If you have COPD, your number one responsibility as a patient is to do what your doctor says and take all your medications as prescribed. This might sound simple on the surface but, in reality, it's much easier said than done.

Like most chronic diseases, COPD is not an easy condition to treat. Many COPD patients have a laundry list of medications and other treatments they have to manage every day.

These medications and treatments are life-saving; they make it easier to breathe and help keep serious COPD symptoms and complications under control. Unfortunately, far too many people with COPD don't take their medications as correctly and consistently as they should.

That's why we've created this guide to show you a variety of practical tips and techniques for managing COPD treatments. We'll show you all the steps you need to take to make sure you use your medications correctly and how to avoid common COPD treatment mistakes.

The more you know about your treatments, the more active role you can take in your health, and the better you will be able to manage your disease. That's why it's important to learn everything you can about your COPD medications and how to use them in the most correct and effective way.

Most People are Bad at Taking Their Medications

How well you take your medications and do the treatments your doctor recommends is a concept known as treatment compliance or medication adherence. Good compliance or adherence means that you follow your doctor's instructions, complete all your treatments, and take all your medications correctly and on time. Poor compliance or adherence simply means that you fail to do at least one of those things consistently.

Unfortunately, a large percentage of people in just about every health and disease category fail to take their medications properly. This is a problem that affects older adults in particular; up to 58% of seniors make mistakes when taking their medication, and more than 25% make a serious mistake.

Studies also show that as many as 63 percent of COPD patients don't take their medications correctly, and that percentage may be even higher if you include improper inhaler use. This high failure rate results in a great deal of unnecessary suffering for those who don't take their medication as prescribed.

In many ways, these statistics are understandable, even as they are still a major cause for concern. COPD treatment regimens can be confusing, time-consuming, and involve many types of medications, which makes them particularly challenging to get right.

COPD Treatment Plans are Complex

COPD is not a static disease; the symptoms get steadily worse over time and they can vary from day to day. What's more, the risk of exacerbation is always around the corner, especially in the later stages of the disease.

Because of this, COPD treatment plans usually change several times over the course of the disease. Many people with COPD also have to follow dynamic treatment plans that involve adjusting their daily treatment according to certain symptom changes.

This type of treatment plan—known as a COPD action plan—helps you keep your symptoms under control when they flare up. However, it also makes treatment more complex and introduces more opportunities to do things wrong.

COPD patients also have a high risk of making mistakes simply because of the sheer number of treatments they have to manage. It's not uncommon for someone with severe COPD to have to take half a dozen medications in addition to supplemental oxygen therapy.

It's Easier to Mess Up Than It Is to Do it Right

When it comes to taking medications, there's a lot that can go wrong. It's easy to make mistakes without realizing it, such as taking the wrong dose or using an empty inhaler.

Every step and instruction for taking your medication is important, and there can be a lot of them to remember. But skipping even one of them can have dangerous consequences that range from worsened symptoms to life-threatening complications.

Unfortunately, people with COPD tend to take medications that are particularly difficult to use, including inhalers, nebulizers, and supplemental oxygen therapy. Doing these treatments correctly can be a difficult skill to master, requiring several steps and precise technique.

Keeping up with these complex treatments is even more challenging for those who are struggling with serious physical or mental symptoms caused by COPD. When you are struggling just to get out of bed, go up the stairs, or remember things, having to adhere to a strict schedule of multiple medications and treatments can be a lot to handle.

What Happens When You Don't Use Medications Correctly: Does it Really Matter?

At this point, you might be wondering if it's really that big of a deal if you don't follow your treatment or medication instructions exactly. The answer is yes, it is a big deal if you don't adhere to your treatment consistently.

You shouldn't mistake the fact that poor treatment compliance is so common for meaning that it's nothing to worry about. It's actually a major issue, which is why COPD doctors and researchers have dedicated so much time and effort to understanding and solving this problem.

