Treating COPD

Stop smoking

Stopping smoking is the main way for people with COPD to help themselves feel better and is the only proven way to reduce the rate of decline in lung function in people with COPD.

Stopping smoking at an early stage of the disease makes a huge difference. Any damage already done to the airways cannot be reversed, but giving up smoking can slow the rate at which the condition worsens.

If COPD is in the early stages and symptoms are mild, no other treatments may be needed. However, it is never too late to stop smoking. Even people with fairly advanced COPD are likely to benefit from quitting, which may prevent further damage to the airways.

Research has shown you are up to four times more likely to give up smoking successfully if you use NHS support along with stop-smoking medicines such as tablets, patches or gum. Ask your doctor about this or go to the NHS Smokefree website.

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If an inhaler is prescribed for you, your GP, practice nurse or pharmacist can explain how to use it. They will check you are using it properly. Most people learn to use an inhaler successfully, but if you are having problems, a spacer or a different type of inhaler device may help you take your medicines correctly. A spacer is a device that increases the amount of medication that reaches the lungs.

Short-acting bronchodilator inhalers

Short-acting bronchodilator inhalers deliver a small dose of medicine directly to your lungs, causing the muscles in your airways to relax and open up.

There are two types of short-acting bronchodilator inhaler:

  • beta-2 agonist inhalers, such as salbutamol and terbutaline
  • antimuscarinic inhalers, such as ipratropium

The inhaler should be used when you feel breathless and this should relieve the symptoms.

Long-acting bronchodilator inhalers

If a short-acting bronchodilator inhaler does not help relieve your symptoms, your GP may recommend a long-acting bronchodilator inhaler. This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours.

There are two types of long-acting bronchodilator inhalers:

  • beta-2 agonist inhalers, such as salmeterol and formoterol
  • antimuscarinic inhalers, such as tiotropium

Steroid inhalers

Steroid inhalers, also called corticosteroid inhalers, work by reducing the inflammation in your airways.

If you are still getting breathless or having flare-ups even when taking long-acting bronchodilator inhalers, your GP may suggest including a steroid inhaler as part of your treatment. Most people with COPD will be prescribed a steroid inhaler as part of a combination inhaler.


Theophylline tablets

If you are getting breathless or having flare-ups when using a combination of inhalers, your GP may prescribe theophylline tablets. Theophylline causes the muscles of your airways to relax and open up.

When you have been taking theophylline tablets regularly, you may need to give a blood sample to measure the amount of theophylline in your blood and help your GP prescribe the appropriate dose of tablet. This will allow you to get the correct dose of theophylline while reducing the likelihood of side effects.

Due to the risk of potential side effects, such as increased heart rate and headaches, other medicines, such as a bronchodilator inhaler, are usually tried before theophylline.

Mucolytic tablets or capsules

Mucolytics, such as carbocisteine, make the mucus and phlegm in your throat thinner and easier to cough up. They are particularly beneficial for people with a persistent cough with lots of thick phlegm or who have frequent or bad flare-ups.

Antibiotics and steroid tablets

If you have a chest infection, your GP may prescribe a short course of antibiotics.

Steroid tablets may also be prescribed as a short course if you have a bad flare-up. They work best if they are taken as the flare-up starts, so your GP may give you a course to keep at home. Occasionally, you may have to take a longer course of steroid tablets. Your GP will give you the lowest effective dose and monitor you for side effects. Side effects are not usual if steroid tablets are given for less than three weeks.

Read more about the medicines used in the chronic obstructive pulmonary disease medicines guide.

Other types of treatment

Nebulised medication

Nebulised medication can be used for severe cases of COPD if other inhaler devices have not worked effectively. A compressor is a machine that administers nebulised medicine through a mouthpiece or a face mask. The medicine is in a liquid form and is converted into a fine mist. This enables a large dose of medicine to be taken in one go.

You can usually choose whether to use nebulised medication with a mouthpiece or a facemask. Your GP will advise you on how to use the machine correctly.

Long-term oxygen therapy

If the oxygen level in your blood is low, you may be advised to have oxygen at home through nasal tubes, also called a nasal cannula, or through a mask. Oxygen is not a treatment for breathlessness, but it is helpful for some patients with persistently low oxygen levels in the blood.

You will probably be referred for more detailed assessment to see whether you might benefit from long-term oxygen therapy.

If you are prescribed long term oxygen therapy, it must be taken for at least 15 hours a day in order to be effective. The tubes from the machine are long so you will be able to move around your home while you are connected. Portable oxygen tanks are available if you need to use oxygen away from home.

The aim of long-term oxygen therapy is to extend your life.

Do not smoke when you are using oxygen. The increased level of oxygen produced is highly flammable, and a lit cigarette could trigger a fire or explosion.

Read more about home oxygen treatment.

Non-invasive ventilation (NIV)

Non-invasive ventilation (NIV) helps a person breathe using a portable machine connected to a mask covering the nose or face. You may receive it if you are taken to hospital because of a flare-up. You may be referred to a specialist centre to see if home NIV could help you. NIV is used to improve the functioning of your lungs.

Pulmonary rehabilitation programmes

Pulmonary rehabilitation is a programme of exercise and education designed to help people with chronic lung problems. It can increase your exercise capacity, mobility and self-confidence.

Pulmonary rehabilitation is based on a programme of physical exercise training tailored to your needs. It usually involves walking or cycling, and arm and strength-building exercises. It also includes education about your disease for you and your family, dietary assessment and advice, and psychological, social and behavioural changes designed to help you cope better. A rehabilitation programme is provided by a multidisciplinary team, which includes physiotherapists, respiratory nurse specialists and dietitians.

Pulmonary rehabilitation takes place in a group and the course usually lasts for about six weeks. During the course, you will learn more about your COPD and how to control your symptoms.

Pulmonary rehabilitation can greatly improve your quality of life.


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