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COPD Treatment: A Complete Guide

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Chronic obstructive pulmonary disease, or COPD, is a group of lung diseases that block the flow of air into and out of your lungs and makes it harder to breathe. A COPD diagnosis means you may have chronic bronchitis or emphysema, or both of these lung-conditions.

Although there’s no cure for this disease, and the lung damage can’t be reversed, there are treatment options available that can slow its progression and help you manage symptoms. Your doctor will determine what treatment plan is right for you based on your stage of disease and severity of symptoms.

The most important step you can take to manage your COPD and curb the progression of the disease is to quit smoking.

In fact, many people with COPD have mild forms of the disease for which little therapy is needed other than smoking cessation.

For more advanced stages, there are several effective therapies that can relieve symptoms, slow the decline of lung function, reduce your risk of complications and exacerbations, and improve your ability to lead an active life.

Prescription Medications for COPD 

There are a number of prescription medications available to manage COPD. Talk to your doctor about which options might be best for you.

Bronchodilators 

Bronchodilators relax the muscles that tighten around the airways. This allows the airways to expand, making it easier to breathe and alleviating coughing and shortness of breath. Most bronchodilators are delivered through an inhaler or can be nebulized so you breathe the medicine straight into your lungs.

Short-Acting Beta-Agonists This type of bronchodilator is used as a “rescue inhaler” for sudden bouts of shortness of breath, such as exercising.

They include:

  • albuterol (ProAir, Ventolin)
  • levalbuterol (Xopenex)
  • ipratropium (Atrovent HFA)
Long-Acting Beta-Agonists This type of bronchodilator is taken every 12 to 24 hours to consistently manage symptoms. These medications provide relief for many hours, but may take longer to start working. They include:

  • arformoterol (Brovana)
  • formoterol (Perforomist)
  • indacaterol (Arcapta Neoinhaler)

  • salmeterol (Serevent)
Short-Acting Anticholinergics Anticholinergics block a chemical that causes the airways to contract and can be either short-acting or long-acting. The medication lasts for four to six hours and starts working 15 minutes after using an inhaler.

  • ipratropium (Atrovent)
  • tiotropium (Spiriva)
Long-Acting Anticholinergics These starts working about 20 minutes after taking it and lasts between 12 and 24 hours, depending on the medication.

  • aclidinium (Tudorza Pressair)
  • tiotropium (Spiriva)
  • umeclidinium (Incruse Ellipta)

Theophylline

Not commonly used in the United States, theophylline is a bronchodilator in pill form. It requires blood level monitoring to make sure the drug level is high enough to be effective, but not high enough to cause serious side effects. Shakiness is a common side effect, but serious side effects may include severe nausea, vomiting, irregular heart beat, and seizures.

  • Elixophyllin
  • Theo-24

Corticosteroids (Steroids) 

These drugs help reduce swelling and mucus production in the airways, making it easier to breathe. Steroids usually involve an inhaler device but can also be taken as a pill for short periods of time if your symptoms are more severe. Long-term use can cause other health problems, including diabetes, weight gain, osteoporosis, cataracts, and making people more susceptible to infections.

  • budesonide (Pulmicort Flexhaler)
  • beclomethasone (Qvar)

Combination Medicines 

Sometimes COPD treatment involves an inhaler or nebulizer with a combination of bronchodilators and steroids, or more than one type of bronchodilator. For some individuals, a combination inhaler can act to both control current symptoms and prevent future symptoms.

Bronchodilator plus inhaled steroid:

  • fluticasone and vilanterol (Breo Ellipta)
  • fluticasone, umeclidinium and vilanterol (Trelegy Ellipta)
  • formoterol and budesonide (Symbicort)
  • salmeterol and fluticasone (Advair HFA, AirDuo Digihaler, others)
Multiple bronchodilators:

  • aclidinium and formoterol (Duaklir Pressair)
  • albuterol and ipratropium (Combivent Respimat)
  • budesonide Formoterol and glycopyrrolate (Breztri Aerosphere)
  • glycopyrrolate and indacaterol (Utibron)

  • olodaterol and tiotropium (Stiolto Respimat)
  • umeclidinium and vilanterol (Anoro Ellipta)

Phosphodiesterase-4 (PDE-4) Inhibitors

This oral medication reduces airway inflammation and is used to prevent worsening COPD symptoms. Roflumilast (Daliresp) is approved in the United States for people with severe COPD and symptoms of chronic bronchitis. Side effects may include diarrhea, weight loss, stomach pain, headache, and dizziness.

Ensifentrine (Ohtuvayre), approved by the U.S. Food and Drug Administration (FDA) in 2024 as a maintenance therapy for COPD, is designed to work as both a bronchodilator and an anti-inflammatory to ease breathing while also helping to clear mucus from the lungs. Ensifentrine accomplishes this by acting on two enzymes in the lungs — phosphodiesterase 3 and phosphodiesterase 4 — that play a role in managing airway inflammation and muscle movements in the lungs. The medication is delivered directly to the lungs through a standard jet nebulizer. Some common side effects included colds, elevated blood pressure, and back pain.

