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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Treatments For Chronic Obstructive Pulmonary Disease


September 10, 2014

Chronic Obstructive Pulmonary Disease
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Treatments For Chronic Obstructive Pulmonary Disease
Treatments For Chronic Obstructive Pulmonary Disease
htmCOPDTx
Treatment may include smoking cessation, use of an inhaler. corticosteroid therapy, antibiotic therapy or oxygen therapy.
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2011-09-02
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InteliHealth/Harvard Medical Content
2014-09-02

Reviewed by the Faculty of Harvard Medical School

Treatments For Chronic Obstructive Pulmonary Disease
First and foremost, if you have chronic obstructive pulmonary disease (COPD) and you smoke, the best treatment is to stop smoking.
Your health-care provider can prescribe bronchodilators that open (dilate) your narrowed airways. Calming down airway inflammation with medications, treating infections and avoiding irritants also help to clear the airways for easier breathing. Oxygen therapy and even surgery may be necessary for severe COPD.

 

Smoking Cessation
Once you stop smoking, your lungs will produce less mucus, as inflammation calms down. Initially, when you stop smoking, you may notice an increase in phlegm and cough as your lungs free themselves of leftover mucus and particles. Afterward, your breathing will get easier. Although the damage to your lungs (and possibly your heart) that has already been done cannot be repaired, further damage can be prevented. Limiting further damage can decrease your risk of dying of COPD.

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Inhalers
Medications can be inhaled through devices called inhalers. Using an inhaler to get the most benefit takes practice.
An inhaler can deliver several types of medications.
Beta-agonists relax the smooth muscles of the airways, allowing them to become wider. This makes breathing easier and facilitates the flow of mucus, which further reduces airway obstruction.
Examples of short-acting beta-agonists include albuterol, terbutaline and metaproterenol. Salmeterol (Serevent) and formoterol (Formadil) are long-acting beta-agonist. Because they last longer than other medications, they are especially helpful for people who have nighttime symptoms. Long-acting beta agonists should only be used when also using a daily inhaled corticosteroid.
Anticholinergics interfere with a chemical that causes the airways to constrict, and they decrease mucous production as well. Ipratropium bromide is a short-acting anticholinergic; tiotropium (Spiriva) is a long-acting anticholinergic.

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Corticosteroids
Corticosteroids can calm the immune system's response to airway irritation. These medications, which may be taken by mouth (prednisone) or inhaled (beclomethasone, fluticasone), are capable of reducing airway inflammation so there is less mucus production and phlegm. In general, corticosteroids are more effective for asthma than for COPD. However, a trial of inhaled corticosteroids in people with moderate or severe COPD is worthwhile. During a COPD flare-up, corticosteroids given by mouth at home or intravenously in the hospital can hasten improvement in symptoms.

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Antibiotics
When COPD worsens abruptly, it is often the result of a bacterial or viral infection. If your doctor suspects a bacterial infection, he or she will prescribe an antibiotic. If your doctor thinks the infection may be caused by the influenza virus, he or she may prescribe an antiviral medication to help kill the flu virus. To be effective, antiviral medication must be given within the first two days of flu symptoms. There are no direct antiviral medications for other adult cold and respiratory viruses.
If you have severe COPD and recurrent flare-ups caused by bacterial infections, your health care provider may suggest that you keep a supply of antibiotics at home to get quick treatment of infections. This way, you can immediately start treatment if you see your sputum change color or you develop fever with more than usual coughing.

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Oxygen Therapy
Oxygen therapy is helpful when blood oxygen levels fall below 89 percent, as measured by a blood test or pulse oximetry. Oxygen may come in a tank or it can be created with a machine called an oxygen concentrator. A plastic tube from the tank or machine carries the oxygen to your nose through nasal prongs or a mask that covers your mouth and nose.
Improvements in blood oxygen levels help relieve shortness of breath and improve mental and physical functioning. Use of oxygen therapy is associated with fewer hospital stays. It can improve overall well-being and prolong life in people with COPD by preventing strain on the heart.
Depending on your blood oxygen levels, your doctor may recommend oxygen therapy when you sleep, when you exert yourself and/or throughout the night and day.

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Other Treatments
Theophylline
Theophylline is an older bronchodilator (a medication that opens the airways) that was often used to treat asthma. In COPD, it helped to improve respiratory muscle strength. Theophylline is rarely prescribed today because it may be toxic if the level of drug in your blood gets too high. Also, it is less effective than other treatments. 

Roflumilast (Daliresp)
Roflumilast is a new oral drug that reduces inflammation in the lung. It is used in people with severe COPD with chronic bronchitis that have frequent flares (called COPD exacerbations).

Surgery
Surgery may be an option for some people with COPD. Two types of surgery that may be considered are lung-reduction surgery and lung transplantation.
Lung-reduction surgery is designed to remove areas of diseased lung from people with advanced emphysema. Lung function, exercise capacity and quality of life improve in some patients, but variable results, including death, make this procedure controversial. Thus, this treatment is not for everyone. Only some people benefit, and others may actually be worse after surgery.
Lung-transplant surgery removes diseased lungs and replaces them with healthy lungs from a donor. This surgery requires opening the chest. Transplant recipients must take immunosuppressants (medications that block the immune system) for the remainder of their lives. Transplant rejection and infection remain major risks after the surgery and may lead to death.

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