Improve breathing with copd

How to Improve Breathing With COPD

De-stress. Stress and COPD go together. Some people with COPD feel stressed and anxious about their breathing. Treating COPD effectively can help reduce this type of stress, Dr. Horovitz says. Exercise can also help you better cope with COPD and stress. Yoga is a great stress-reducing option. One study done at the Chicago Medical School at Rosalind Franklin University of Medicine and Science showed that people with COPD who practiced yoga for six weeks improved their quality of life and lung function, at least in the short-term range of the study.

Avoid all smoke. Smoking is the primary risk factor for COPD. In fact, up to 90 percent of COPD deaths are caused by smoking, according to the American Lung Association. “Stop smoking as soon as you can, and if you don’t smoke, don’t start,” Horovitz says. Aboussouan says that “even second- or third-hand smoking is something to avoid.” Secondhand smoke, of course, comes from other people smoking around you, and third-hand smoke refers to the smell of smoke left behind on surfaces, such as clothing, carpets, and in cars. Other airborne irritants to avoid include oven cleaners, spray polish, and other household cleaning agents, especially if they contain bleach or ammonia. Be aware that you might also react negatively to perfumed soaps, shampoos, and cosmetics.

Take your medication. COPD medications can help manage symptoms, including shortness of breath. “Make sure you’re taking the right medications and get evaluated to make sure your lung function is as good as it can be,” Horovitz says. “COPD-related lung damage can’t be reversed, but it can be controlled.”

Natural home remedies for COPD

The following home remedies and natural treatments can help people with COPD manage their symptoms and slow disease progression:

1. Quit smoking

Share on PinterestQuitting smoking can slow COPD progression.

Smoking is the leading cause of COPD in the United States and is responsible for around 90 percent of COPD-related deaths.

Tobacco smoke irritates the airways within the lungs. Inflammation and obstruction of the airways causes them to narrow, making it difficult for air to pass in and out.

According to a recent review, people with COPD who smoke have a more rapid decline in lung function, more complications, and an increased risk of mortality.

Smoking may also reduce the effectiveness of inhaled steroid medications that doctors use to treat severe COPD.

Quitting smoking is the most effective action that someone who smokes and has COPD can take to slow disease progression. People can see a doctor for advice on how to quit smoking, or they may visit for step-by-step guidance.

2. Improve air quality in the home

Certain irritants inside the home can make breathing more difficult for people with COPD. Common irritants include:

  • paints and varnishes
  • chemical cleaning products
  • pesticides
  • tobacco smoke
  • dust
  • pet dander

People can improve air quality in their home by:

  • limiting contact with household chemicals
  • opening windows to increase airflow
  • using an air filtration system
  • having air filtration systems cleaned regularly to prevent growth of harmful mold and mildew
  • vacuuming and removing clutter to prevent dust from building up
  • washing bed linens every week to reduce dust mites

3. Practice breathing exercises

Practicing breathing exercises aim to improve the symptoms of COPD by improving the muscles a person uses to take breaths and improve their ability to exercise.

A 2012 Cochrane systematic review compared groups of people with COPD who used breathing exercises with people who did not for 4–15 weeks.

Breathing exercises included:

  • Pursed-lip breathing. This is when a person inhales through their nose and exhales through tightly pursed lips.
  • Diaphragm breathing. This means contracting the diaphragm in order to breathe more deeply. The belly visibly expands while breathing in, and it deflates when breathing out.
  • Pranayama. This is a controlled breathing technique common in yoga practice. Pranayama involves concentrating on areas of the body involved in breathing.

The researchers found no differences in symptoms such as shortness of breath and quality of life, but people who used breathing exercises experienced improved exercise tolerance. Breathing exercises may help people with COPD who have difficulty exercising.

4. Manage stress levels

Share on PinterestEmotional stress can weaken the immune system and increase the risk of COPD flare-ups.

COPD can cause sudden symptom flare-ups, or exacerbations. Anxiety and depression may increase the risk of flare-ups. Engaging in stress management strategies will improve general health.

One study found that people with COPD who also had anxiety or depression were more likely to be readmitted to the hospital within 30 days of leaving. Emotional stress may weaken the immune system, increasing the risk of respiratory infections.

