Medications for COPD
Your doctor will decide with you which medications to use depending on how severe your COPD is, how it affects your everyday life, and any side effects you may have had.
They are a type of medicine you inhale that open up your airways to help you breathe more easily.
If you only get short of breath when you’re active, your doctor will give you a short-acting bronchodilator. This will help your breathing quickly and the effects last for 4 to 6 hours.
If you’re breathless daily, 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 version, but in general they are all thought to be equally effective.
Some people need to use inhaled steroids as part of their treatment. This is to reduce inflammation in the airways and reduce the risk of flare-ups or exacerbations. 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 whose condition is an overlap of asthma and COPD.
If you’re prescribed steroids for your COPD you take 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.
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 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 lose it, you can get a replacement from your pharmacy or GP. It is 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.
Taking your inhalers
If you are given inhaled medicine to take regularly make sure that you use it every day as prescribed, even if you feel well. This can also reduce the risks of a flare-up.
You can take your inhaled medicine in different ways. These include different sorts of inhalers:
- dry powder inhalers – breathe in as hard as you can and hold your breath for up to ten seconds or as long as you comfortably can
- pressurised metered dose inhalers – they produce a puff of medication like an aerosol – use a slow deep breath in and hold your breath for up to ten seconds or as long as you comfortably can
- spacers – these attach to pressurised metered dose inhalers 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 used in an emergency when you need large doses of inhaled medicine, such as during a flare-up. Most people don’t need such a big dose and get as much benefit from normal inhalers as long as they use them correctly with a spacer device
Do you know how to use your inhaler?
Your inhaler will only help if you use it correctly. Ask your doctor, nurse or pharmacist to show you how to use each type of inhaler you have and make sure they review your technique at least every year.
If you cough up a lot of sputum, you may be given a drug called a mucolytic as a tablet or syrup. This may make your sputum thinner and easier to cough up.
If you want to know more about your medication, ask your chemist, doctor or nurse.
Inhaled medications can sometimes cause a dry mouth, but it’s very uncommon to get serious side effects, as the doses are usually very small. Have a look at the leaflet that comes in the packet with them.
Inhaled steroids can sometimes make your voice hoarse or give you a fungal infection, called thrush, in your mouth. This is easy to treat. You can reduce the risk of this happening by using your inhaler correctly and rinsing your mouth out and spitting after every time you use it.
Steroid tablets can cause side effects, so it’s important not to take more than you need to control your condition and not to take them for longer than you need. Usually a 5-day course is long enough. Most people with COPD do not benefit from taking longer courses of steroid tablets. If necessary, you'll be given the lowest effective dose and monitored closely for side effects. Side effects include increased appetite, difficulty sleeping, diabetes, weakening of the bones (osteoporosis), thin skin that bruises easily, cataracts and severe mood changes.