Patients with Chronic Obstructive Pulmonary Disease (COPD) may use one or more drugs in addition to their maintenance drugs, steroids and bronchodilators, to help prevent or control their symptoms.
Steriods
Steroids, also called corticosteroids or glucocorticoids, are medications that help reduce the swelling and inflammation in the airways of the lungs. Steroids are used to prevent and control exacerbations in people with severe COPD, rather than for quick relief of symptoms.
Inhaled steroids work best for controlling symptoms and preventing exacerbations, times when symptoms flare up. Your doctor may prescribe regular use of inhaled steroids if you have severe to very severe COPD, particularly if your symptoms are not controlled with bronchodilators. Some doctors start by prescribing a short course of steroids to see if your symptoms improve. Then, if it does control your symptoms, the dose will be tapered down to find the lowest dose that works while minimizing side effects.
When used to control an exacerbation, steroids are usually taken as pills, referred to as oral steroids, or delivered through a vein, called intravenous steroids. The steroid can shorten the time it takes to restore your lung function and may help you avoid having another exacerbation right away.
Benefits
Inhaled steroids may help patients with severe, otherwise uncontrolled COPD reduce the number of times they have exacerbations. Steroids do not appear to improve the overall decline of lung function. Unlike with asthma, steroids do not immediately reverse COPD symptoms.
When used to control an exacerbation, a steroid can shorten the time it takes you to recover lung function and may help you avoid having another exacerbation right away.
The side effects of steroids depend on your dose, how long you use them, and whether you’re using inhaled steroids or taking pills. Inhaled steroids usually cause the fewest side effects, because the medication stays in the lungs and very little of it enters the blood stream.
The most common side effects of inhaled steroids are a sore mouth, hoarse voice, and infections in the throat and mouth. The most common side effect is called thrush, which is a yeast infection in the mouth. You can reduce your chance of getting these side effects by gargling and rinsing your mouth with water after inhaling a dose of steroids.
Oral steroids have many more side effects than inhaled steroids. Short-term use may cause a bigger appetite, stomach upset, fluid retention, mood swings, or changes in blood sugar and blood pressure. Most patients will not experience all of these side effects.
Long-term use of steroids may cause more serious side effects, like high blood pressure, thinning bodies, cataracts, muscle weakness, easier bruising, and slower wound healing. For this reason, long-term use of oral steroids is not recommended for the treatment of COPD.
Vaccines, Antibiotics, Alpha-1-antitrypsin & Expectorants for COPD
Vaccines for flu and pneumonia are important for preventing viral lung infections. Antibiotics are used to treat bacterial lung infections. Alpha-1-antitrypsin therapy can help certain young COPD patients, if they cannot produce this protein on their own. Other agents, called expectorants, may be used for loosening mucus and moving it out of the airways.
Vaccines to Prevent Common Lung Infections
Vaccines are used regularly to help reduce the chance of getting lung infections. This is especially important for people with COPD, who are more vulnerable to infections that affect their lungs. COPD patients are advised get a flu shot every year. Most doctors also recommend that COPD patients also have a current pneumococcal vaccine, which protects them for several years from several types of bacteria that cause pneumonia.
Antibiotics to Treat Bacterial Infections
Bacterial infections in the lungs can contribute to flare ups, also called exacerbations, of symptoms in people with COPD. The color of your mucus may indicate whether an infection is bacterial or viral. Remember: Only bacterial infections can be treated with antibiotics. Antibiotics may be prescribed to treat the infections, but their use is controversial, because of the risk of certain bacteria becoming resistant to antibiotics.
Expectorants to Loosen Mucus
Expectorants are medications that can help loosen your mucus by thinning the lung’s secretions. Expectorants can make it easier for some COPD patients to cough mucus out of their lungs. Although research has not shown them to be effective for all patients, your doctor may have you try an expectorant. If it helps manage your symptoms, you will likely continue using it. If not, you will discontinue it.