Mindfulness meditation may help reduce emotional distress. A small-scale 2015 study found that an 8-week mindfulness meditation course improved respiratory rate in people with COPD compared with the control group. People also reported improved emotional function after six classes.

5. Maintain a healthy weight

People with COPD who are underweight have a higher risk of mortality than people with COPD who are overweight. Researchers are still investigating the impact of obesity on COPD outlook.

People with COPD who are underweight are more likely to experience:

  • weakness in the breathing muscles
  • reduced ability to exercise
  • reduced lung capacity

According to a recent review, a balanced diet can help people with COPD by improving lung function. A balanced diet also has metabolic and heart benefits. People who are underweight may especially benefit from a nutritional diet high in calories, protein, and unsaturated fats.

This type of diet increases a person’s energy and helps build muscle when combined with exercise. However, more large-scale studies are needed before researchers understand the benefits of this diet for people with COPD.

6. Develop muscle strength

Many people with COPD have difficulty exercising because breathing is harder. However, avoiding exercise can worsen symptoms such as muscle weakness and fatigue.

The following exercises may help people with COPD improve muscle strength and increase exercise capacity:

  • Interval training. This entails alternating periods of high- and low-intensity exercise. Interval training is good for people with severe COPD, as it exercises muscles without overloading the heart and lungs.
  • Strength training. This uses resistance methods such as weights, resistance bands, and a person’s own body weight to increase muscle size and strength. Building up the muscles in the lower body can help improve shortness of breath.

Once a person begins to lose fitness, exercise becomes increasingly difficult, and lung function may worsen. People should therefore start an exercise regime at an early stage for the best benefits.

7. Water-based exercises

People with COPD may have muscle or bone conditions that make it more difficult to exercise. Water exercises place less stress on the body, which can make them easier and more manageable for people with COPD.

A 2013 study found that water-based exercises might increase a person’s exercise capacity and quality of life. In people with COPD and physical disabilities, water-based exercises were more effective than both land-based exercise and no exercise.

The researchers suggested that these effects might be due to the unique properties of water, which support body weight through buoyancy and provide resistance to increase exercise intensity.

What can you do to manage your COPD?

You can do a lot to help manage your condition yourself. Knowing all you can about your condition, your symptoms, your medications and how to cope with flare-ups will make your day-to-day life easier. Keeping active and doing exercise can make a big difference – many people find this helps them more than inhaled drugs.

This section explains the benefits of:

  • keeping active
  • learning how to control your breathing
  • eating well and keeping a healthy weight
  • taking care of your emotional wellbeing

Also find out what else you can do and where you can find more information on managing your condition.

“If you have a lung condition, you can’t sit around and wait for other people to take care of you – you need to take care of yourself! I fully believe you get out of it what you put in” Peter

Keeping active

If you have COPD, being active and exercising can help you to improve your breathing, fitness and quality of life. Don’t avoid activities that make you breathless: you’ll get less fit and out of breath more easily. Regular exercise can help reverse this by strengthening your muscles. Exercise also benefits your heart and blood pressure, and makes you less likely to develop conditions such as diabetes and osteoporosis (fragile bone disease).

There are many different ways to be active – find one that you might enjoy.

Some ideas for getting active

The best way to learn how to exercise at the right level for you is to take part in pulmonary rehabilitation. Ask your doctor to refer you.

There is strong evidence that people with COPD benefit from PR and exercise more generally. Remember again that it is not harmful to make yourself breathless.

Controlling your breathing

There are techniques and positions that can help you cope when you get out of breath and feel more in control of your breathing.

Some people with COPD who joined a singing group said singing helped them to manage their symptoms better.

Find out more and find a group near you

If you practise breathing techniques and use them every day, they’ll help you when you’re active or if you suddenly feel short of breath. Try different breathing techniques to find what helps you. There are also positions that can help you to practise breathing control or to control your breathing when you get breathless. Talk to your respiratory physiotherapist or nurse to find out what works for you.

Have a look at the techniques and positions

Top tips to manage your breathlessness

  • Use a towelling robe after showering or bathing, as you’ll use less energy than drying off with a towel.

  • Using a handheld battery-powered fan to blow air onto your face can help you to feel less breathless.

  • Plan your day in advance to make sure you have plenty of opportunities to rest.