However, nobody is perfect, and there's usually no reason to worry if you only make a mistake every once in a while. On the other hand, you should always make it a top priority to take your medications on time and adhere to all the other treatments your doctor prescribes.

If you don't comply with treatment or forget to take your medication too often, it can make it much more difficult to control your symptoms and manage your disease. This leads to worsened breathing problems, exacerbations, and other COPD complications that can hurt your quality of life.

For instance, one study showed that COPD patients who didn't use their inhalers correctly had worse symptoms, including coughing and more severe shortness of breath, than patients who practiced proper inhaler technique.

Other research shows that poor medication adherence can have a variety of serious consequences, including:

• Less ability to control COPD symptoms
• Increased shortness of breath
• Increased risk for COPD exacerbations
• Increased risk of death (poor treatment adherence can double or triple your mortality risk)
• More frequent hospitalizations
• Increased health care needs and disease-related costs
• Reduced quality of life

Even things that seem minor, like skipping a step when you use your inhaler, can have a major effect on how well your medication works. You could end up getting too small a dose, too large a dose, or not getting any medication at all.

In some cases, using medications incorrectly can cause dangerous side effects or life-threatening complications. If your supplemental oxygen flow is not set right, for example, it can lead to dangerous breathing problems, including severe hypercapnea (high blood carbon dioxide levels) and death in the most extreme cases.

Are You a Compliant Patient?

When you're taking several medications and have a complex disease, it's normal—and even expected—to make small mistakes here and there. However, those mistakes should be few and far between, and overall you should be following your treatments exactly as prescribed.

Unfortunately, many people don't even realize how poorly they are complying with treatment or how frequently they make mistakes. You might make more mistakes than you realize, which is why it's important to give it some serious consideration.

You can get a better idea of your overall compliance by answering a few yes or no questions about your medication habits. The following questions are part of the Medication Adherence Questionnaire (PDF link), a scale that is used often by doctors and researchers to measure how well a patient is adhering to their medication.

To use this scale, choose either “yes” or “no” as an answer to each question or statement. Choose the answer that is most accurate based on your actions and beliefs during the past week.

Medication Adherence Questions:

• Do you ever forget to take your medication?
• Are you careless at times about taking your medication?
• When you feel better, do you sometimes stop taking your medication?
• Sometimes if you feel worse when you take the medication, do you stop taking it?

If you answered yes to any of these questions, then you probably aren't taking your medication as consistently and correctly as you should. The more questions you respond “yes” to, the poorer your medication adherence is.

You can use these questions to help you identify where things are going wrong, and use that insight to find solutions. You should also tell your doctor if you're having trouble taking your medications as prescribed for any reason; this will not only help your doctor make better decisions about your treatment, but will also give your doctor the opportunity to offer solutions and advice.

Common COPD Medication Mistakes to Avoid

We've talked already about how poor treatment adherence is alarmingly common among people with COPD. However, we haven't talked much about what kinds of mistakes patients are making and what exactly they are failing to do.

Research shows that there are several specific areas of treatment that tend to be the most problematic, including taking medication consistently and using proper inhaler technique. If you or someone you love has COPD, it's important to be aware of these common problems so you can avoid making the same mistakes.

Taking Medications Based on How You Feel

One common, yet dangerous, mistake that patients make is stopping their medication when their COPD symptoms start to get better. Some people think that, because they feel fine, they don't need to continue taking their medication.

However, this is not true; you should always take your medication exactly as your doctor tells you to, regardless of how good or bad your COPD symptoms are. If you notice your symptoms improve, you should take it as a sign that your medication is working, and continue to take it as prescribed.

It's important to trust your doctor's advice and remain diligent about your treatment, even if you sometimes feel like it's not necessary to take your medication. If you have any problems or concerns, bring them up with your doctor instead of trying to take things into your own hands.

You need to take your medications consistently every day in order to keep your symptoms under control. Reducing your dose, stopping your medication, or taking it inconsistently will only make it more difficult to manage your disease.

