Medications for Chronic Obstructive Pulmonary Disease (COPD)

Bronchodilators

Common names include:

• Albuterol (Proventil or Ventolin inhalers)
• Salmeterol (Serevent inhaler)
• Terbutaline (Brethine tablets)
• Ipratropium bromide (Atrovent inhaler)
• Theophylline (Theobid duracaps, Theo-Dur, Slo-Bid, Uni-Dur)

These drugs work by relaxing the smooth muscles of the respiratory tract, which causes the bronchial passages to open, making breathing easier. Depending on the specific medication that is prescribed, these drugs may be taken by mouth, inhaled, injected, or given intravenously (into a vein).

In a recent review of 23 studies, salmeterol reduced episodes of worsening symptoms in patients with stable COPD who did not respond well to short-acting inhalers, like Albuterol. *1

Possible side effects include:

• Fast heartbeat
• Nervousness, trembling
• Headache
• Heartburn or nausea
• Insomnia

Corticosteroids

Common names include:

• Beclomethasone (Beclovent or Vanceril inhalers)
• Triamcinolone (Azmacort inhaler)
• Budesonide (Pulmicort inhaler)
• Flunisolide (AeroBid inhaler)
• Fluticasone (Flovent inhaler)

Corticosteroids reduce inflammation in the airway walls and are frequently used if airway obstruction cannot be kept under control with bronchodilators. They are often provided in an inhaled form that works directly on inflamed lung tissue. Few serious side effects are associated with their use if inhaled. In more advanced stages of COPD, corticosteroids may be prescribed in pill form; while this presents a greater risk of complications, the benefit to an individual seriously ill with COPD usually outweighs these risks. During severe flare of symptoms, or as COPD progresses, IV or oral steroids (such as prednisone) may be required.

Possible side effects from inhalation therapy include:

• Headache
• Dry throat or mouth
• Hoarseness
• Mouth or throat fungus (thrush)

In a review of 47 studies, researchers found that long-term use of inhaled corticosteroids did not slow the decline in lung function, nor did it reduce mortality from COPD. However, it did modestly reduce the number of exacerbations and slow the decline in overall quality of life.*2

Antibiotics

Common names include:

• Tetracycline or Doxycycline (Achromycin, Sumycin)
• Ampicillin or Amoxicillin (Polycillin, Amoxil)
• Trimethoprim-sulfamethoxazole (Bactrim, Septra)
• Clarithromycin (Biaxin)
• Azithromycin (Zithromax)
• Cephalosporin (Keflex, Ceftin, Cefzil)
• Erythromycin (Emycin, EES)
• Quinolone (Cipro, Levaquin)

Antibiotics kill bacteria and are used to treat infections that could further compromise breathing. They are frequently prescribed at the first sign of a respiratory infection, such as increased production of green or yellow sputum. They are usually taken by mouth for 7-10 days. Some are taken with food or on an empty stomach. It is usually best to avoid alcohol while taking antibiotics. Some antibiotics, such as tetracycline, should not be taken if you are pregnant.

Some of the more likely side effects include:

• Diarrhea
• Headache
• Stomach ache
• Sore mouth or tongue
• Vaginal itching due to growth of fungus or yeast
• Increased sensitivity to sunlight (tetracycline)
• Rash

A review of 21 trials found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days) in people with chronic bronchitis and mild-to-moderate COPD episodes.*3

Mucolytics, Expectorants, and Bland Aerosols

Common names include:

• Acetylcysteine (Mucomyst)
• Guaifenesin (Humibid LA, Robitussin, Duratuss G, Organidin NR)
• Saline, sodium bicarbonates

Mucolytics are drugs that help to dissolve mucus in the respiratory tract. They are given by inhalation of nebulization (aerosol) to reduce the thickness of respiratory tract fluid. The loosened material can then be coughed up more effectively.

Expectorants also help to thin mucus and phlegm. They are usually provided as capsules or as syrup.

Bland aerosols are made from solutions of salt or bicarbonate of soda. These aerosols, which thin and loosen mucus, are inhaled. Treatments usually last 10-15 minutes and are taken 3-4 times daily. Bronchodilators are sometimes added to the aerosols. Although some of these medicines are available over-the-counter, others require a prescription.

Possible side effects include:

• Diarrhea
• Dizziness
• Nausea

Diuretics

Common names include:

• Furosemide (Lasix)
• Hydrochlorothiazide (Esidrix, Dyazide, Maxzide)

Diuretics (water pills) help the body flush out excess fluid. They are prescribed to avoid excess water retention associated with the heart complications of COPD. You will be monitored closely while on diuretics to avoid dehydration and potassium imbalances that can lead to abnormal heart rhythms. Your doctor may also suggest dietary changes while you are taking diuretics. For example, you may be advised to increase your intake of orange juice or bananas, which are rich in potassium.

Possible side effects include:

• Dizziness or light headedness when getting up
• Muscle cramps or pain
• Diarrhea
• Loss of appetite
• Increased sensitivity to sunlight