  • Find simple ways to cook, clean and do other chores. You could use a small table or cart with wheels to move things around your home, and a pole or tongs with long handles to reach things.

  • Put items that you use frequently in easy-to-reach places.

  • Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.

  • Using a wheeled walking frame can make it easier to get around if you are short of breath.

Eating well and keeping a healthy weight

It’s important to eat a balanced diet and maintain a healthy weight. Your doctor or nurse can help you to work out what your healthy weight should be and can refer you to a dietician or local scheme to help you if necessary.

If you’re overweight it will be harder for you to breathe and move around.

If you’re losing too much weight because eating makes you feel breathless, or you find it difficult to shop and prepare meals, try to eat little and often. Ask your doctor or nurse about nutritional supplements

Read more information on eating well, maintaining a healthy weight and how your diet can affect your symptoms.

Take care of your emotional wellbeing

Living with a long-term condition can affect many aspects of your life. Physical symptoms such as breathlessness and coughing, feeling more tired and being less active can mean you feel stressed, anxious or depressed.

The risk of anxiety and depression is greater in people with more severe COPD, people who have been admitted to hospital, and those with low oxygen levels.

Treatment is available to support you. Many other people have experienced anxiety and depression and have recovered. They are both very normal reactions to living with COPD. Talk to your health care professional about medications and counselling.

Don’t bottle things up – talking to someone you trust, including your health care professional, can help. It’s very important to stay active and sociable, and to learn more about COPD. This will help you to understand and cope better with your condition. You might want to get involved with a local group to meet others going through a similar experience.

Have a look at our information about looking after your mental health.

Our support groups are for people living with a lung condition and their families. It’s a great way to get more information and make new friends.

You can find your local group here.

What else can I do to manage my COPD better?

  • Sleep and rest: make sure you sleep well and get enough rest every day. This will help with your energy levels. For advice about how to get a good night’s sleep, have a look at the . Talk to your health care professional if that doesn’t help.
  • Ask for help if you need it: ask your health care professional about ways you can adapt your home to help you move around more easily. An occupational therapist and your local council can help you with this.
  • Be aware of your symptoms: if your ankles swell, tell your health care professional. Medicines can help reduce this. But many people with COPD have other conditions, and leg swelling or a rapid heartbeat can be a sign of a heart condition.
  • Plan ahead: it’s important to talk to your doctor or nurse about longer-term treatments and advance care planning. This means thinking about what you would like to happen if your condition gets worse, or you experience more severe flare-ups, to help your family and your doctor to understand your wishes. Find more information on advance care planning and taking control of your choices.

Further information:

If you smoke, stopping smoking is the best thing you can do. Find out about the support you can get to help you stop smoking.

Sex and COPD

Having an illness like COPD can affect any relationship. It can make you feel tired, anxious or depressed. You might worry about sex if you are afraid that you will become too short of breath, or need to cough up sputum.

Your doctor, nurse or physiotherapist can help you to manage this, don’t worry about asking them. For example, discuss with them your questions about getting or maintaining an erection; urine leakages and the impact of other conditions you may have, such as heart problems.

More information on sex and breathlessness

Looking after someone with COPD

If you care for a family member or partner, it is important to continue to enjoy things together and for the person with COPD to keep as active and independent as they can.

Read our information for carers

Financial help

If you have COPD, or you care for someone who does, then you might be entitled to financial support.

Read about financial help here

Next: Managing COPD flare-ups >

Your doctor may prescribe more than one type of medication. Here are the most common types used to treat COPD:

Bronchodilators. This class of medications helps widen airways. These medications may make breathing easier and reduce the number of episodes if the disease acutely worsens. Your doctor is likely to first prescribe an inhaled bronchodilator. To take it, you breathe in using a device such as a metered dose inhaler, dry powder inhaler, or nebulizer. Metered dose inhalers (MDIs) use a chemical to push medication out of the inhaler.

You may need to combine more than one bronchodilator or use a combination product for the best results.

