Add-On Therapy for COPD: What to Ask Your Doctor

Having chronic obstructive pulmonary disease (COPD) can make it difficult to breathe. You may experience wheezing, coughing, chest tightness, and other symptoms that affect your everyday life.

While there's no cure for COPD, getting on treatment and making the right lifestyle adjustments can help you manage your symptoms and enjoy a good quality of life.

If you're diagnosed with mild COPD, quitting cigarettes if you smoke and avoiding secondhand smoke may be enough to control your symptoms. With moderate or severe COPD, your doctor will likely prescribe a medication to relax the muscles around your airway and improve your breathing.

Bronchodilators are sometimes the first line of defense for improving chronic coughing and shortness of breath. These include short-acting bronchodilators like albuterol (ProAir) and levalbuterol (Xopenex HFA). These are taken only as a preventive measure and before activity.

Long-acting bronchodilators for everyday use include tiotropium (Spiriva), salmeterol (Serevent Diskus), and formoterol (Foradil). Some of these bronchodilators may be combined with an inhaled corticosteroid.

These inhalers deliver medication directly to the lungs. They are effective, but depending on the severity of your COPD, a bronchodilator might not be enough to control your symptoms. You may need add-on therapy to improve your breathing.

What is add-on therapy?

Add-on therapy for COPD refers to any treatment added to your current one.

COPD affects people differently. A medicine that works for one person may not work for another. Some people have excellent results with only a bronchodilator inhaler. Others need additional treatment.

If your COPD worsens and you're unable to perform simple tasks without experiencing shortness of breath or coughing, add-on therapy might help control your symptoms.

There is more than one type of add-on therapy for COPD. Your doctor can recommend additional treatment based on the severity of your symptoms.

1. Add-on inhaler

Your doctor may prescribe another inhaler to take with your bronchodilator. These include an inhaled steroid to reduce inflammation in your airways. You can use a separate steroid inhaler, or a combination one that has the medication of a bronchodilator and steroid. Rather than using two inhalers, you only have to use one.

2. Oral medications

Inhaled steroids are recommended for people who experience frequent exacerbations of COPD. If you have acute flares, your doctor may prescribe an oral steroid for five to seven days.

Oral steroids also reduce airway inflammation. These aren't recommended for long-term use, given the number of possible side effects.

Another add-on therapy you can take with a bronchodilator is an oral phosphodiesterase-4 inhibitor (PDE4). This medication also helps reduce airway inflammation.

You can also take theophylline to relax the muscles around the airways. This is a type of bronchodilator used as an add-on therapy for COPD that isn't well-controlled. Sometimes it's combined with a short-acting bronchodilator.

3. Antibiotics

Developing a respiratory infection like bronchitis, pneumonia, or flu can make COPD symptoms worse.

If you have increased wheezing, coughing, chest tightness, and flu-like symptoms, see a doctor. You may need an antibiotic to treat the infection and relieve your COPD symptoms.

4. Oxygen therapy

Severe COPD may require supplemental oxygen to deliver extra oxygen to your lungs. This can make it easier to complete everyday activities without experiencing breathlessness.

5. Pulmonary rehabilitation

If you experience shortness of breath after exercising, climbing stairs, or exerting yourself, you might benefit from pulmonary rehabilitation. This type of rehab program teaches exercises and breathing techniques that strengthen your lungs and reduce breathlessness.

6. Mucus thinner

COPD can also increase mucus production. Drinking water and using a humidifier can thin or loosen mucus. If this doesn't help, ask your doctor about mucolytic tablets.

Mucolytic tablets are designed to thin mucus, making it easier to cough it up. Side effects of mucus thinners include sore throat and increased coughing.

7. Nebulizer

You may need a nebulizer for severe COPD. This therapy converts liquid medication into a mist. You'll inhale the mist through a face mask. Nebulizers deliver medication directly to your respiratory tract.

What are possible side effects of add-on therapy?

Before choosing an add-on therapy for COPD, make sure you understand the potential side effects of a particular treatment plan. Some are mild and subside as your body adjusts to the medication.

Possible side effects of steroids include a higher risk of infection and bruising. Long-term steroid use can also cause weight gain, cataracts, and an increased risk of osteoporosis.

Oral medications like PDE4 inhibitors may cause diarrhea and weight loss. Side effects of theophylline may include nausea, rapid heartbeat, tremors, and headaches.

How effective are add-on therapies?

The goal of COPD add-on therapy is to manage exacerbations. It can also slow disease progression.

People respond differently to treatments. You'll work closely with your doctor to find the add-on therapy that's best to control your symptoms. Your doctor may order a pulmonary function test to evaluate how well your lungs work, and then recommend an add-on therapy based off of these results.

Even though there's no cure for COPD, treatment can help people with the condition live a happy and full life.

Takeaway

If your COPD symptoms haven't improved with your current treatment, or are worsening, talk to your doctor. Add-on therapy taken with a bronchodilator may improve lung function, allowing you to live without persistent wheezing, coughing, or breathlessness.