers – these devices turn the medicine into a mist that you can breathe in. They’re normally only used in an emergency when you need large doses of inhaled medicine, such as during a flare-up.

It’s normal for COPD symptoms to vary a bit from day to day. But if you notice your symptoms are worse for two or more days, you’re having a flare-up (an acute exacerbation).

Your doctor may prescribe a rescue pack of drugs to keep at home in case you need them to treat a flare-up. Rescue packs include:

Steroid tablets

Steroid tablets can help you get better quickly during a flare-up but can cause side effects if taken at a high dose or for a long time. A supply of steroid tablets will normally last for five days, with the aim to reduce the inflammation in your airways.

Antibiotics

Antibiotics usually help if you have signs of a bacterial chest infection. This could be:

• becoming more breathless than normal
• coughing more than normal
• a change in colour or consistency in your phlegm (mucus).

Antibiotics won’t help if your chest infection is caused by a virus. It’s very important to only take antibiotics appropriately and when necessary. It’s usually a five-day course.

Mucolytics

If you cough up a lot of phlegm (mucus), you may be given a drug called a mucolytic as a tablet or syrup. This may make your phlegm thinner and easier to cough up.

You can read more about the mucolytic treatment carbocisteine on the NHS website.

Steroid inhalers can sometimes make your voice hoarse or give you a fungal infection, called thrush, in your mouth.

You can reduce the risk of side effects from inhalers by:

• using your inhaler correctly
• using a spacer with your MDI inhaler
• rinsing your mouth out after every time you use your inhaler.

Steroid tablets can help during flare-ups but cause side effects if taken at a high dose or for a long time. Longer courses of steroids should only be prescribed by a COPD specialist. You should be given the lowest effective dose and be closely monitored for side effects. Side effects of steroid tablets include increased appetite, difficulty sleeping, diabetes, weakening of the bones (osteoporosis), thin skin that bruises easily, cataracts and severe mood changes.

You and your doctor will decide together which medications you should use. If you’re concerned about side effects, or want to know more about your medication, ask your pharmacist, doctor or nurse.