Examples of bronchodilators used as COPD treatment include:

  • Anticholinergic bronchodilators block acetylcholine, a chemical “messenger” that makes airways constrict. They may help you breathe easier and lower the number of acute episodes you have. They may be short-acting (used 4 times a day) or long-acting (used once daily).
  • Short-acting beta-agonists is a COPD treatment you may use if you have symptoms every once in a while, such as while exercising. They are used as needed for treatment of symptoms. They may also prevent a full-fledged attack when you feel shortness of breath coming on. Long-acting beta-agonists are available for twice daily use. You may still need to use a short-acting beta-agonist as a “rescue” therapy to quickly control a sudden attack.
  • Methylxanthines may be helpful for people who have trouble with inhaled medications. That’s because you can take them orally. However, this medication is used less often than in the past due to its side effects. Methylxanthines are tried in instances when, despite treatment optimization, symptoms still persist.

Corticosteroids. These medications may help reduce airway inflammation. Inhaled corticosteroids are mainly used in those whose symptoms are not well controlled with bronchodilators only. That’s because they work less well for COPD than they do for other lung problems such as asthma.

Daliresp. This is a pill that’s part of a new class of COPD treatment — it’s an inhibitor of an enzyme called phosphodiesterase type 4 (PDE-4). Daliresp prevents COPD flares in people whose condition is associated with chronic bronchitis. The drug is not intended for other types of COPD.

Antibiotics. Your doctor may prescribe antibiotics to treat a bacterial infection in your respiratory tract, such as sinusitis, acute bronchitis, or pneumonia.


3. Discussion

“Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease” . A Cochrane review including 31 randomized controlled trials in COPD found clinically and statistically significant improvements in exercise capacity and quality of life following rehabilitation. On average the expected increase in VO2 is 10–20% of baseline and between 32 and 65 m for the 6 minutes walking distance . Hence, there are no data supporting a raise in FEV1. In our case we observed a gain in lung function, maximal exercise capacity and 6 minutes walking test beyond all expectations. Although the effects of training on an individual may be much larger than the group average, most of the effect should be attributed to the larger maximal ventilation by a steep increase in FEV1. The latter is not explained by a spontaneous recovery of FEV1 post pneumonia, as baseline FEV1 values have been continuously lower for 10 consecutive years prior to the event.

If we take a closer look at lung function changes, deflation with the characteristic drop of RV and a corresponding increase in FVC and FEV1 occurred within a stable TLC. Although one may assume that the introduction of Tiotropium in the maintenance therapy resulted in static deflation, the magnitude of this response (almost 1.0 L) is too large to be true. Mean improvements in FEV1 with Tiotropium on top of LABA/ICS combinations are normally between 60 and 100 ml and although the individual effect-size may be much larger, other possibilities need to be considered . We would recommend checking the X-rays, as we think of autobullectomy.

X-rays and CT scan confirmed our hypothesis; the giant bulla earlier seen in the right upper lobe disappeared (Fig. 2). Usually, pulmonary bullae gradually enlarge and spontaneous regression is very rare . A Pubmed search revealed only 8 relevant articles with reference to the spontaneous resolution of pulmonary bullae, most often due to infection of the bulla (bullitis), leading to an autobullectomy. The assumption for the autobullectomy hypothesis is an inflammatory process (e.g. infection, tumor, blood clot) within the bulla leading to obstruction of the supplying bronchus and subsequent collapse.

A/X-ray of the chest before and after the pneumonia. B/CT images of the apical bullae before the infectious episode. C/Corresponding CT images 4 years after the infectious event.

Bullectomy should be considered when the hyperinflation is thought to contribute to dyspnea and exercise limitation. Other indications for surgical bullectomy are complications: hemoptysis, recurrent pneumothorax, and infectious bullitis. In the absence of any complication, experts recommend surgical bullectomy only when the bulla takes at least one third, preferably one-half, of the hemithorax . In 2001, bullectomy was considered but not performed in our patient because of limited complaints and subjective wellbeing. In retrospect, given subjective and objective improvements in dyspnea and exercise capacity after autobullectomy, we may conclude that surgical bullectomy at the time of diagnosis would have been a good treatment option.

COPD management

An effective COPD management plan includes four components: (1) assess and monitor disease; (2) reduce risk factors; (3) manage stable COPD; (4) manage exacerbations.

The goals of effective COPD management are to:

  • Prevent disease progression
  • Relieve symptoms
  • Improve exercise tolerance
  • Improve health status
  • Prevent and treat complications
  • Prevent and treat exacerbations
  • Reduce mortality

These goals should be reached with a minimum of side effects from treatment, a particular challenge in patients with COPD where comorbidities are common. The extent to which these goals can be realized varies with each individual, and some treatments will produce benefits in more than one area.