Not Reading the Instructions

When you pick up your medication from the pharmacy, it usually comes with a packet of papers with detailed information about your medicine. Many people simply ignore this packet or throw it in the trash as soon as they get home.

However, this packet contains all kinds of valuable knowledge meant to help you take your medicine correctly and avoid dangerous mistakes. While it might seem like a lot to go through, you should take the time to read through the whole packet for each medication you take.

If you don't, you could miss vital health warnings or important information about dosages, side-effects, drug interactions, and more. It's also a good idea to keep these information packets in a file at home in case you need to reference them later.

Medical stuff can be tricky, however, and reading about your medication will only help you if you understand what it means. That's what your doctor and pharmacist are there for; they can help you go through the information and explain anything else about the medication that you need to understand.

Not Using Your Inhaler Correctly

Even though inhalers are the main line of treatment for COPD symptoms, the vast majority of people don't actually use them correctly. The numbers are actually quite alarming: up to 90% of COPD patients fail to use proper inhaler technique.

Research also shows that improper inhaler use can significantly affect how well the medication works. It can worsen respiratory symptoms, increase your risk of being hospitalized, and may even double your chances of developing a COPD exacerbation.

Here is a list of some of the most common inhaler mistakes you should avoid (note that some only apply to certain types of inhalers):

• Not using the spacer correctly
• Using an empty inhaler (e.g. not checking the dose counter or making sure there is a spray)
• Not priming the inhaler before use
• Not exhaling before taking a dose
• Not inhaling at the correct time when taking a dose
• Inhaling too quickly
• Not aiming the inhaler correctly (it should spray toward the back of your throat)
• Not holding your breath after taking a dose
• Not using correct head and body posture
• Not rinsing out your mouth after using a steroid inhaler

All of these mistakes can affect your dosage and how well your medication works. That's why it is vital to learn how to use your inhaler correctly and avoid making blunders like these.

Not Using Oxygen As Often As You Should

Poor treatment compliance is a major issue among people with COPD who use supplemental oxygen therapy. This is often due to inconvenience, discomfort, and worries about how it might look in public.

Research shows that a large percentage COPD patients who use long-term supplemental oxygen therapy use oxygen for fewer hours per day than their doctor prescribed. Another 23% of patients refuse to ever use their oxygen outside their homes, in spite of their doctor's instructions to do so.

But even though oxygen therapy can be difficult and uncomfortable, it's very important to use it exactly as you're supposed to. If your doctor prescribes it, then you need it to keep your blood oxygen levels from dropping dangerously low (a condition known as hypoxemia).

Failing to use oxygen correctly will worsen hypoxemia, which can lead to serious health conditions including heart problems, cognitive impairment, respiratory failure, and even death. That's why it's imperative to use your oxygen, and use it correctly, despite how challenging it might be.

It's easy to focus on the negatives, but you should instead try to focus on the fact that oxygen is a life-saving medication that can make your life better rather than worse. It's not always easy to integrate oxygen therapy into your life, but for many people it is a necessary part of treating COPD.

Not Using a COPD Action Plan

Any person who takes medication for COPD should have a proper COPD action plan. This ensures that you always have a clear set of instructions to guide you when taking your daily medications and treatments.

COPD treatment is rarely simple, which is why verbal instructions from your doctor and basic medication schedules aren't enough; you need a clear and thorough written plan. If you don't have a proper COPD action plan to guide you, you will be much more likely to take your medication incorrectly and make other risky mistakes.

Unlike a simple medication schedule, an action plan is dynamic; it tells you how to treat your symptoms based on how severe they are that day. It is essentially a set of several medication schedules with instructions for how and when to use each one.

For example, you would have a plan for typical days, when your symptoms are at baseline, and a different plan for atypical days when you feel worse than you usually do. Each plan tells you which medications—and how much—to take, as well as how you should adjust your activity level and other treatment-related advice.

