What medications have helped you the most

COPD: which drugs help?

This article was written according to journalistic and scientific standards and was reviewed by our medical advisor Prof. Dr. Ulrich Cegla (pulmonologist) checked.

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Last updated: 01/27/2020 | easier-breathe editorial team

New drugs have significantly improved the effectiveness of COPD therapy in recent years. But you, too, can contribute a lot to the success of the treatment.

With the help of medication, you can slow the progression of COPD and, in an emergency, get a quick breath. New combination preparations in particular show an improved effect. You can do a lot for the success of drug therapy yourself!

In this post we will show you

  • the basic drugs for COPD and their effects,
  • which drugs are important for an emergency,
  • what you can contribute to the success of the therapy and
  • which drugs are new on the market.

What medications will help you with COPD?

Depending on the severity and symptoms, different groups of active ingredients are used in COPD:

1. Bronchodilator drugs

 cure effective
long-lasting
Anticholinergics
z. B. ipratropiumz. B. tiotropium, aclidinium
Beta-2 mimeticsz. B. Salbutamolz. B. formoterol, salmeterol, indacaterol

 

Bronchodilator drugs - called bronchodilators - make up the Basis of COPD therapy. They widen your airways and thereby reduce shortness of breath and coughing.

Basically one can differentiate short- and long-acting bronchodilators:

  • Short-acting bronchodilators are drugs that are used when needed. If you have acute breathing difficulties, they will give you a quick breath.
  • Long-acting bronchodilators are used regularly in advanced COPD. They widen the bronchi permanently.

Also the active ingredient Theophylline is another option. It is used when the drugs from the group of long-acting bronchodilators cause side effects in a patient.

Why is that correct use of inhaled medication so important for COPD treatment? Pulmonologist Dr. Eckehard Frisch explains:

2. Anti-inflammatory drugs

Medications containing cortisone
e.g. budesonide, fluticasone, beclometasone
PDE-4 inhibitorsRoflumilast

 

Inhaled cortisone (ICS) inhibits the inflammatory processes in the airways. It thus helps to avoid acute worsening of COPD (exacerbations). Long-term administration of cortisone is only intended for patients with an increased risk of exacerbation.

When does cortisone help with COPD?

In addition to cortisone, the PDE-4 inhibitor also belongs Roflumilast (Daxas®) in the group of anti-inflammatory drugs. Roflumilast - given as a tablet - inhibits the production of the harmful enzyme PDE-4, which promotes inflammatory processes in the lungs. Roflumilast significantly reduces the number of exacerbations, particularly in COPD patients of the "blue bloater" type with a strong cough and a lot of sputum.

3. Expectorant drugs

Herbal expectorants (e.g. with the active ingredients N-acetylcysteine, ambroxol or cineol) can help you, especially in the winter months, to liquefy stuck secretions and to reduce the exacerbation rate. However, the guideline does not generally recommend the use of these drugs.

All COPD patients, however, will Measures to mobilize secretions recommended so that the bronchial mucus does not stick. Special respiratory therapy devices, so-called PEP systems (e.g. RC-Cornet® PLUS, Flutter VRP1®) help here. Regular training with these devices loosens the tough bronchial mucus and makes it easier to expectorate.

4. Emergency medication

If you suffer from severe shortness of breath, you need to act quickly. This also includes certain medicinal measures:

  1. First take two puffs of your short-acting reliever medication and wait for it to work.
  2. If there is no improvement after 5–10 minutes, inhale two more puffs and take a corticosteroid tablet (40–50 mg).

Breathlessness in COPD: what to do in an emergency?

 

5. Drug treatment of exacerbations

Cortisone: A severe exacerbation can lead to a life-threatening situation, especially at an advanced stage. The clinical emergency treatment provides for an increase in the basic therapeutic drug dose and the administration of high-dose cortisone in tablet form. The cortisone can be discontinued after 14 days or given in descending doses.

Properly treat exacerbations in COPD

 

Antibiotics: If you have a proven bacterial infection, you should be treated with antibiotics for one week. Due to the risk of developing resistance, the long-term administration of antibiotics is only indicated for very severe COPD and a high risk of exacerbation.

When are antibiotics used for COPD?

Tips for long-term treatment success

  1. Work confidently with your pulmonologist: For the treatment to be successful, an open and constructive conversation is important in order to adapt the drug therapy to your individual needs.
  2. Talk about your complaints openly and in as much detail as possible: How often and when do you cough? What color is your sputum? When does shortness of breath occur? Do you have pain?
  3. Prepare well for your specialist appointments: Observe the effects and possible side effects of the medication. Write down your findings and questions, which you will then discuss together at the next appointment.
  4. Never stop taking your medication on your own - This also applies if you are in a symptom-free phase of COPD.
  5. Avoid common mistakes when inhaling medication: Have your doctor or pharmacist show you how to use the prescribed inhalation system correctly. The use of an inhalation aid is recommended when inhaling with metered dose inhalers.
  6. Find out about theTreatment without drugs: In addition to drug therapy, other measures are decisive for the success of treatment in COPD!

New COPD drugs

Thanks to the development new combination preparations In recent years, better drug treatment options are available today than ever before. Combination preparations are drugs that combine different types of active ingredients in one drug. The prerequisite for the approval of such preparations is that they work better when combined than their individual components.

For COPD, several combination preparations have come onto the market in recent years that have been able to demonstrate such an additional benefit:

  • The combination of two long-acting bronchodilators (glycopyrronium and indacaterol) has proven to be an effective agent against exacerbations in studies (trade names Ultibro Breezhaler®, Xoterna Breezhaler®).
  • Triple therapy is also new on the market. The preparation combines two long-acting bronchodilators (formoterol and glycopyrronium) and the corticosteroid beclometasone. The drug with the trade name Trimbow® benefits patients who have an increased risk of exacerbation despite dual bronchodilation.
  • Patients who cough up thick mucus in the morning could benefit from a combination preparation with the active ingredients aclidinium and formoterol, which is taken twice a day (trade name Brimica® Genuair®).
  • There are currently also other drugs and new therapeutic approaches in the development. It goes z. B. to so-called CXCR-2 antagonists, which counteract the accumulation of neutrophils in the lungs.

Swell:

Vogelmeier, C. (et al.): S2k - guidelines for diagnosis and therapy of patients with chronic obstructive bronchitis and emphysema (COPD). Pneumology 2018; 72: 253-308.

Global Initiative for Chronic Obstructive Lung Disease: Global Strategy for the Diagnosis, Management and Prevention of COPD (2020 Report).

Lazaar, A.L. (et al.): E.ffect of the CXCR2 antagonist danirixin on symptoms and health status in COPD. In: European Respiratory Journal, October 2018, 52 (4).