In selecting a treatment plan, the benefits and risks to the individual and the costs, direct and indirect, to the community must be considered. Patients should be identified before the end stage of the illness, when disability is substantial. However, the benefits of spirometric screening, of either the general population or smokers, are still unclear. Educating patients and physicians to recognize that cough, sputum production, and especially breathlessness are not trivial symptoms is an essential aspect of the public health care of this disease.

Reduction of therapy once symptom control has been achieved is not normally possible in COPD. Further deterioration of lung function usually requires the progressive introduction of more treatments, both pharmacologic and nonpharmacologic, to attempt to limit the impact of these changes. Acute exacerbations of signs and symptoms, a hallmark of COPD, impair patients’ quality of life and decrease their health status. Appropriate treatment and measures to prevent further exacerbations should be implemented as quickly as possible.

Component 1: Assess and monitor disease

  • Diagnosis of COPD is based on a history of exposure to risk factors and the presence of airflow limitation that is not fully reversible, with or without the presence of symptoms.
  • Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnoea.
  • For the diagnosis and assessment of COPD, spirometry is the gold standard as it is the most reproducible, standardized, and objective way of measuring airflow limitation. FEV1/FVC
  • Health care workers involved in the diagnosis and management of patients with COPD should have access to spirometry.
  • Measurement of arterial blood gas tensions should be considered in all patients with FEV1

Component 2: Reduce risk factors

  • Reduction of total personal exposure to tobacco smoke, occupational dusts and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and progression of COPD.
  • Smoking cessation is the single most effective and cost-effective way to reduce the risk of developing COPD and stop its progression. Brief tobacco dependence treatment is effective and every tobacco user should be offered at least this treatment at every visit to a health care provider.
  • Three types of counseling are especially effective: practical counseling, social support as part of treatment, and social support arranged outside of treatment.
  • Several effective pharmacotherapies for tobacco dependence are available, and at least one of these medications should be added to counseling if necessary and in the absence of contraindications.
  • Progression of many occupationally induced respiratory disorders can be reduced or controlled through a variety of strategies aimed at reducing the burden of inhaled particles and gases.

Component 3: Manage stable COPD

  • The overall approach to managing stable COPD should be characterized by a stepwise increase in treatment, depending on the severity of the disease.
  • For patients with COPD, health education can play a role in improving skills, ability to cope with illness, and health status. It is effective in accomplishing certain goals, including smoking cessation.
  • None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease. Therefore, pharmacotherapy for COPD is used to decrease symptoms and complications.
  • Bronchodilator medications are central to the symptomatic management of COPD. They are given on an as-needed basis or on a regular basis to prevent or reduce symptoms.
  • The principal bronchodilator treatments are 2-agonists, anticholinergics, theophylline, and a combination of one or more of these drugs.
  • Regular treatment with inhaled glucocorticosteroids should only be prescribed for symptomatic patients with COPD with a documented spirometric response to glucocorticosteroids or for those with an FEV1
  • Chronic treatment with systemic glucocorticosteroids should be avoided because of an unfavourable benefit-to-risk ratio.
  • All patients with COPD benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnoea and fatigue.
  • The long-term administration of oxygen (> 15 h per day) to patients with chronic respiratory failure has been shown to increase survival.

Component 4: Manage exacerbations

  • Exacerbations of respiratory symptoms requiring medical intervention are important clinical events in COPD.
  • The most common causes of an exacerbation are infection of the tracheobronchial tree and air pollution, but the cause of approximately one-third of severe exacerbations cannot be identified.
  • Inhaled bronchodilators (particularly inhaled 2-agonists or anticholinergics), theophylline, and systemic, preferably oral, glucocorticosteroids are effective for treatments for acute exacerbations of COPD.
  • Patients experiencing COPD exacerbations with clinical signs of airway infection (e.g., increased volume and change of color of sputum, or fever) may benefit from antibiotic treatment.
  • Noninvasive positive pressure ventilation (NIPPV) in acute exacerbations improves blood gases and pH, reduces in-hospital mortality, decreases the need for invasive mechanical ventilation and intubation, and decreases the length of hospital stay.

