Currently, there is no cure for chronic obstructive pulmonary disease (COPD). Therefore, treatment for COPD takes a multifaceted disease management approach. The major current directions of COPD management include: assessing and monitoring the disease, reducing risk factors, managing stable COPD, preventing and treating acute worsening of the disease, and managing associated illnesses.
Bronchodilators are medicines that relax smooth muscle around the airways, increasing the caliber of the airways and improving airflow, a major symptom of both chronic bronchitis and emphysema. Bronchodilators can reduce the symptoms of shortness of breath, wheeze and exercise limitation, resulting in an improved quality of life for people with COPD. These medicines do not slow down the rate of progression of the underlying disease. Bronchodilators are usually administered with an inhaler or nebulizer. There are two major types of bronchodilators: β2 agonists and anticholinergics.
β2 agonists & Anticholinergics
Anticholinergics appear to be superior to β2 agonists in COPD. Anticholinergics reduce respiratory deaths while β2 agonists have no effect on respiratory deaths. Each type may be either long-acting (with an effect lasting twelve hours or more) or short-acting (with a rapid onset of effect that does not last as long). β2 agonists cause smooth muscle in the airway to relax. There are several β2 agonists available. Salbutamol or albuterol (common brand name: Ventolin) and terbutaline are widely used short-acting β2 agonists that provide rapid relief of COPD symptoms. Long-acting β2 agonists (LABAs) such as salmeterol and formoterol are used as maintenance therapy and lead to improved airflow, exercise capacity, quality of life and possibly a longer life.
Anticholinergics cause smooth muscle in the airway to relax by blocking stimulation from cholinergic nerves. Ipratropium is the most widely prescribed short-acting anticholinergic drug. Like short-acting β2 agonists, short-acting anticholinergics provide rapid relief of COPD symptoms. A combination of the two is commonly used for a greater bronchodilator effect. Tiotropium is the most commonly prescribed long-acting anticholinergic drug for patients with COPD. It may have fewer side effects than other anticholinergic drugs. Regular use is associated with improvements in airflow, exercise capacity, quality of life and possibly a longer life.
Corticosteroids reduce inflammation in the airways, in theory reducing the lung damage and airway narrowing caused by inflammation. Unlike bronchodilators, they do not act directly on the airway smooth muscle and do not provide immediate relief of COPD symptoms.
Some of the more common corticosteroids are prednisone, fluticasone, budesonide, mometasone and beclomethasone. Corticosteroids are used in tablet or inhaled form to treat and prevent acute exacerbations of COPD. Inhaled corticosteroids have not been shown to beneficial for people with mild COPD as they have been for those with either moderate or severe COPD. Most people with COPD who use inhaled corticosteroids also use a long-acting bronchodilator, so inhaled corticosteroids are often combined with a LABA in the same inhaler. Theophylline is a bronchodilator that, in high doses, can reduce symptoms for some people with COPD.
Oxygen can be delivered in different forms: in large containers, in smaller containers with liquid oxygen, or with the use of an oxygen concentrator which derives oxygen from the air in the room. Supplemental oxygen does not greatly improve shortness of breath, but it can allow people with COPD and low oxygen levels to do more exercise and household activity. Long-term oxygen therapy for at least sixteen hours a day can improve the quality of life and survival for people with COPD and low blood oxygen and the complications from the disease. Lower oxygen flow rates are generally safer than high flow rates for individuals with severe COPD.
Pulmonary rehabilitation is a program of exercise, disease management and counseling, coordinated to benefit the individual with COPD. Pulmonary rehabilitation has been shown to improve shortness of breath and exercise capacity. It has also been shown to improve the sense of control patients have over their disease as well as their emotions. Being either underweight or overweight can affect the symptoms, degree of disability and prognosis of COPD. People with COPD who are underweight can improve their breathing muscle strength by increasing their calorie intake. When combined with regular exercise, pulmonary rehabilitation can lead to improvements in COPD symptoms.
Sudden worsening of COPD can be partially prevented. Infections are responsible for approximately half of COPD worsening, some of which can be prevented by vaccination against infections. Regular medication use can prevent some COPD worsening. LABAs, long-acting anticholinergics, inhaled corticosteroids and low-dose theophylline have all been shown to reduce the frequency of COPD worsening. The symptoms are treated using short-acting bronchodilators. A course of corticosteroids, usually in tablet or intravenous rather than inhaled form, can speed up recovery. Antibiotics are often used but will only help if the COPD worsening is due to an infection and may require hospital care.
Author’s Note: For further reading on COPD, see these useful references: