There's currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the symptoms.
- stopping smoking – if you have COPD and you smoke, this is the most important thing you can do
- inhalers and medications – to help make breathing easier
- pulmonary rehabilitation – a specialised programme of exercise and education
- surgery or a lung transplant – although this is only an option for a very small number of people
Your doctor will discuss the various treatment options with you.
The National Institute for Health and Care Excellence (NICE) has produced guidance on the diagnosis and treatment of COPD, which outlines the care you can expect to receive.
If you smoke, stopping is the most effective way to prevent COPD getting worse.
Although any damage done to the lungs and airways can't be reversed, giving up smoking can help prevent further damage.
This may be all the treatment that's needed in the early stages of COPD, but it's never too late to stop – even people with more advanced COPD are likely to benefit from quitting.
If your COPD is affecting your breathing, you'll usually be given an inhaler. This is a device that delivers medication directly into your lungs as you breathe in.
Your doctor or nurse will advise how to use your inhaler correctly and how often to use it.
There are several different types of inhaler for COPD. The main types are described below.
Short-acting bronchodilator inhalers
For most people with COPD, short-acting bronchodilator inhalers are the first treatment used.
Bronchodilators are medications that make breathing easier by relaxing and widening your airways.
There are two types of short-acting bronchodilator inhaler:
- beta-2 agonist inhalers – such as salbutamol and terbutaline
- antimuscarinic inhalers – such as ipratropium
Short-acting inhalers should be used when you feel breathless, up to a maximum of four times a day.
Long-acting bronchodilator inhalers
If you experience symptoms regularly throughout the day, a long-acting bronchodilator inhaler will be recommended instead.
This works in a similar way to a short-acting bronchodilator, but each dose lasts for at least 12 hours, so they only need to be used once or twice a day.
There are two types of long-acting bronchodilator inhaler:
- beta-2 agonist inhalers – such as salmeterol, formoterol and indacaterol
- antimuscarinic inhalers – such as tiotropium, glycopyronium and aclidinium
Some new inhalers contain a combination of a long-acting beta-2 agonist and antimuscarinic.
If you're still getting breathless when taking long-acting inhalers or have frequent flare-ups (exacerbations), your GP may suggest including a steroid inhaler as part of your treatment.
Steroid inhalers contain corticosteroid medication, which can help reduce the inflammation in your airways.
Steroid inhalers are normally prescribed as part of a combination inhaler that also includes one of the long-acting medications mentioned above.
If your symptoms aren't controlled with inhalers, your doctor may recommend taking tablets or capsules as well.
The main medications used are described below.
Theophylline is a tablet that relaxes and opens up the airways. It's usually taken twice a day.
You may need to have regular blood tests during treatment to check the level of medication in your blood.
This will help your doctor work out the best dose to control your symptoms while reducing the risk of side effects.
Possible side effects include:
- feeling and being sick
- difficulty sleeping (insomnia)
- noticeable pounding, fluttering or irregular heartbeats (palpitations)
Sometimes a similar medication called aminophylline is also used.
Mucolytic tablets or capsules
If you have a persistent chesty cough with lots of thick phlegm, your doctor may recommend taking a mucolytic medication called carbocisteine.
Mucolytic medications make the phlegm in your throat thinner and easier to cough up.
They're taken as a tablet or capsule, usually three times a day.
If you have a particularly bad flare-up, you may be prescribed a short course of steroid tablets to reduce the inflammation in your airways.
A 7 to 14-day course of treatment is usually recommended, as long-term use of steroid tablets can cause troublesome side effects such as:
- weight gain
- mood swings
- weakened bones (osteoporosis)
Your doctor may give you a supply of steroid tablets to keep at home and take as soon as you start to experience a bad flare-up.
Longer courses of steroid tablets must be prescribed by a COPD specialist. You'll be given the lowest effective dose and monitored closely for side effects.
Your doctor may prescribe a short course of antibiotics if you have signs of a chest infection, such as:
- coughing up yellow or green phlegm
- a high temperature (fever)
- a rapid heartbeat
- chest pain or tightness
- feeling confused and disorientated
Sometimes you may be given a course of antibiotics to keep at home and take as soon as you experience symptoms of an infection.
Pulmonary rehabilitation is a specialised programme of exercise and education designed to help people with lung problems such as COPD.
It can help improve how much exercise you're able to do before you feel out of breath, as well as your symptoms, self-confidence and emotional wellbeing.
Pulmonary rehabilitation programmes usually involve two or more group sessions a week for at least six weeks.
A typical programme includes:
- physical exercise training tailored to your needs and ability – such as walking, cycling and strength exercises
- education about your condition for you and your family
- dietary advice
- psychological and emotional support
The programmes are provided by a number of different healthcare professionals, including physiotherapists, nurse specialists and dietitians.
The British Lung Foundation has more information about pulmonary rehabilitation.
If you have severe symptoms or experience a particularly bad flare-up, you may sometimes need additional treatment.
Nebulised medication may be used in severe cases of COPD if inhalers haven't worked.
This is where a machine is used to turn liquid medication into a fine mist that you breathe in through a mouthpiece or a face mask. It enables a large dose of medicine to be taken in one go.
You'll usually be given a nebuliser device to use at home after being shown how to use it.
Long-term oxygen therapy
If your COPD results in a low level of oxygen in your blood, you may be advised to have oxygen at home through nasal tubes or a mask.
This can help stop the level of oxygen in your blood becoming dangerously low, although it's not a treatment for the main symptoms of COPD, such as breathlessness.
Long-term oxygen treatment should be used for at least 16 hours a day.
The tubes from the machine are long, so you will be able to move around your home while you're connected. Portable oxygen tanks are available if you need to use oxygen away from home.
Don't smoke when using oxygen. The increased level of oxygen is highly flammable and a lit cigarette could cause a fire or explosion.
Read more about home oxygen treatment.
Ambulatory oxygen therapy
Some people with COPD will benefit from ambulatory oxygen – oxygen used when you walk or are active in other ways.
If your blood oxygen levels are normal while you're resting but fall when you exercise, you may be able to have ambulatory oxygen therapy rather than long-term oxygen therapy.
Non-invasive ventilation (NIV)
If you're taken to hospital because of a bad flare-up, you may have a treatment called non-invasive ventilation (NIV).
This is where a portable machine connected to a mask covering your nose or face is used to support your lungs and make breathing easier.
Surgery is usually only suitable for a small number of people with severe COPD whose symptoms aren't controlled with medication.
There are three main operations that can be done:
- bullectomy – an operation to remove a pocket of air from one of the lungs, allowing the lungs to work better and make breathing more comfortable
- lung volume reduction surgery – an operation to remove a badly damaged section of lung to allow the healthier parts to work better and make breathing more comfortable
- lung transplant – an operation to remove and replace a damaged lung with a healthy lung from a donor
These are major operations carried out under general anaesthetic, where you're asleep, and involve significant risks.
If your doctors feel surgery is an option for you, speak to them about what the procedure involves and what the benefits and risks are.