4 Types of Exercises for COPD

These four types of exercise can help you if you have COPD. How much you focus on each type depends on the COPD exercise program your health care provider suggests for you.

Stretching exercises lengthen your muscles, increasing your flexibility.

Aerobic exercises use large muscle groups to move at a steady, rhythmic pace. This type of exercise works your heart and lungs, improving their endurance. This helps your body use oxygen more efficiently and, with time, can improve your breathing. Walking and using a stationary bike are two good aerobic exercises if you have COPD.

Strengthening exercises involve tightening muscles until they begin to tire. When you do this for the upper body, it can help increase the strength of your breathing muscles.

Breathing exercises for COPD help you strengthen breathing muscles, get more oxygen, and breathe with less effort. Here are two examples of breathing exercises you can begin practicing. Work up to 5 to 10 minutes, three to four times a day.

Pursed-lip breathing:

  1. Relax your neck and shoulder muscles.
  2. Breathe in for 2 seconds through your nose, keeping your mouth closed.
  3. Breathe out for 4 seconds through pursed lips. If this is too long for you, simply breathe out twice as long as you breathe in.

Use pursed-lip breathing while exercising. If you experience shortness of breath, first try slowing your rate of breathing and focus on breathing out through pursed lips.

Diaphragmatic breathing:

  1. Lie on your back with knees bent. You can put a pillow under your knees for support.
  2. Place one hand on your belly below your rib cage. Place the other hand on your chest.
  3. Inhale deeply through your nose for a count of three. Your belly and lower ribs should rise, but your chest should remain still.
  4. Tighten your stomach muscles and exhale for a count of six through slightly puckered lips.

Chronic Obstructive Pulmonary Disease (COPD)

You can prevent or ease your COPD symptoms, like shortness of breath, cough, mucus build-up and tiredness by taking your prescribed medication. Different types of medications treat different symptoms. Sometimes, you may have a flare-up where your symptoms get worse and your doctor may prescribe extra medications to help you feel better. To get the full benefit from your medication, you must follow the doctor’s instructions and take the medications exactly as prescribed. Some medications need to be taken only when you need them, like a quick-relief bronchodilator. Others need to be taken regularly. If you are unsure when or how to take your medications or use your devices, ask your doctor, respiratory educator, pharmacist or other healthcare provider.

Keep a list of all of the medications you take and show it to your doctor and pharmacist, so they can check for drug interactions.

Types of Medications

There are many types of medications and treatments available to make your life with COPD easier. These include both inhaled and oral (taken by mouth) medications:

  • Bronchodilators to relieve shortness of breath
  • Combination bronchodilators and antiinflammatories to relieve shortness of breath and to prevent flare-ups
  • Antibiotics to fight infections
  • Supplemental oxygen (oxygen tank) to help with low oxygen and energy levels
  • Vaccines for flu and pneumonia to help prevent infections


The main medication treatment for COPD comes in inhalers (sometimes, these are called puffers). There are many types of inhalers and devices.

Bronchodilator Inhalers

Bronchodilators open up the airways in the lungs, making it easier to breathe. There are two main groups of bronchodilators: beta2-agonists and anticholinergics.
Beta2-agonists relieve breathlessness. They can be taken for prevention or providing a quick relief. They are inhaled medicines that can be short-acting or long-acting. Short-acting beta2-agonists are often used as a “rescue” or quick-relief medicine to open airways quickly. Long-acting beta2-agonists may also be taken regularly to prevent breathlessness.
Anticholinergics relieve breathlessness, but in a different way than beta2-agonists. They are also inhaled medicines that are effective in treating COPD, especially when they are taken on a regular
basis. There are short-acting and long-acting anticholinergics.

Here is a list of short-acting bronchodilators you may be prescribed:

  • Atrovent® MDI
  • Airomir® MDI
  • Bricanyl® Turbuhaler®
  • Ventolin® Diskus®
  • Ventolin® MDI

Here is a list of long-acting bronchodilators you may be prescribed:

  • Incruse™ Ellipta®
  • Seebri® Breezhaler®
  • Spiriva® Handihaler®
  • Spiriva® Respimat®
  • Tudorza® Genuair®
  • Foradil® Aerolizer®
  • Onbrez® Breezhaler®
  • Serevent® Diskus®
  • Striverdi® Respimat® (available in Canada only in combination)

Combination Inhalers

If you have on-going breathing problems, your doctor may prescribe a combination medicine. Combination inhalers are “preventer” medicines that need to be taken every day. There are many different medication combinations available and may contain some of the short and long-acting bronchodilators listed above. The most common combinations contain two or three medicines in one inhaler.