Once you have an action plan, it's important to make sure you understand it and remember to follow it every day. That means means paying close attention to your symptoms, knowing how to choose the right plan, and knowing what the instructions in each plan mean.

To learn about COPD actions plans and see some examples of what they look like, take a look at our guide on the topic here.

Important Things to Know About Your Medications

In order to take your medications properly, you should have a thorough understanding of each medication and treatment you use. That includes basic things like the correct way to take your medications and how much you're supposed to take, and more detailed information like any interactions they have with other drugs and medications.

Ideally, most of the practical information you need to know about your medication should be included in your COPD action plan. However, your action plan is simply an overview of your treatment, and it won't give you all of the detailed information you need to use your medications responsibly.

The more you learn about your medications, the less likely you are to make errors that could affect your medication or put your health at risk. Here's a quick overview of what you should know and where to get the information you need.

Know the Name and Purpose of Your Medication

First of all, it's important to know the name and the general purpose of each medication you take. In other words, you should be able to answer the following questions: What is your medication called, what do you take it for, and what is it supposed to do?

You need this knowledge to understand your treatment plan and why you need to take your medications. It will also help you better communicate with your doctor and others about your treatment.

Fortunately, this kind of basic information is generally easy to find. You can get it from your doctor, your pharmacist, your prescription info packet, or the information printed on medication bottle or packaging.

However, it's best to get this information first hand from your doctor, who can explain the purpose of your medication in easy-to-understand terms. He can also help you understand how the medication benefits your specific condition, and what kinds of outcomes you can expect.

Know Your Dosage and Frequency

Dosage is everything in medicine; if you get too much or too little of a medication, it can significantly change its effects. That's why, in order to take your medication correctly, you need to know exactly how much medicine you're supposed to take.

This is known as your dosage, and getting it right is vital for ensuring your medication works as it should. Your dose frequency is also important, which simply means you need to know how long you're supposed to wait between each dose.

For example, your medication instructions might say to take a dose every certain number of hours, or give you a maximum number of doses you can take in a 24-hour period. Your doctor might also give you more specific instructions for how often you should take your medication every day.

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Know When to Take Your Medications

In many cases, you should take your medication at a specific time every day. For example, your doctor might tell you to use your daily inhaler right after you get up in the morning.

These time-based instructions are important to know and follow, because when you take your medication can affect how well it works. It's also important to keep the dose schedule for each different medication straight; that's where having a detailed medication schedule really comes in handy.

You also need to know when to take medications that are reserved for specific circumstances, such as when your symptoms get worse. You'll likely have a set of medications to take every day (e.g. long-acting bronchodilators), medications you can use as-needed (e.g. a short-acting rescue inhaler), and a set of medications you're only supposed to use when you notice the signs of an oncoming exacerbation (e.g. antibiotics and corticosteroids).

Make sure you know the differences between all these different medications, and know when to use them per your COPD action plan. Pay special attention to as-needed medications like rescue inhalers (and sometimes supplemental oxygen), which can be particularly tricky to use correctly.

Know What to Do if You Miss a Dose

No matter how careful you are, you're bound to accidentally miss a dose sooner or later. Whenever that happens, you'll need to know what to do next.

For example, let's say you just realized that you forgot an inhaler dose that you were supposed to take earlier. Should you go ahead and take the missed dose now, or wait until the next dose you have scheduled?

The answer will likely depend on a variety of things, including the type of medication and how long it's been since the missed dose. If you ask your doctor, he can tell you what to do in a specific case, and how to handle similar situations in the future.

The information that comes with your medication may also give you advice for what to do when you miss a dose. Whatever you do, it's b

Inhaled medications form the backbone of COPD treatment, and they're vital tools for keeping the respiratory symptoms of COPD under control. If you're like most people with COPD, you probably have at least one inhaler to help you manage your symptoms at home.

