New Treatments for COPD: Inhalers, Surgery, and More

Long-acting bronchodilators

Long-acting bronchodilators are used for daily maintenance therapy to control symptoms. These medications relieve symptoms by relaxing muscles in the airways and removing mucus from the lungs.

Long-acting bronchodilators include salmeterol, formoterol, vilanterol, and olodaterol.

Indacaterol (Arcapta) is a newer long-acting bronchodilator. The Food and Drug Administration (FDA) approved the drug in 2011. It treats airflow obstruction caused by COPD.

Indacaterol is taken once daily. It works by stimulating an enzyme that helps muscle cells in your lungs relax. It starts working rapidly, and its effects can last a long time.

This drug is an option if you experience shortness of breath or wheezing with other long-acting bronchodilators. Possible side effects include coughing, runny nose, headache, nausea, and nervousness.

Your doctor may recommend a long-acting bronchodilator if you have both COPD and asthma.

Short-acting bronchodilators

Short-acting bronchodilators, sometimes called rescue inhalers, aren't necessarily used every day. These inhalers are used as needed and provide fast relief when you have breathing difficulties.

These types of bronchodilators include albuterol (Ventolin HFA), metaproterenol (Alupent), and levalbuterol (Xopenex).

Anticholinergic Inhalers

An anticholinergic inhaler is another type of bronchodilator for the treatment of COPD. It helps prevent muscle tightening around the airways, too.

It's available as a metered-dose inhaler, and in liquid form for nebulizers. These inhalers can be short-acting or long-acting. Your doctor may recommend an anticholinergic if you have both COPD and asthma.

Anticholinergic inhalers include tiotropium (Spiriva), ipratropium, aclidinium (Tudorza), and umeclidinium (available in combination).

Combination inhalers

Steroids can also reduce airway inflammation. For this reason, some people with COPD use a bronchodilator inhaler along with an inhaled steroid. But keeping up with two inhalers can be an inconvenience.

Some newer inhalers combine the medication of both a bronchodilator and a steroid. These are called combination inhalers.

Other types of combination inhalers exist, too. For example, some combine the medication of short-acting bronchodilators with anticholinergic inhalers or long-acting bronchodilators with anticholinergic inhalers.

There's also a triple inhaled therapy for COPD called fluticasone/umeclidinium/vilanterol (Trelegy Ellipta). This medication combines three long-acting COPD medications.

Roflumilast (Daliresp) helps decrease airway inflammation in people with severe COPD. This medication can also counteract tissue damage, gradually improving lung function.

Roflumilast is specifically for people who have a history of severe COPD exacerbations. It isn't for everyone.

Side effects that can occur with roflumilast includes diarrhea, nausea, back pain, dizziness, decreased appetite, and headache.

Some people with severe COPD eventually need a lung transplant. This procedure is necessary when breathing difficulties become life-threatening.

A lung transplant removes a damaged lung and replaces it with a healthy donor. However, there are other types of procedures done to treat COPD. You may be a candidate for another type of surgery.

Bullectomy

COPD can destroy the air sacs in your lungs, resulting in the development of air spaces called bullae. As these air spaces expand or grow, breathing becomes shallow and difficult.

A bullectomy is a surgical procedure that removes damaged air sacs. It can reduce breathlessness and improve lung function.

Long volume reduction surgery

COPD causes lung damage, which also plays a role in breathing problems. According to the American Lung Association, this surgery removes about 30 percent of damaged or diseased lung tissue.

With damaged portions removed, your diaphragm can work more efficiently, allowing you to breathe easier.

Endobronchial valve surgery

This procedure is used to treat people with severe emphysema, a form of COPD.

With endobronchial valve surgery, tiny Zephyr valves are placed in the airways to block off damaged parts of the lungs. This reduces hyperinflation, allowing healthier sections of your lungs to work more efficiently.

Valve surgery also reduces pressure on the diaphragm and lessens breathlessness.

COPD is a condition that affects about 16 million people worldwide. Doctors and researchers are continually working to develop new medications and procedures to improve breathing for those living with the condition.

Clinical trials are evaluating the effectiveness of biologic drugs for the treatment of COPD. Biologics are a type of therapy that targets the source of inflammation.

Some trials have examined a drug called anti-interleukin 5 (IL-5). This drug targets eosinophilic airway inflammation. It's been noted that some people with COPD have a large number of eosinophils, a specific type of white blood cell. This biologic drug may limit or reduce the number of blood eosinophils, providing relief from COPD.

More research is needed, though. Currently, no biologic drugs are approved for the treatment COPD.

Clinical trials are also evaluating the use of stem cell therapy for the treatment of COPD. If approved in the future, this type of treatment could be used to regenerate lung tissue and reverse lung damage.

COPD can range from mild to severe. Your treatment will depend on the severity of your symptoms. If traditional or first-line therapy doesn't improve your COPD, speak with your doctor. You may be a candidate for an add-on therapy or newer treatments.