Here is a list of combination inhalers you may be prescribed:

  • Short-acting beta2-agonist and short-acting anticholinergic
    • Combivent Respimat®
  • Long-acting beta2-agonist and corticosteroid
    • Advair® Diskus®
    • Breo™ Ellipta®
    • Symbicort® Turbuhaler®
  • Long-acting beta2-agonist and long-acting anticholinergic
    • Anoro® Ellipta®
    • Duaklir® Genuair®
    • Inspiolto™ Respimat®
    • Ultibro® Breezhaler®
  • Long-acting beta2-agonist, long-acting anticholinergic and corticosteroid
    • Trelegy™ Ellipta®

Long-acting bronchodilators will help relieve shortness of breath for longer periods of time, and if combined with an inhaled corticosteroid, will also bring down the swelling in your airways. Don’t
worry – these are not the same steroids as those taken by some bodybuilders to build muscle. Over time, combination medicines can help prevent COPD flareups. Combination medicines may not help right away.
If you need immediate help, take your quick-relief bronchodilator medicine.

Nebulizer Medication

Nebulizer is a device that turns medication into fine mist and delivers it into your airways, using a mouthpiece or a mask. Nebulizers can be used for those patients who have a difficult time using inhalers.

Oral Medications

Corticosteroid Pills

Corticosteroids also come as pills, most often known as prednisone. Corticosteroid pills have more side effects than the inhaled corticosteroids that are in combination medicines. Corticosteroid pills are often used for short periods of time – usually when you have a COPD flare-up. If you need to take corticosteroid pills on a regular basis, your healthcare provider will work to keep you on the lowest dose necessary. You can talk with your healthcare provider about side effects of your medication.


Bacterial infections in your airways may cause some of your COPD flare-ups. Antibiotics can help in these cases. However, antibiotics will not work if your flare-up was caused by a viral infection. Sometimes people may be experiencing both bacterial and viral infections at the same time. Prednisone is often prescribed along with antibiotics. Sometimes antibiotics are prescribed on a regular basis for those patients with frequent flare-ups. Your respirologist or family doctor will monitor you closely for improvements and side effects.

Working with your COPD team on a COPD action plan will ensure you have clear directions on what to do and what medicine to take if you have a flare-up.

Phosphodiesterase-4 Inhibitors

Phosphodiesterase-4 Inhibitors (PDE-4) medications are a type of oral medication that decreases inflammation in the lungs. This pill is used for patients with a history of frequent flare-ups and
chronic cough with mucus (phlegm). It can prevent flare-ups and should be used along with regular inhalers.


Mucolytics help to remove secretions (unwanted contents like phlegm) from the lung by thinning mucus so it is easier to cough up. These medications are for patients with frequent flare-ups.


(N-acetylcysteine – NAC), may prevent flare-ups.

Today I have some good news about chronic obstructive pulmonary disease or COPD. This is an umbrella term covering a number of conditions, including chronic bronchitis and emphysema, where people have difficulty breathing because of lung damage. Smoking is by far the biggest cause of COPD, but environmental factors and genetics can also play a part. It’s a common, debilitating and life-threatening condition. It’s a global problem and in the UK it’s the second highest cause of hospital admission. COPD places a huge burden on the patient and on healthcare budgets, with much of the costs due to treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. in hospital. We need some good news on this and some good evidence to guide decisions about managing COPD.

