Chronic obstructive pulmonary disease (COPD) medications can help you breathe more easily and improve your quality of life.
You take some types every day, but you use others for quick relief only when you need them.
"Figuring out the right COPD medication regimen often involves some trial and error, especially in advanced cases, as the response to treatment can vary from person to person," says Mahmoud Moammar, MD,director of the pulmonary program at Providence St. Joseph Hospital in Orange, Calif.
What Are the Different Types of COPD Medication?
Doctors can choose from among many different COPD medications.
They'll take into account things such as:
- How serious your condition is
- How often you have symptoms
- Whether you've had COPD flares
- Other health issues such as heart disease, osteoporosis, or diabetes
- Whether you smoke
They can also consider how you prefer to take your medicine and how well you use your inhaler.
Since the medications used to treat COPD have different purposes, you may need two or three kinds to ease your symptoms. Take your medications exactly as prescribed to make sure you get the most help from them. And be patient. "It can take days to weeks to see the response to treatment," Moammar says.
What Are Bronchodilators?
These drugs help the muscles around your airways relax so you can breathe more easily. You usually take them with a handheld inhaler, which releases the medication in puffs that you inhale. Sometimes, you might use a nebulizer instead. It runs on batteries or electricity and turns liquid medicine into a mist that you breathe in.
Bronchodilators can be:
Short-acting. They work fast and wear off in four to eight hours. You might use this kind before you do activities that make it harder to breathe or when you need fast symptom relief. If your COPD is mild, you may only need this type.
Long-acting. You use these daily to maintain symptom relief. They last between 12 and 24 hours, depending on the type. You may need both short-acting and long-acting bronchodilators if you have moderate to severe COPD.
There are three categories of bronchodilators: beta2-agonists, anticholinergics, and theophylline.
Beta2-agonists. There aretwo types:
Short-acting beta2-agonists (SABAs) include:
- Albuterol
- Levalbuterol (Xopenex)
Long-acting beta2-agonists (LABAs) include:
- Arformoterol (Brovana)
- Formoterol (Foradil, Perforomist)
- Indacaterol (Arcapta Neoinhaler)
- Olodaterol (Striverdi Respimat)
- Salmeterol (Serevent)
Beta2-agonists can make you feel shaky and speed up your heartbeat after you take them, but this usually only lasts for a few minutes. You may have trouble sleeping. These medications can also cause cramps in your hands, legs, and feet, but this isn't common.
Anticholinergics. Ipratropium (Atrovent HFA) is the only short-acting anticholinergic. Long-acting ones include:
- Aclidinium (Tudorza Pressair)
- Revefenacin solution (Yupelri)
- Tiotropium (Spiriva)
- Umeclidinium (Incruse Ellipta)
Theophylline. Thismedicine is not inhaled. You swallow it. Its brand names include:
- Elixophyllin
- Theo-24
- Theo-Dur
While you take it, you need to get your blood levels tested every once in a while. This helps your doctor make sure you're getting the right amount. Too much theophylline could cause severe side effects. You may notice you're shaky when you take theophylline. Get medical help right away if you have serious side effects such as:
- Extreme nausea
- Vomiting
- Irregular heartbeat
- Seizures
How Can Corticosteroids Help?
Also known as steroids, corticosteroids help calm the swelling in your lungs so it's easier to breathe. Most of the time, you use them with an inhaler or nebulizer. If you have a COPD flare-up, your doctor may give you steroid pills for a short time. That way, they can get into your system and start working faster.
Inhaled steroids include:
- Beclomethasone (Qvar)
- Budesonide (Pulmicort)
- Ciclesonide (Alvesco)
- Mometasone (Asmanex)
Side effects may include hoarseness, sore throat, and mouth or throat infections.
Oral steroids used for COPD include:
- DexPack (Dexamethasone)
- Methylprednisolone (Medrol)
- Prednisolone (Flo-Pred, Orapred, Pediapred, etc.)
- Prednisone
Your doctor will usually only give you steroid pills for a short time. That's because taking them too long can cause side effects, such as:
- Weight gain
- Bruising
- High blood pressure
- Swelling in your ankles or feet
- Osteoporosis (weak bones)
- Cataracts
- Mood changes
- Muscle weakness
- Higher blood sugar
- Increased risk of infection
COPD Medication for Combination Therapies
Sometimes your doctor may prescribe an inhaler or nebulizer that has more than one medicine in it.
Inhalers with both bronchodilators and inhaled steroids include:
- Budesonide and formoterol (Symbicort)
- Budesonide, formoterol, and glycopyrrolate (Breztri Aerosphere)
- Fluticasone and salmeterol (Advair/AirDuo RespiClick)
- Fluticasone and vilanterol (Breo Ellipta)
- Fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta)
- Formoterol and mometasone (Dulera)
Inhalers that contain more than one kind of bronchodilator include:
- Aclidinium and formoterol (Duaklir)
- Albuterol and ipratropium (Combivent Respimat)
- Formoterol and glycopyrrolate (Bevespi Aerosphere)
- Olodaterol and tiotropium (Stiolto Respimat)
- Umeclidinium and vilanterol (Anoro Ellipta)
When Are Antibiotics Used as COPD Medication?
