COPD medications fall into 2 categories: 

• reliever medicines, taken during flare-ups (exacerbations) or for immediate relief of symptoms, and 
  
• maintenance medicines, taken every day, whether or not you have symptoms, to help make breathing easier over the long term.
  

Depending on the severity of your COPD, you may be prescribed short-acting or long-acting bronchodilators.

• If your COPD is mild, your doctor may prescribe a short-acting inhaled bronchodilator.
  
• If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators.
  
• If your symptoms aren't controlled with inhalers, your doctor may recommend taking tablets or capsules as well.
  

Inhalers

Inhalers are devices that deliver medicines directly into your lungs as you breathe in. There are several different inhaler devices for COPD. Not all inhalers are used the same way.

Your doctor, nurse or pharmacist can advise you on how to use your inhaler correctly and how often to use it.

Find out more about COPD medicine inhalers.

There are two types of short-acting bronchodilator inhaler:

• short-acting beta-2 agonists (SABAs) such as salbutamol (Ventolin, Asmol or Airomir) and terbutaline (Bricanyl Turbuhaler)
  
• short-acting muscarinic antagonists (SAMAs) such as ipratropium (Atrovent).
  

Short-acting inhalers last for 4–6 hours and are used for quick relief of symptoms or in emergencies. You may be prescribed both a SABA and a SAMA to use together.

Carry your reliever with you at all times. Ask your doctor, nurse or pharmacist about when and how often to use a quick reliever.

If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler may be prescribed to keep your airways open. This kind of medicine also helps reduce the risk of flare-ups.

Long-acting bronchodilators last about 12–24 hours, so they are used once or twice a day.

There are two types of long-acting bronchodilator inhaler:

• long-acting beta-2 agonists (LABAs) such as indacaterol (Onbrez Breezhaler), salmeterol (Serevent Accuhaler) and formoterol (Oxis, Foradile)
  
• long-acting muscarinic antagonists (LAMAs) such as tiotropium (Spiriva), glycopyronium (Seebri), umeclidinium (Incruse Ellipta ) and aclidinium (Bretaris Genuair).
  

If you have moderate COPD, you may be given either two separate inhalers or a combination of two different types of bronchodilators (a LABA plus a LAMA). These come as one inhaler in a fixed dose.

Some inhalers are indicated for the treatment of COPD but may not be listed on the Pharmaceutical Benefits Scheme.

These include Ultibro Breezhaler, Spiolto Respimat, Anoro Ellipta, and Brimica GenuAir.

If you have been prescribed a fixed-dose combination of medicines (a LABA plus a LAMA), you should stop taking any individual LABA or LAMA medicines you were using before.

If you have been prescribed a LAMA, you should stop taking any SAMA medicines you were using before.

Talk to your health professional about possible side effects such as shaky hands (tremors) and a rapid heartbeat.

If you have regular flare-ups of your COPD or you still have symptoms after using a long-acting inhaler, you may be prescribed an inhaled corticosteroid as part of your treatment.

This will most likely be a combination of medicines that includes a LABA (to relieve shortness of breath) and an inhaled corticosteroid (to reduce swelling of the airways). These should be taken daily, either once or twice depending on the medicine.

These medicines include Symbicort (Turbuhaler or Rapihaler), Seretide (Accuhaler or MDI) and Breo.

Some people who continue to have symptoms may need to move to a triple therapy treatment including an inhaled corticosteroid, a LABA and a LAMA.

Inhaled corticosteroids are also used in people whose condition is an overlap of COPD and asthma. They are not recommended to be used alone for the treatment of COPD.

Inhalers that contain only a corticosteroid include Flixotide (MDI or Accuhaler), QVAR, Pulmicort and Alvesco.

Side effects

• Inhaled corticosteroid medicines have side effects including sore throat, irritation of the tongue and mouth, and sore raised patches in the mouth (thrush).
  
• Other side effects from bronchodilator medicines may occur in some people, such as shaky hands (tremors) and a rapid heartbeat.
  

These side effects are less likely if you take your medicines as directed by your health professional and rinse your mouth out with water immediately after using your inhaler.

In some cases of severe COPD, methylxanthines such as theophylline may be prescribed. These medicines are less commonly used because they can interact with other medicines (such as some antibiotics) and can have serious side effects.

Medicines called phosphodiesterase type-4 inhibitors are sometimes prescribed for people with severe COPD and symptoms of chronic bronchitis who continue to experience moderate exacerbations after taking combination therapy.

Oral corticosteroids are designed to reduce inflammation in the lungs that leads to swelling and narrowing of the airways and are commonly used for short periods of time during flare-ups of COPD. Examples of these medicines are prednisone (Sone, Panafcort) and prednisolone (Solone, Panafcortelone).¹

In severe COPD which is difficult to control with inhaled treatment, lower doses of prednisolone may be used long term.²

Corticosteroids given as tablets can be life-saving medications, and in most situations the benefits of treatment far outweigh the possible disadvantages.²

Corticosteroid tablets have more side effects than the corticosteroids in combination inhaler medicines, but these side effects usually occur when the tablets are taken in high doses or for a long time.² If you need to take corticosteroid tablets for more than a short time, your health professional will prescribe the lowest dose necessary.

References

1. Lung Foundation Australia. COPD-X concise guide for primary care, 2020. [Online] .

2. Lung Foundation Australia. Corticosteroid therapy in respiratory disease. Milton, QLD: Lung Foundation Australia. [Online].

Antibiotics

You may be prescribed antibiotics, as needed, to treat flare-ups and lung infections that are caused by bacteria. If your infection is caused by a virus, antibiotics will not help you to get better.

Antibiotics may be prescribed if you have a fever, pneumonia and other signs of bacterial infection.¹

Find out more about antibiotics and COPD.

Mucolytics

Mucolytics are used to reduce the stickiness of mucus (sputum). They come in either a tablet or a liquid form.

References

1. Yang IA, Brown JL, George J, Jenkins S, McDonald CF, McDonald V, Smith B, Zwar N, Dabscheck E. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2020. Version 2.61, February 2020..

For more information on your medications, see the Consumer Medicine Information for your brand of medicine, available on our Medicine Finder page or from your pharmacist or doctor.

If you have any questions about medicines, you can speak to one of our pharmacists at NPS Medicines Line. 

Call  1300 633 424. 

You can ring Monday to Friday, 9 am to 5 pm, Australian Eastern Standard Time (excluding NSW public holidays).

For non-medicine products, further information may also be available from the manufacturer.

The MedicineWise smartphone app has been developed by NPS MedicineWise. It can help you keep an up-to-date list of all the medicines you take and get reminders on how and when to take your medicines.

Find out more about the MedicineWise app and how it can help you.