So, what is the good news? We have a bunch of new and updated reviews from the Cochrane Airways Group which have some decent evidence to guide us on some things that work with respect to managing COPD. Here are 3 things that improve the health and quality of life of people with COPD and help keep them out of hospital:

  1. Integrated disease management
  2. Inhaled long-acting beta2-agonists (LABAs)
  3. Tiotropium (a long-acting bronchodilator)

Let’s take a look. First, integrated disease management (IDM) programmes for people with COPD. We’ve yet to find a neat definition that people agree on, but essentially IDM is a multi-faceted, multi-disciplinary approach to managing long-term conditions such as COPD, which aims to improve the quality and efficiency of care. Health services work with each other and with the patient and supporting self-management is a key element. The authors of this new review concluded “IDM not only improved disease-specific QoL and exercise capacity, but also reduced hospital admissions and hospital days per person.” These findings are based on moderate or high quality evidence too, so we can be confident about the findings.

The evidence comes from 26 randomizedRandomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). controlled trialsA trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). (RCTs) with almost 3000 people with mild through to very severe COPD, in a variety of healthcare settings and countries. The programmes varied but all included caregivers from at least two disciplines with two components (such as education and exercise) and lasted for three months or more. They found moderate quality evidence that

  • IDM improved quality of life (as measured by the Chronic Respiratory Questionnaire ) in all domains: fatigue, dyspnoea, emotional and mastery, until 12 month follow-up. More evidence is needed for longer term effects
  • IDM improved people’s exercise capacity (six minute walking distance) at 12 months. Unsurprisingly, programmes featuring exercise brought about the greatest improvements in exercise capacity

They found high quality evidence that

  • IDM reduced respiratory-related hospital admissions. 15 patients need to be treated with IDM to prevent 1 being admitted to hospital over 3 to 12 months
  • IDM reduced length of hospital stay by three days

No adverse effects were reported in the IDM group.

Better quality of life and fewer hospitalizations were the happy findings of another new review looking at inhaled long-acting beta2-agonists (LABAs) for COPD. There is moderate quality evidence from 26 RCTs with 15,000 people who had moderate to severe COPD, comparing LABAs with placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. (dummy inhalers). They found that, compared to placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine., people taking LABAs

  • reported improved quality of life (as measured by the St George’s Respiratory Questionnaire), though there was quite a lot of variation between studies
  • had fewer exacerbations, including those needing hospitalization (18 fewer hospitalized per 1000 people over 7 months)
  • had better lung function

There was no difference in the number of deaths or serious adverse effects. The reviewers note that trialClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. evidence will be needed to establish whether new and emerging LABAs such as indacaterol are as safe, effective and cost-effective as well established LABAs and that comparison with other long-acting medicines would be helpful.

A review putting tiotropium and ipratropium bromide head to head found moderate to high quality evidence that tiotropium treatment led to improved lung function, fewer COPD exacerbations, fewer hospital admissions (including those for COPD flare-ups) and better quality of life compared with ipratropium bromide. It was also associated with fewer adverse effects. Tiotropium is available as two different inhalers, Respimat and Handihaler, and there are some safety concerns around the Respimat device but it will not be clear whether these are justified until current trial results have been published, and these will be reported in another review.

Finally, a review looking at the inhaled corticosteroid (ICS) beclometasone dipropionate (BDP), one of the cheaper, less potent and widely used ICS, as there is a need to look separately at different ICS to guide treatmentSomething done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. choices. Apart from high quality evidence that BDP combined with LABAs led to greater improvements in lung function than LABAs alone, there’s not much that can be said with any confidence due to shortcomings in the evidence. Shame.

Overall, there’s lots of decent evidence here for both patients and providers about treatments that have been shown to work, helping people with COPD enjoy a better quality of life, stay as well as possible and stay out of hospital. I call that good news.

Page last updated 09 November 2016.


Kruis AL, Smidt N, Assendelft WJJ, Gussekloo J, Boland MRS, Rutten-van Mölken M, Chavannes NH. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2013, Issue 10. Art. No.: CD009437. DOI: 10.1002/14651858.CD009437.pub2.

Kew KM, Mavergames C, Walters JAE. Long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2013, Issue 10. Art. No.: CD010177. DOI: 10.1002/14651858.CD010177.pub2.

Cheyne L, Irvin-Sellers MJ, White J. Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2015, Issue 9. Art. No.: CD009552. DOI: 10.1002/14651858.CD009552.pub3.

De Coster DA, Jones M, Thakrar N. Beclometasone for chronic obstructive pulmonary disease. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2013, Issue 10. Art. No.: CD009769. DOI: 10.1002/14651858.CD009769.pub2.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *