What to ask when prescribed a new COPD medication

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that makes it more difficult to breathe. COPD is most often caused by smoking tobacco, and quitting all forms of smoking is a priority for treatment.

Nonsmokers also develop this condition. Other risk factors include exposure to irritants (chemical fumes, wood smoke, air pollution) and history of chronic respiratory infections. A rare genetic disorder called alpha-1 antitrypsin (AAT) deficiency can also cause COPD.

How COPD affects the lungs and airways

COPD has two main types, emphysema and chronic bronchitis. However, most cases have at least some overlap between the two.

Emphysema occurs when there is damage to the tiny air sacs of the lungs, called alveoli. This causes air to become trapped inside the lungs and disrupts the ability of the lungs to pass oxygen into the bloodstream.

Chronic bronchitis is damage, scarring, and inflammation of the large airways that lead to the lungs. This causes chronic cough and large amounts of mucus in these airways, which makes it difficult to breathe.

What medications are used to treat COPD?

There is no cure for COPD and treatment focuses on managing symptoms, preventing the disease from getting worse, addressing any health problems caused by COPD, and improving quality of life.

Most treatment plans will include medications. Medications for COPD fall into two broad categories:

• Quick-relief medications. These are taken when symptoms worsen and are intended to provide relief and help a person breathe easier.
• Maintenance medications. These are medications that are taken long term, to help reduce inflammation, improve breathing day-to-day, and prevent flare ups.

Types of medications can include:

• Bronchodilators, which help relax and open up the airways. These are inhaled medications available in quick-relief and long-acting formulations.
• Anti-inflammatory drugs. Corticosteroids are the most common example. Inhaled corticosteroids may be prescribed in combination with other inhaled medications. Oral corticosteroids may be given in short courses when inflammation needs to be reduced quickly.
• Combination inhalers, which include a combination of bronchodilators and/or inhaled corticosteroids.
• Biologic medications. These are injectable medications that act on the immune system to reduce inflammation. These may be added to a treatment plan if other medications are unable to control symptoms.
• PDE inhibitors, add-on medications that block PDE enzymes and have both bronchodilating and anti-inflammatory effects. These include a PDE4 inhibitor taken as a pill, and a dual PDE3/PDE4 inhibitor that is taken with a nebulizer.

What to ask when prescribed a new COPD medication

Treatment plans often include multiple medications, the most common example being a quick-relief medication and a maintenance medication.

You may also be prescribed different medications at different times. For example, an antibiotic may be prescribed to treat a bacterial infection. It’s important to know how each medication works and how to take each medication as directed.

Here are some questions to ask your healthcare provider:

• What is the name of the medication? What dosage am I taking?
• How does this medication work to treat COPD?
• Why are you recommending this medication for me?
• How is this medication administered? COPD medications can be taken as pills, inhaled (with a nebulizer or inhaler), or injected.
• How often will I need to take this medication? Is this a quick-relief medication or a maintenance medication?
• What is the goal of taking this medication? How will we know if this medication is working?
• What can I do to get the most benefit from this medication?
• Is there anything that I need to avoid while taking this medication?
• Is there anyone who should not take this medication? It’s a good idea to review your family medical history, personal medical history, and the full prescribing information for each medication.
• What is the risk of side effects? Is there any risk of severe side effects?
• Can this medication interact with other medications? Your healthcare provider should always have an up-to-date list of medications you are taking, including prescription medications, over-the-counter medications, and supplements (including herbal supplements). Your pharmacist is also an excellent source of information.
• What will this medication cost? Ask what you can do and who you can talk to if you have concerns about the cost of a medication.

Other parts of a treatment plan

In addition to medications, treatment for COPD may also include pulmonary rehabilitation, oxygen therapy (supplemental oxygen), and surgery. Treatment is individualized and will depend on the severity of the COPD as well as a person’s age, overall health, and other factors.

People with COPD are also at risk for severe complications from common respiratory infections like the flu, RSV, pneumonia, and COVID-19, and vaccinations are an important part of treatment.

Work with your healthcare team

Taking a medication as directed will help you get the most out of your treatment for COPD. If you have difficulty taking any medication for any reason, tell your healthcare provider, who will be your best source of information.