COPD inhalers come in many different shapes, sizes, and brands, each with their own unique dosages and medicine combinations. Most of these inhalers fall into one of three main types: maintenance inhalers (for daily use), rescue inhalers (for as-needed use), and steroid inhalers (for reducing exacerbations).

Many people with COPD use more than one type of inhaler, especially those whose symptoms are continuous and at least moderate in severity. In fact, typical treatment for the more advanced stages of COPD includes a daily maintenance inhaler, for baseline symptom control, and a rescue inhaler for quick relief when symptoms get worse.

But despite the fact that these medications are such an integral part of COPD treatment, many patients who use inhaled medications don't really understand how important they are or even how they work. That's why we've created this guide to tell you all about COPD inhalers, including how they affect your lungs and how they help your manage your disease.

In this post, we're going to go over the two main types of inhalers used to treat COPD—maintenance inhalers and rescue inhalers—to explain what they do, how they differ, and how they fit into COPD treatment as a whole. We'll also explain how these medications actually work inside your body that makes it easier to breathe.

If you or someone you love has COPD, it's worth taking the time to learn as much as you can about these key COPD medications, even if you're not taking them yet. After all, knowing what to expect can make it easier to adjust as your COPD symptoms, prescriptions, and COPD treatment needs inevitably change over time.

Learning about your medications and familiarizing yourself with these treatments can even help you use your medications more effectively and be more pro-active about managing your disease. The more knowledge you have, the easier it will be follow your COPD treatment plan, understand your medication instructions, and avoid common medication mistakes.

COPD Inhaler Basics: What Do They Do & Why Are They Important?

Because COPD has no real cure, the main purpose of most COPD medications—including COPD inhalers—is symptom management. That is, COPD medications can be used to reduce, delay, or prevent the negative symptoms (especially respiratory symptoms) caused by COPD, even if they can't fully stop or get rid of the disease

As we mentioned before, there are three main types of COPD inhalers, and each uses a different type of medication or combination of medications. Each medication is designed to target specific biological processes in the lungs and airways, and how they alter those processes determines their specific therapeutic effect.

These are the three main categories of COPD inhalers:

• Rescue inhalers use short-acting bronchodilators, a type of medication that works very quickly to relax and open up your airways.
• Maintenance inhalers use medications known as long-acting bronchodilators, which also relax your airways but have subtler, longer-lasting effects.
• Steroid inhalers contain corticosteroid medications, which target the body's immune system to suppress inflammation in the lungs. These are mainly prescribed to reduce COPD exacerbations, and we discuss them in more detail in a separate guide.

As you can see, each type of inhaler plays a unique role in COPD treatment, which is why many patients need to use a combination of two or more types of inhalers to keep their symptoms in check. The most commonly used are the two types of bronchodilator medications, which are widely prescribed as a mainstay of treatment for people with moderate to severe COPD.

It's also important to note that some people with COPD use steroid combination inhalers, which contain both a corticosteroid medication and a long-acting bronchodilator. If you're interested in learning more about steroid inhalers, you can check out our guide on steroid medications and how they are used to treat COPD.

What Are Bronchodilator Inhalers?

The focus of this guide is bronchodilator inhalers, which include both rescue inhalers and maintenance inhalers. Both of these medications have similar effects on the lungs and play vital roles in the everyday management of COPD symptoms.

Both short-acting and long-acting bronchodilators help your airways open up wider by forcing the smooth muscles that surround your airways to relax. This effect is known as bronchodilation and it makes it easier to breathe by improving airflow to and from the lungs.

The “broncho” part of the word bronchodilation refers to the bronchial tubes, which are the main, large airways that carry air to and from the lungs. “Dilation” simply means to make something—in this case, the bronchial tubes—wider, larger, or more open.

Bronchodilation is the opposite of bronchoconstriction, which happens when the smooth muscle surrounding the airways contracts, squeezing the airways down tight and reducing the size of the space inside. Bronchoconstriction is a major cause of breathing problems in people with COPD, and it's what bronchodilator medications are mainly designed to correct.