Antibiotics 

Bacterial or viral infections can lead to COPD symptom exacerbations, like intensified coughing, mucus production, and shortness of breath. Antibiotics, like azithromycin (Zithromax), can help treat those infections, but side effects and antibiotic resistance may limit their use.

Mucolytics

Mucolytics are used to break up mucus in the lungs, making it easier to cough up. It comes in oral, intravenous (IV), and nebulizer forms. Examples include:

  • guaifenesin (Mucinex)
  • mucolyte (bromhexine)
  • availnex (carbocysteine)
  • mucomyst (N-acetylcysteine)

Biologics

Biologics — which are made from living cells or components of living organisms, like proteins — are a newer class of medication for COPD that work by targeting parts of the immune system that contribute to chronic inflammation. In 2024, the FDA approved dupilumab (Dupixent) for COPD, making it the first-ever biologic for COPD.

Dupilumab is an injectable therapy for certain adults with poorly controlled COPD who have high levels of eosinophils, white blood cells that can cause inflammation in the lungs and trigger breathing problems. The drug isn’t approved as a stand-alone treatment, but as an “add-on” therapy, especially for people whose symptoms aren’t adequately controlled with inhaled medications.

Supplemental Oxygen 

If you have severe COPD and low levels of oxygen in your blood, you may require extra oxygen, or oxygen therapy, which is oxygen from a tank that’s provided through nasal prongs or a mask. This can help protect your organs from damage, improve your sleep, and help you become more active with fewer symptoms.

In severe cases, doctors may recommend a lung transplant or surgery to help improve your lung function.

There are three basic types of surgical options for COPD treatment:

Lung Volume Reduction Surgery (LVRS) This involves removing a portion of diseased lung tissue, then joining together the remaining tissue. It can help relieve pressure on the breathing muscles and improve lung elasticity and gas exchange, but only a small subset of patients are candidates for this procedure. They include individuals with advanced COPD, people younger than 75, and people who haven't smoked for at least six months and are unable to exercise well even after completing a pulmonary rehabilitation program.

Bullectomy People with a specific type of emphysema called bullous emphysema develop “air bubbles” (called bullae) due to the destruction of the walls between the air sacs in their lungs. In a bullectomy, the surgeon removes these bubbles. Surgeons typically operate on people who are struggling with symptoms despite treatment, or who have large areas of involvement in the lungs.

Lung Transplant If your COPD has caused severe, irreparable lung damage, your doctor may recommend a lung transplant. A lung transplant can improve your ability to breathe. But like any major operation, this procedure comes with risks and potential complications, including infection, organ rejection, and risks associated with anti-rejection drugs that are required following a lung transplant.

You can also ease COPD symptoms and slow the progression of the disease by taking some simple steps on your own. These include:

  • Participate in a pulmonary rehabilitation program. These personalized treatment programs typically combine COPD education, breathing strategies, exercise training, nutrition advice, and psychological counseling. Their goal is to help you stay active and carry out your everyday activities and improve your well-being. Talk to your doctor about referral to a program.
  • Get vaccinated. Respiratory infections are more dangerous when you have COPD. It’s especially important that you get all the recommended shots to prevent COVID-19, flu, and pneumonia.
  • Avoid lung irritants. The lungs of people with COPD are sensitive to certain irritating substances in the air. In addition to quitting smoking, also avoid exposure to secondhand smoke, exhaust fumes, strong perfumes, cleaning products, paint or varnish, excessive dust, and pollution.
  • Eat a healthy diet. Your body uses food as fuel for all of its activities, and that includes breathing. Talk to your doctor and a registered dietitian about diet changes that may help ease your COPD symptoms and increase your energy. Eating well can also help you maintain a healthy weight. Being overweight will make breathing even more difficult, while being underweight can leave you feeling weak and tired and more prone to lung infections.

The best way to prevent COPD is to never start smoking, and if you do smoke, to quit.

Smoking is responsible for up to 8 out of 10 COPD-related deaths, and 38 percent of U.S. adults diagnosed with COPD report current smoking.

Tobacco smoke triggers inflammation (irritation and swelling) that narrows the airways. Smoke also damages cilia (hairlike projections that line the airways) so they can’t do their job of removing mucus and trapped particles from the lungs.

If you have trouble quitting smoking, talk to your doctor about smoking cessation programs and products that can help you. Combining nicotine replacement with counseling, group support, and medication offers the best chance for success.

Other Ways to Reduce Your Risk of COPD

Smoking isn’t the only cause of COPD. As many as 1 out of 4 Americans with COPD never smoked cigarettes.

Long-term exposure to lung irritants — including secondhand smoke, air pollution, and chemical fumes or dusts from the environment or workplace — can also put you at risk of developing COPD.

Here are some tips to reduce your exposure to airborne irritants:

  • If you have a wood-burning stove or fireplace, make sure it’s well ventilated.
  • Stay indoors if there’s noticeable air pollution outside, such as smog or a nearby wildfire.
  • Make your home and work environment free from secondhand smoke.
  • If you work in an environment where you are exposed to chemical fumes and dust, speak with your supervisor about respiratory protective equipment and other ways to protect yourself.

Additional reporting by Julia Califano.

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