If you have a bacterial infection in your lungs, such as bronchitis or pneumonia, your doctor may prescribe an antibiotic to help clear it up. These infections can make your COPD worse.
If you have frequent COPD flare-ups even though you use bronchodilators and steroids, your doctor might suggest regular use of an antibiotic called azithromycin (Zithromax) to reduce them.
The most common side effect is diarrhea . Less commonly, azithromycin can also cause:
- Itchy skin
- Flu-like symptoms
- Headache
- Upset stomach
- Vomiting
Let your doctor know if you notice any side effects.
What Are Phosphodiesterase Inhibitors?
Phosphodiesterase inhibitors are medicines that stop certain enzymes in your body, called phosphodiesterases (PDEs), from lowering the amount of a chemical called cyclic adenosine monophosphate (cAMP). This substance helps control muscle movement, heart function, and inflammation.
Your body has different types of PDEs in different areas, and each one does a specific job. For instance, PDE3 controls blood flow and clotting, while PDE4 affects inflammation in your lungs. When you take a phosphodiesterase inhibitor, the medicine relaxes the muscles around your airways, reduces swelling, and makes it easier to breathe.
Ensifentrine (Ohtuvayre) is an inhaled phosphodiesterase PDE3 and PDE4 inhibitor that you use twice a day to help keep your airways open. It comes in a nebulizer.
Taking ensifentrine sometimes causes side effects such as:
- Back pain
- Diarrhea
- Trouble peeing
Roflumilast (Daliresp) is a PDE4 inhibitor you take as a pill. If you live with severe COPD, your doctor might prescribe this to reduce flare-ups.
Side effects include:
- Weight loss
- Diarrhea
- Nausea
- Dizziness
- Muscle spasms
- Back pain
- Headache
- Extreme mood changes
- Thoughts of suicide
If you notice any side effects while taking this drug, tell your doctor right away.
How Do Mucolytic Drugs Work?
These medications thin your mucus so you can cough it up more easily. You can take them by mouth or inhale them. Sometimes, they're also given by IV (through a vein in your arm.)
Mucolytic drugs for COPD include:
- N-acetylcysteine (can be given in a nebulizer)
The most common side effects of the oral types are nausea, vomiting, upset stomach, diarrhea, and heartburn. The inhaled type can sometimes cause:
- Fever
- Nausea
- Vomiting
- Runny nose
- Clammy skin
- Irritation in your mouth, throat, or lungs
- Breathing difficulties
- Chest tightness
- Wheezing
Are There Over-the-Counter COPD Medications?
You need a prescription to get relief from most COPD symptoms. Over-the-counter inhalers aren't meant to be used for COPD.
If you have COPD-related pain, ask your doctor if it's a good idea to take nonprescription pain relievers such as aspirin or ibuprofen.
What Does the Future of COPD Medications Look Like?
Researchers keep looking for other drugs that might help treat COPD.
Cancer drugs. Some cancer drugs called ErbB inhibitors may help treat COPD in the future. One study showed they might lower inflammation and lung damage. But researchers need to do more studies to know if they really work for people with COPD.
Biologics. These drugs are made from living organisms, such as proteins. The FDA has approved a biologic drug called mepolizumab (Nucala) for COPD. It's known as an interleukin-5 (IL-5) antagonist and can be used to treat people with COPD who have high levels of eosinophils (a type of white blood cell) in their blood. This condition is known as eosinophilia.
Like other drugs such as benralizumab (Fasenra), dupilumab (Dupixent), and reslizumab (Cinqair), mepolizumab is also used in people with severe asthma who have eosinophilia.
Takeaways
COPD doesn't have a cure, but different medications can make you more comfortable. Some treatments are used daily so you can breathe more easily, while you may need others only when you're having a flare-up. You may need to try many medications, combinations, or dosages before you find a treatment that's right for you.
FAQs About COPD Medication
What was the first drug for COPD?
The first drug specifically used to treat COPD was isoproterenol, which doctors began prescribing through inhalers in the 1960s. Before that, treatment options were limited to antibiotics and low-dose theophylline.
What is the best medicine for COPD?
There's no single best medicine for COPD. The right treatment depends on your symptoms, health history, and how your body responds. Your doctor will choose the medicine that works best for you. You may need different treatments over time, especially if something such as air pollution or an infection causes a flare-up.
What are the three medication inhalers for COPD?
Three commonly prescribed medication inhalers for COPD treatment include:
- Budesonide/formoterol (Symbicort)
- Fluticasone/salmeterol (Advair)
- Fluticasone/umeclidinium/vilanterol (Trelegy)
What's the newest drug for COPD?
Among the newest drugs for COPD are ensifentrine (Ohtuvayre), approved in 2024 to relax airway muscles and reduce swelling, and mepolizumab (Nucala), a biologic approved in 2025 for adults with hard-to-control COPD that's linked to certain types of inflammation.
What is the best antibiotic for COPD?
There's no single "best" antibiotic for COPD. The right one depends on your age, health conditions, allergy history, and whether you have a bacterial infection or need to prevent a flare-up. Your doctor will choose the safest and most effective option based on your situation.
What is the best syrup for COPD?
A frequently used mucolytic syrup for COPD is carbocysteine, which helps loosen thick mucus and may also reduce inflammation in the airways. Your doctor can decide if this type of medicine is a good fit for your symptoms.