There are two main types of bronchodilator medications: beta-2 agonists and anticholinergics, both of which come in both short-acting and long-acting varieties. Many COPD inhalers contain only one type of bronchodilator (a beta-2 agonist or an anticholinergic), while others use a combination of both.

We'll discuss these bronchodilator inhalers in more detail in just a bit, but first you need to understand why people with COPD have problems with bronchoconstriction in the first place. That's why, in this next section, we're going to give you a brief explanation of how COPD triggers the chronic bronchoconstriction that COPD inhalers are meant to relieve.

Of course, COPD is a complex disease, and there are many complex factors contributing to COPD symptoms that are beyond the scope of this guide. However, a general knowledge of how airway inflammation and constriction happen is vital for understanding how bronchodilator inhalers work

If you've learned about these topics already (perhaps from other guides in our Respiratory Resource Center), feel free to skip ahead to the section “How Bronchodilators Work in the Body to Make it Easier to Breathe.”

Airway Inflammation & Bronchoconstriction: Major Causes of Breathing Problems in People with COPD

You might already know that COPD affects not only your lungs, but also your airways, including the large bronchial tubes that carry the air to and from your lungs when you breathe. COPD causes your airways to be frequently—if not continuously—inflamed, which is one of the main causes of COPD symptoms, especially those associated with chronic bronchitis.

Bronchoconstriction is, in part, the body's reaction to this inflammation, and one of the major reasons for restricted airflow and shortness of breath in people with COPD. Inflammation also triggers the airways to produce more mucus than usual, which causes congestion in the airways that restricts even more air from flowing through.

This extra mucus is especially problematic when the airways are already constricted, because it makes it more difficult to remove the mucus from the lungs. Instead of allowing the mucus to move up and out of the airways (which is the main purpose of coughing and other mucus clearance techniques), bronchoconstriction causes the mucus to get stuck inside the narrow airspace, creating a particularly stubborn source of obstruction.

In this way, airway constriction is one of the main reasons why people with COPD experience symptoms like coughing and shortness of breath, which are the defining symptoms of the disease. The excess mucus and airway inflammation triggers the need to cough, while the bronchoconstriction and mucus obstruction makes it more difficult to breathe.

Additionally, it takes extra energy to breathe air through narrowed and obstructed airways, which wears out the muscles in your chest that you use to breathe. This breathing muscle exhaustion, in addition to bronchoconstriction, also makes it more difficult to empty your lungs completely when you exhale.

The air that you cannot push out stays trapped inside the lungs, preventing them from collapsing all the way. The stale air also takes up valuable space that's needed for the fresh, oxygen-rich air that you take in when you inhale.

This, in addition to other damage caused by inflammation, can eventually cause irreparable damage to the lungs, including a complication known as lung hyperinflation. This occurs when the lung tissue loses its elasticity, becoming too stiff to expand and collapse fully when you breathe; this essentially “stretches out” and enlarges the lungs, causing even more air trapping and making it more difficult to breathe.

All of these effects, which are largely a consequence of bronchoconstriction, are a major cause of shortness of breath and general breathing difficulties in people with COPD. Because of this, many COPD medications—including bronchodilators—are designed specifically to reduce bronchoconstriction.

In the next section we'll build on these concepts—particularly bronchoconstriction—to explain how bronchodilators work in your respiratory system to make it easier to breathe. Then, we'll discuss how long-acting and short-acting bronchodilators are used to treat COPD, including what they're prescribed for, why they're effective, and what you should know about their benefits and risks.

How Bronchodilators Work in the Body to Make it Easier to Breathe

As we've mentioned already, all bronchodilators have a similar effect, which is to “open up” or widen the space inside the airways. This reduces airway obstruction and allows air to flow through more freely, making it both easier to breathe and easier to move mucus up through the airways and out of the lungs.

