Managing COPD: Medicines for Long-term Control

You may need several types of medicine to manage your COPD symptoms. These medicines may include inhaled bronchodilators, corticosteroids, and antibiotics. They are given using inhalers or nebulizers, or as pills.

Woman holding inhaler, preparing to use it

Severity of symptoms

Your treatment is based on how severe your symptoms are. For example, if you have mild to moderate COPD, you may have shortness of breath once in a while. It may not get in the way of your daily activities. If you have moderate to severe COPD, you may have shortness of breath all day. This can make it hard to walk even a few steps.

Mild to moderate COPD. You may need short-acting "rescue" medicines only once in a while, when your symptoms get worse. These medicines give quick relief from symptoms. They don't keep symptoms from happening again.
Moderate to severe COPD. You will need to take "maintenance" medicine for long-term control if you have more severe symptoms and flare-ups. This is especially true if you need to stay in the hospital for a flare-up. You may also take short-acting rescue medicines regularly. Or you may use these if your symptoms get worse, even with long-term control medicines. You may also need other medicines, such as antibiotics or corticosteroids, by mouth if you have flare-ups. Antibiotics fight bacterial infections. Corticosteroids help ease inflammation and swelling in your airways. You may also be started on oxygen at home for a short-term or long-term period.

To prevent lung infections, ask your healthcare provider about flu and pneumonia vaccines. Also, ask about pulmonary rehab programs. These programs focus on strengthening exercises and improving your quality of life. Programs may also have health coaches to support and encourage you.

Long-acting controller medicines

Long-term control medicines work over a longer period of time. They help to control and prevent symptoms of COPD. They take longer to work, but they may last for 12 to 24 hours. Short-acting medicines work faster, but they may last for only 4 to 6 hours. You take most of these medicines with an inhaler or a nebulizer. You take some medicines by mouth.

Always use correct inhaler and nebulizer techniques for your prescribed medicine delivery system. Refer to the information that came with your medicine from the manufacturer. Or contact your healthcare provider if you have any questions about how to use the device, such as a metered-dose inhaler or nebulizer.

Bronchodilators

These medicines help relax the muscles around your airways so that they open up and allow more air through. There are both long-acting and short-acting bronchodilators. Here are types of long-acting bronchodilators.

Type of medicine	Examples	What it does	How it is taken	Notes
Beta 2-agonists	formoterol salmeterol	Helps relax the muscles around your smaller airways so you can breathe more easily	Inhaler or nebulizer	There are also short-acting forms for quick relief
Anticholinergics	tiotropium	Helps relax the muscles around your large airways so you can breathe more easily	Inhaler or nebulizer	There are also short-acting forms for quick relief
Methylxanthines	theophylline	Helps relax your airway muscles. They may also ease swelling in your lungs so you can breathe more easily.	By mouth	Not often prescribed

Inhaled corticosteroids

These medicines help ease swelling in your airways. After using corticosteroids in your inhaler or nebulizer, gargle and rinse out your mouth with water to prevent thrush, a fungal (yeast) infection. Spit the water out. Don’t swallow the water. If a mask was used, wash your face, especially around your mouth and nose, with warm water to prevent a skin rash.

Examples of these medicines are beclomethasone, budesonide, and fluticasone. They come as prefilled inhalers or as medicines taken by a nebulizer.

Combination medicines

There are also combinations of medicines that may be taken with an inhaler or a nebulizer. They may be a combination of a corticosteroid and a bronchodilator.

Taking your medicines

To get the relief you need, it's important to take your medicines correctly. Your healthcare provider or pharmacist can help. Follow these tips:

Use reminders to take your medicines on time. You might set an alarm on your phone or watch. Keep your medicines in a place where you spend a lot of time so that you will see them and be reminded.
Regularly look at how to correctly use your inhaler and nebulizer. Show your technique to your healthcare provider. It's very important to follow the correct techniques when using these devices.
All medicines have side effects. Know what to expect and which side effects to tell your provider about.
Get refills on time so that you don't run out of any of your medicines. When you travel, keep your medicines with you. Bring extra doses in case your return is delayed. If you're flying, keep your medicines in your carry-on bag.
Make a list of all your medicines, including all your inhaled medicines. Include the name, dose, why you take it, and when you take it. Make sure the list is always up-to-date.
Take your medicines or the list to each healthcare provider’s appointment and any hospital visits. Remember to update the medicine list and all copies after your visit. Be sure to add the date the list was last updated.
Consider wearing a medical alert bracelet or necklace.
If you smoke, talk to your healthcare provider for help quitting. This includes not using e-cigarettes. Smoking is a major cause of COPD.

