If you live with chronic obstructive pulmonary disease (COPD), steroids can help during a flare. Nonsteroid medications can help you manage daily symptoms and may lead to fewer side effects and fewer complications over time.
"Nonsteroids are a core treatment for COPD," says Ahmad Abu Homoud, MD, medical director of the Pulmonary Hypertension Center at Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey.
Here's why, and the different nonsteroid options your doctor could suggest.
How COPD Affects Your Lungs
COPD means that you have chronic (ongoing) damage to your lungs. Inflammation inside your airways makes it harder for air to get through.
"There is a progressive obstruction in the lungs, and that usually leads to three main symptoms: shortness of breath, cough, and phlegm production," Abu Homoud says.
COPD can also make you tired and cause your chest to feel tight.
The most common types of COPD are:
Emphysema, in which the small air sacs of your lungs are damaged and can't send enough oxygen into your bloodstream
Chronic bronchitis, a condition that inflames your bronchi, causing coughing and sputum production that lasts for at least three months and over the course of two years. This happens in the airways, the tubes that send air to and from your lungs
How do you get COPD?
"COPD happens because of what we inhale throughout our lives," Abu Homoud says.
Smoking is the most common reason, but your lungs could get damaged because of many other noxious irritants, like asbestos, chlorine, or ammonia, that you're exposed to at work or at home.
Your genes may also raise your risk of COPD.
Steroid Treatment for COPD
When lung inflammation isn't controlled, COPD symptoms get worse. These flares, or what doctors call "exacerbations," can last days or weeks.
Many things can cause a flare, including being exposed to pollution, very cold weather, or an infection.
"Each time you get an exacerbation, your lung function never returns to normal," Abu Homoud says. "More exacerbations can accelerate the progression of COPD."
Steroids, which suppress the immune system, can reduce inflammation and shorten the recovery time of the flare.
Systemic steroids come in pills you swallow or an IV (given through a vein in your arm).
Inhaled steroids are breathed in through your mouth.
Your doctor may prescribe steroids if you have frequent flares.
Common side effects of steroids
Like other drugs, using steroids for too long can cause side effects. These can include:
- Mood swings
- Weight gain
- Swelling (fluid retention)
- High blood sugar
- Eye issues, including glaucoma
- A vitamin D deficiency
- Issues with your adrenal gland
- Osteoporosis
- A higher risk of infections (like pneumonia)
Because of these risks, unless your symptoms flare, "we really need to depend on nonsteroidals," Abu Homoud says.
Nonsteroid Treatment Options for COPD
COPD therapies that manage your symptoms without steroids include:
Bronchodilators
These medicines are available as inhalers or nebulizers. When you inhale them, they relax and open your airways. They come in a few different forms.
Short-acting beta2-agonists (SABAs)
These are sometimes called "rescue treatments." You'll probably notice a difference within minutes of using one.
SABAs for COPD include:
- Albuterol (ProAir, Proventil, Ventolin)
- Levalbuterol (Xopenex)
- Salbutamol (Salamol)
Short-acting anticholinergics
Bronchodilators relax the smooth muscle around your airways, which helps open them so you can breathe more easily. These treatments work in different ways. Some block a neurotransmitter called acetylcholine, which helps reduce the tightness in your lungs. The most common one used for COPD is:
- Ipratropium (Atrovent)
Long-acting beta2-agonists (LABAs)
Like SABAs, these relax the muscles that help you breathe. But LABAs don't work quickly. They help manage your ongoing symptoms rather than relieve shortness of breath or inflammation. Your doctor may prescribe one like:
- Arformoterol (Brovana)
- Formoterol (Perforomist) and indacaterol
- Olodaterol (Striverdi Respimat)
- Salmeterol (Serevent)
Long-acting anticholinergics (LAMAs)
These treatments can help loosen your chest, preventing it from tightening, and make it easier to breathe. They can also help prevent flare-ups. Depending on the type, one dose can last up to 24 hours.
- Aclidinium Bromide (Tudorza Pressair)
- Glycopyrrolate (Lonhala Magnair)
- Revefenacin (Yupelri)
- Tiotropium Bromide (Spiriva Handihaler)
- Umeclidinium (Incruse Ellipta)
Some newer medicines combine a bronchodilator with an anticholinergic.