This is the main way in which bronchodilators reduce shortness of breath, but they can also help mitigate other long-term complications related to airway constriction. This includes things like breathing muscle fatigue, air trapping, and lung hyperinflation.

However, the question of how bronchodilator medications are able to relieve airway constriction through biological mechanisms is a bit more complex. This is further complicated by the fact that there are three main classes of bronchodilator medications: beta-2 agonists, anticholinergics, and methylxanthines.

Beta-2 agonists and anticholinergics are the most widely used bronchodilators, while methylxanthines (such as theophylline) are sometimes also prescribed. However, the use of methylxanthines to treat COPD symptoms is somewhat controversial, partially due to their high toxicity and partially due to a lack of research and understanding of their effects.

Because of this, we're going to limit our discussion here to the two main types of bronchodilator medications: beta-2 agonists and anticholinergics. Both classes of medication work by reducing airway constriction, but they differ significantly in how they achieve this effect.

Beta-2 Agonists Bronchodilator Medications

The first major type of bronchodilator is a class of drugs known as beta-2 agonists. These medications work by activating a specific type of receptor, known as a beta-2-adrenoreceptor (or beta-2 receptor, for short), which is found in the airway tissues as well as other parts of the body.

This receptor has the ability to affect the smooth muscles in the airways; these are the same muscles that contract in response to inflammation, causing airway constriction in people with COPD. When the beta-2 receptor gets activated, it stops those smooth muscles from contracting, forcing them to relax, resulting in bronchodilation that opens up the airways and makes it easier to breathe.

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Taking a beta-2 agonist medication via an inhaler or nebulizer delivers the medication directly to your lungs and airways, where it absorbs into the cells lining the insides of your airway walls. Once inside, they can activate the beta-2 receptors in those cells, triggering airway muscle relaxation.

However, not all of the beta-2 agonist medication stays in the lungs; some of it inevitably gets absorbed into your bloodstream as well. The bloodstream carries the drug to beta-2 receptors located in other parts of body (e.g. the smooth muscle of the heart and blood vessels); this can trigger unwanted side effects like an increased heart rate and blood vessel dilation.

If you use a short-acting beta-2 agonist, this relaxation happens very quickly, providing almost instant relief from shortness of breath. Long-acting beta-2 agonists, however, work much more slowly, taking several hours to begin working, and often taking days to provide noticeable symptom relief after you first start taking the medication.

Anticholinergic Bronchodilator Medications

Anticholinergics (also known as muscarinic antagonists) are a second type of bronchodilator medication that are used in COPD treatment. It's common for anticholinergics to be combined with a beta-2 agonist in a single inhaler.

Unlike beta-2 agonists, which relieve airway constriction by triggering airway muscles to relax, anticholinergics help prevent airway constriction by inhibiting a certain signal that triggers bronchoconstriction.

This “certain signal” is produced by an important type of receptor—known as a muscarinic receptor—which is found in cells all over the body, including the lungs and airways. These receptors are responsible for triggering the parasympathetic nervous system response, which affects different parts of the body in different ways.

In the lungs and airways, the parasympathetic response does two main things, both of which make it more difficult to breathe. First, it triggers the airway tissues to secrete more mucus (causing obstruction), and second, it triggers the airway muscles to contract (causing bronchoconstriction).

Here's where anticholinergics come in; these medications work by blocking muscarinic receptors in your lungs and airways, essentially rendering them inactive. This prevents the parasympathetic response from getting triggered in the first place, thereby preventing the airway narrowing and mucus obstruction it causes.

Just like beta-2 agonists (and other inhaled medications), a small amount of the anticholinergics you breath in will get absorbed into your bloodstream, even though most of it gets absorbed in the lungs. This leads to some muscarinic receptor activation in other parts of the body, which can cause negative side effects like constipation, confusion, and an irregular heartbeat.