Sample medicine list

Your name: ____________________ Date: ____________________
Medicine name	Dose	When to take	Purpose
Nebulizer medicine 1	0.25 mg/mL	Every 4 hours	Ease airway swelling
Inhaler medicine 1	25 mcg	Every 4 hours	Relax airway muscles
Pill 1	200 mg	Every 4 hours, as needed	Pain relief

Using an inhaler

You may use an inhaler for some of your medicines. The inhaler sends the medicine directly into your lungs. Make sure you know how to use your inhaler correctly. If you need help, ask your healthcare provider, nurse, or pharmacist.

Using your inhaler (no spacer)

A metered-dose inhaler sends a measured amount of medicine to your lungs. The medicine must be breathed deeply into your lungs for it to work.

Here’s how to use an inhaler:

First, wash your hands. Then, check the expiration date and the counter on the inhaler. Make sure the inhaler still has doses left. Also check that the metal canister is put correctly into the plastic boot.
Remove the cap from the inhaler mouthpiece. Shake the inhaler several times.
If this is the first time you are using the inhaler, you need to prime it. That means making sure it is ready to use. Follow the manufacturer’s instructions. Prime the inhaler in the air away from your face.
The inhaler is now ready to use.
Your healthcare provider will tell you whether to use the “closed-mouth” or “open-mouth” method.
Empty your lungs completely by taking a "deep breath in” and tilting your head back slightly and blowing air out.
For the “closed-mouth” method, put the inhaler mouthpiece in your mouth, past your teeth and above your tongue. Close your lips tightly around the mouthpiece to create a tight seal so the medicine doesn’t spray in your eyes.
Or for the open-mouth method, hold the inhaler up to your mouth, with the mouthpiece 2 finger-widths away from your lips.
Make sure you are standing up or sitting up straight in a chair. Always keep your inhaler at chin level.
Press down on the canister 1 time to release the medicine. At the same time, breathe in deeply and slowly for 3 to 5 seconds.
Remove the mouthpiece from your mouth if you are using the closed-mouth method. Or move it away from your mouth if you are using the open-mouth method. Then, close your lips.
Hold your breath for up to 10 seconds, if you can. Then breathe out slowly through your mouth.
Repeat these steps for each puff of medicine. Wait at least 15 seconds to 1 minute before taking the next puff, or as long as directed by your healthcare provider.
If you’re using a steroid inhaler, gargle and rinse with water to prevent thrush, a fungal (yeast) infection. Spit the water out. Don’t swallow the water. Clean your inhaler after every use or at least once a week or as directed by the manufacturer of the device.

Using your metered-dose inhaler with spacer

First, wash your hands. Then, check the expiration date and the counter on the inhaler. Make sure the inhaler still has doses left. Also check that the metal canister is put correctly into the plastic boot.
Remove the cap from the inhaler. Shake the inhaler several times.
If this is the first time you are using the inhaler, you need to prime it. That means making sure it is ready to use. Follow the manufacturer's instructions. Prime the inhaler in the air away from your face.
The inhaler is now ready to use.
Next, remove the cap and look into the mouthpiece of the spacer to make sure nothing is in it (the spacer).
Attach the spacer to the inhaler.
Remove the cap from the spacer mouthpiece.
Empty your lungs completely by taking a "deep breath in” and tilting your head back slightly and blowing air out.
Put the mouthpiece of the spacer in your mouth, past your teeth and above your tongue. Make sure your tongue doesn't block the opening of the spacer mouthpiece. Close your lips tightly around it to create a tight seal.
If you are using a spacer with a mask, make sure the mask covers your nose and mouth. There should be no space between your skin and the mask.
Make sure you are standing up or sitting up straight in a chair. Always keep your chin level.
Press down on the canister 1 time to release the medicine. Then breathe in slowly and deeply until all the medicine in the spacer is gone or as directed by your healthcare provider. If your spacer has a whistle built in, hearing the whistle means you are breathing in too quickly.
Remove the spacer mouthpiece from your mouth and close your lips.
Hold your breath for up to 10 seconds, if you can. Then breathe out slowly through your mouth.
Repeat these steps for each puff of medicine. Wait at least 15 seconds to 1 minute before taking the next puff, or as long as directed by your healthcare provider.
If you’re using a steroid inhaler, rinse and gargle with water to prevent thrush, a fungal (yeast) infection. Spit the water out. Don’t swallow the water. If a mask was used, wash your face, especially around your mouth and nose, with warm water to prevent a skin rash.
Clean your inhaler and spacer after every use or at least once a week or as directed by the manufacturer of the device.

Using a nebulizer

You may also use a nebulizer for some of your medicines. A nebulizer is a machine that sends medicine directly into your lungs. You add medicine to the nebulizer. It creates a fine mist that you breathe in using a mouthpiece or a mask. You can find the nebulizer at a medical supply company. The company or your healthcare provider will teach you how to use it. It's very important to clean the equipment and change the supplies as you are told. This is to make sure you don’t breathe in any germs.