What’s the Best Treatment for COPD?
Although COPD is irreversible, treatment can slow disease progression, reduce symptoms, prevent flare-ups and improve quality of life. What’s the best treatment for COPD? The following details updated treatment recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD):
Quitting smoking is the single most important intervention for all COPD patients who continue to smoke. Effective smoking cessation treatment may include:
- Nicotine replacement therapy – no matter which form you choose – nicotine gum, nicotine inhalers, nicotine nasal sprays, nicotine patches, under-the-tongue, nicotine tablets or nicotine lozenges – studies have shown that nicotine replacement therapy increases long-term abstinence rates in smokers. Talk to your health care provider about the proper use of these products to increase their effectiveness.
- Smoking cessation medications – Studies have found that Chantix (varenicline), Wellbutrin (bupropion) and Elavil (nortriptyline) increase long-term quit rates in smokers when combined with a supportive intervention program that includes counseling and quit smoking support groups.
- Behavioral counseling – all smokers who are motivated to quit should receive a referral from their health care provider to the most intensive smoking cessation counseling program available. Studies have shown that combining behavioral counseling with medication produces the most favorable results for smoking cessation.
Although no drug treatment has been found to modify the progression of lung function decline in COPD, COPD medications can help reduce symptoms and prevent complications. Some medications are taken as needed while others are taken on a regular basis.
- Bronchodilators – these medications increase a patient’s forced expiratory volume in one second (FEV1), or change other values related to spirometry, by relaxing and expanding the smooth muscle of the airways. There are three types of bronchodilators used in the treatment of COPD: beta2-agonists, anticholinergics and methylxanthines. Bronchodilators can be either short-acting or long-acting.
- Corticosteroids – regular treatment with inhaled corticosteroids (steroids) improves COPD symptoms and quality of life, increases lung function and reduces the frequency of COPD flare-ups. An inhaled corticosteroid combined with a long-acting bronchodilator is recommended on a routine basis for COPD patients who exhibit symptoms and are at high risk for flare-ups. Oral corticosteroids are only recommended during COPD flare-ups and only for brief periods of time.
- Phosphodiesterase-4 Inhibitors – these drugs suppress inflammation by blocking the action of PDE4, an enzyme that’s overproduced in COPD and asthma. Daliresp (roflumilast), the only drug in this class approved for the treatment of COPD, is a once-daily oral medication that has been shown to improve FEV1 in patients also treated with Serevent (salmeterol) or Spiriva (tiotropium) and reduce COPD flare-ups in patients with chronic bronchitis.
- Antibiotics – should only be prescribed for the treatment of bacterial infections associated with COPD flare-ups and other types of bacterial infections. Daily, prophylactic treatment with antibiotics is currently not recommended for the routine treatment of COPD.
- Flu and pneumonia vaccines – getting an annual flu vaccine reduces serious illness and death in COPD patients. Pneumonia vaccines lower the risk of pneumococcal pneumonia and are recommended for COPD patients 65 years of age and older and younger COPD patients with significant co-existing illnesses such as heart disease.
- Oxygen therapy – long-term oxygen therapy administered for more than 15 hours a day has been shown to increase survival in COPD patients with severe resting hypoxemia (low blood oxygen levels). Your health care provider may recommend long-term oxygen therapy if your oxygen saturation level, as measured by a pulse oximeter, is at or below 88% and/or your partial pressure of oxygen (PaO2), as measured by an arterial blood gas study, is at or below 55 mg Hg.
- Pulmonary rehabilitation – a formal pulmonary rehabilitation program reduces COPD symptoms, improves quality of life and increases participation in everyday activities. Along with exercise training, pulmonary rehab covers a wide range of problems in COPD not directly related to the lungs, including exercise de-conditioning, social isolation, altered moods (depression, anxiety), muscle wasting and weight loss.
- Surgical treatments – surgical options for COPD include lung volume reduction surgery (LVRS), bronchoscopic lung volume reduction (BLVR), lung transplant and bullectomy. Surgical intervention is generally reserved for a select group of patients with severe disease in whom standard medical treatments (inhalers, oxygen, pulmonary rehabilitation, etc.) have failed to improve symptoms.
The Bottom Line
COPD treatment should be individualized for each patient and guided by the severity of a patient’s symptoms, their risk of COPD flare-ups, availability of the medication and the patient’s response. To ensure you’re getting the best treatment for COPD, talk to your health care provider today.
Global Strategy for the Diagnosis, Management and Prevention of COPD – 2016. Updated December, 2015.
By Deborah Leader RN, BSN, PHN