Antibiotics
Some antibiotics, like azithromycin, may help prevent flare-ups. Your doctor may also prescribe an antibiotic if you have an infection or your symptoms get worse. Antibiotics that help with COPD include:
- Amoxicillin
- Clarithromycin
- Doxycycline
Biologics
These medicines come as injections (shots). They block signals in your body that cause inflammation. Biologics approved to treat some types of COPD include:
- Dupilumab (Dupixent)
- Mepolizumab (Nucala)
Roflumilast (Daliresp)
This COPD medicine blocks an enzyme in your body that triggers inflammation. It can reduce how often you have flare-ups and help you breathe better. It does not stop a flare that has already started.
Bilevel positive airway pressure (BiPAP) machine
When you use this device while you sleep, it helps regulate your breathing and keep your airways open. It doesn't go inside your body; you put a mask over your nose. Then, the machine adjusts the pressure of the air you breathe in and out.
A BiPAP machine can help you sleep more comfortably, especially during a flare-up.
Pulmonary rehab
This is a combination of exercises, nutrition advice, knowledge about your condition, and breathing techniques. "Pulmonary rehab has very good evidence," Abu Homoud says. "It reduces symptoms and improves quality of life and functional status."
Side Effects of Nonsteroid COPD Treatments
Based on the type of treatment you have, you could have:
- Anxiety or feeling nervous
- Restlessness (trouble sitting still)
- A faster heart rate
- Nausea
- Trouble sleeping
- A dry throat or eyes
- A funny taste in your mouth
- Headaches
- Muscle cramps
- Weight loss
- A higher risk of infections
"A lot of times, the majority of patients have no problems with them," Abu Homoud says.
Which COPD Treatment Is Right for You?
"Each COPD patient is different, and the way we manage them is different, too," Abu Homoud says.
When choosing a nonsteroidal COPD treatment, your doctor will consider any other health issues that you have, like:
- Heart problems
- Eye conditions, like glaucoma
- Prostate issues
- Whether you're pregnant or nursing
It's also important for your doctor to know all other medications that you take, including recreational drugs and over-the-counter supplements, even if the label says that they're "natural."
What to Know About Your COPD Treatment Plan
You might ask your doctor:
When should I take my medications? Review your treatments with your doctor. Ask how to store them and what to do if you miss a dose. This can help keep you safe.
Can you show me the best way to use my inhaler? "Many times, symptoms aren't controlled because the inhaler is not being used correctly," Abu Homoud says.
How soon should I see you after a flare? "Usually, we recommend within two weeks, unless there's other stuff going on," Abu Homoud says.
Lifestyle Changes to Help Manage COPD
You can also make these changes to breathe a little easier:
Stop smoking. It causes your COPD to get worse faster. Ask your doctor for tips on quitting.
Try to get to a healthy weight. When you carry excess weight, your lungs have to work harder.
Stay active. If your doctor agrees that it's a safe choice for you, you might try yoga. "You build core muscles, stretch, and focus on breathing techniques – these are all very beneficial," Abu Homoud says.
Watch what you eat. A nutritious diet can fuel your body while protecting you from infections. Talk to your doctor about the Mediterranean diet, which focuses on fruits, vegetables, whole grains, legumes, healthy fats like olive oil, and lean protein like chicken.
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Ahmad Abu Homoud, MD, medical director, Pulmonary Hypertension Center, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey.
Mayo Clinic: "COPD," "Roflumilast (oral route)."
National Institute for Health and Care Excellence: "COPD (acute exacerbation): antimicrobial prescribing."
Cleveland Clinic: "Chronic Obstructive Pulmonary Disease (COPD)," "BiPAP," "What To Eat When You Have COPD," "Bronchodilator."
COPD Foundation: "Quitting Smoking," "Treatment and Medications for COPD."
National Health Service: "Treatment – Chronic Obstructive Pulmonary Disease (COPD)."
American Thoracic Society: "Chronic Obstructive Pulmonary Disease (COPD)."
American Lung Association: "The Potential Risks of Repeated Corticosteroid Use."
Asthma + Lung UK: "Long-acting beta-2 agonist (LABA) inhalers."
International Journal of Chronic Obstructive Pulmonary Disease: "Roflumilast: a review of its use in the treatment of COPD."
Dupixent.com: "Side Effects."
