Chronic obstructive pulmonary disease (COPD) is the most common lung disease in the world, affecting more than 391 million adults globally.
To help doctors determine the most effective COPD treatment, the Global Initiative for Obstructive Lung Disease (GOLD) was created in 1997 as a joint effort of the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the World Health Organization.
GOLD has developed guidelines for COPD care based on three characteristics of the disease:
- Shortness of breath (dyspnea)
- Lung function
- Flare-ups (exacerbations), including their symptoms, severity, and how often they happen
These guidelines continue as doctors learn more about COPD and new treatments are developed. At present, the standard treatments involve single, dual, and triple therapies.
Three Approaches to Ease COPD Symptoms
COPD is caused by irritants in the lungs. They create breathing problems that get worse over time. The most common COPD symptoms include:
- Shortness of breath
- Persistent wet cough
- Frequent lung infections
- Wheezing
As time goes on, these symptoms typically become more severe and make it harder to manage your day-to-day life.
As your COPD gets worse, you may have exacerbations, or flare-ups. Although everyone is different, a flare-up is typically when you have symptoms that last more than 2 days and that are worse than usual. For example, you may:
- Cough more
- Have changes in the color, amount, or thickness of the phlegm that you cough up
- Find it hard to catch your breath
- Have trouble sleeping
- Wheeze or breathe noisily
- Feel tired or fatigued
Your flare-ups might be so severe that you have to go to the hospital.
Depending on your lung function, symptoms, and how many flare-ups you’ve had, your doctor will decide on the best course of treatment for you. This may involve taking one or a combination of prescription therapies.
Treatment Options
Bronchodilator inhalers are the first treatment for most people who have COPD. Bronchodilators are medicines that relax and widen your airways so you can breathe easier. They may be short-acting, lasting for 3 to 6 hours.
If you have symptoms regularly or have flare-ups despite using a short-acting bronchodilator, your doctor may recommend a long-acting bronchodilator inhaler. With this type of inhaler, each dose lasts for at least 12 hours, so you only use them once or twice a day.
There are two types of long-acting bronchodilator inhalers prescribed to treat COPD:
Long-acting beta-2 agonists (LABA): These relax the muscles around the airways in your lungs, allowing you to breathe easier.
Long-acting antimuscarinic antagonists (LAMA): These block the tightening of smooth muscles around your airways.
There is a third type of therapy that uses corticosteroid medicines with a steroid inhaler, or ICS. It helps reduce the inflammation in your airways.
Steroid inhalers are typically prescribed for COPD as part of a combination treatment that includes a LABA or LAMA. But studies show that ICS may raise your chances of getting pneumonia if you have COPD.
Dual and Triple Therapies
Research shows that if a single therapy doesn’t control your symptoms, combining two or three COPD treatments might. A combo therapy can help by more directly addressing how COPD affects the way air gets to your lungs and how your lungs function.
Dual therapy. If your COPD symptoms are severe, bronchodilators with both LABA and LAMA medications may be a better option than a single treatment. This treatment combines both medications into one inhaler. Studies show this one-two punch may ease shortness of breath and make flare-ups happen less often. This combo also has a lower risk of pneumonia than treatments that include ICS.
ICS plus a LABA is another combination therapy that’s widely used for patients with more severe COPD. Studies have shown that this dual treatment may improve lung function and cut down on flare-ups more than a placebo or a LABA alone. Studies also find that this combination is less likely to raise your chances of cardiovascular problems than dual LAMA/LABA or triple therapy.
Triple therapy. If you’re already being treated with ICS/LABA combination therapy and still have shortness of breath, your doctor may add a LAMA to your prescription. The combination may help improve airflow and help you breathe easier. It will also lessen inflammation in your airways. If you have frequent flare-ups, it may also decrease the number that you have and make future ones less likely.
Triple therapy is typically only recommended after dual therapy no longer works.
Show Sources
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SOURCES:
Chronic Obstructive Pulmonary Disease: Journal of the COPD Foundation: "GOLD Stage and Treatment in COPD: A 500 Patient Point Prevalence Study."
The Lancet Respiratory Medicine: "Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis."
Global Initiative for Chronic Obstructive Lung Disease: "About Us."
CDC: "Chronic Obstructive Pulmonary Disease (COPD)."
Drugs in Context: "Is ‘GOLD’ standard for the management of COPD in clinical practice?"
Centers of Disease Control and Prevention: "Chronic Obstructive Pulmonary Disease (COPD)."
NHS.uk: "Symptoms: Chronic obstructive pulmonary disease," "Treatment: Chronic obstructive pulmonary disease."
American Lung Association: "Prevent COPD Exacerbations or Flare Ups," "Treating COPD."
Cleveland Clinic: "Bronchodilator."
StatPearls: "Beta2-Agonists."
Clinics in Chest Medicine: "Corticosteroids in Chronic Obstructive Pulmonary Disease: Benefits and Risks."
Respiratory Medicine: X: "Dual bronchodilators in chronic obstructive pulmonary disease: Evidence from randomized controlled trials and real-world studies."
International Journal of Clinical Practice: "Optimising treatment for COPD – new strategies for combination therapy."
European Respiratory Journal: "Combination therapy with long-acting bronchodilators and the risk of major adverse cardiovascular events in patients with COPD: a systematic review and meta-analysis."
International Journal of Chronic Obstructive Pulmonary Disease: "Beyond Dual Bronchodilation - Triple Therapy, When and Why," "Risk of Pneumonia Associated with Inhaled Corticosteroid in Patients with Chronic Obstructive Pulmonary Disease: A Korean Population-Based Study."