There are several types of both short-acting and long-acting antocholinergics, which are used in short-acting and long-acting bronchodilators respectively. The quicker-acting versions work for up to 6 hours, while longer-acting anticholinergics can work for more than 24 hours.

Bronchodilators in COPD Treatment

Long-Acting Bronchodilators: Long-Term Symptom Relief

The purpose of long-acting bronchodilator inhalers in COPD treatment is to provide long-term relief from persistent COPD symptoms, particularly shortness of breath. They're considered a cornerstone of COPD treatment, and they're one of the most frequently-prescribed medications to treat COPD.

Long-acting bronchodilators are often referred to as “maintenance inhalers” because they help control the “stable,” everyday symptoms of COPD. This helps to reduce and stabilize symptoms, and helps prevent them from flaring up, which are some of the primary goals that doctors and people with COPD strive for with long-term disease maintenance.

Long-acting bronchodilators take a while after you start taking them (up to several days or weeks) to reach full effect, but they continue working for a long time (about 12-24 hours) once they do. This makes them essentially useless for immediate symptom relief, but extremely effective for sustained, long-term COPD symptom control.

Long-Acting Bronchodilator Therapy in COPD Treatment

Some people begin long-acting bronchodilator therapy as soon as the get diagnosed with COPD, but not everyone does. Some people who get diagnosed in the early stages of the disease don't require long-term treatment (or sometimes any treatment, yet) because their symptoms are still very mild or infrequent.

However, almost everyone who has COPD will need a long-term maintenance treatment eventually. As the disease progresses and COPD symptoms become more frequent, more persistent, and more severe, many patients need long-acting bronchodilators to keep their symptoms under control.

Most of the time, if you're prescribed a long-acting bronchodilator inhaler, you will need to use it once or twice a day, every day. Because long-acting bronchodilators take so long to work, it's vital to take them consistently so they can stay active in your body throughout the day.

This is why it's important to use your maintenance inhaler on a regular schedule; it ensures that the medicine works constantly and reliably to keep your symptoms suppressed. Try to avoid skipping or delaying your daily inhaler doses and do your best to follow the treatment plan precisely.

Unfortunately, some people mistakenly believe that they only need to use their maintenance inhaler when they're actively experiencing symptoms. This misconception leads them to use their inhaler inconsistently, or to stop using their inhaler altogether when their COPD symptoms improve.

However, this can be very dangerous; it can increase your risk for exacerbations, cause your symptoms to rebound, and make it more difficult to control your COPD symptoms in the long run. That's why, if your doctor prescribes you a daily maintenance inhaler, you need to follow his instructions exactly, and never stop taking your medication unless your doctor says it's okay.

Common Long-Acting Bronchodilator Medications Used to Treat COPD

Here we've listed some of the most common long-acting bronchodilator medications used to treat COPD. The brand names are listed first, and the pharmaceutical drug name is in parentheses.

Beta-2 Agonist Only:

• Arcapta Neohaler (indacaterol)
• Brovana (arformoterol)
• Perforomist (formoterol)
• Serevent (salmeterol)
• Stiverdi (olodaterol)

Anticholinergic Only:

• Incruse (umeclidinium)
• Seebri (glycopryrrolate)
• Spiriva Respimat (tiotropium)
• Tudorza (aclidinium)

Combined Beta-2 Agonist and Anticholinergic:

• Anoro (umeclidinium and vilanterol)
• Bevespi Aerosphere (glycopyrrolate and formoterol)
• Stiolto (olodaterol and tiotripium)
• Utibron (indacaterol and glycopyroolate)

Short-Acting Bronchodilators: Short-Term Symptom Relief

Short-acting bronchodilators (also known as “quick-relief inhalers” or “rescue inhalers”) are important in COPD treatment because they can provide immediate, short-term relief from COPD symptoms. Just like maintenance inhalers, quick relief inhalers work by relaxing airway muscles to reduce airway obstruction and make it easier to breathe.

However, unlike long-acting bronchodilators, which take hours to work and require regular, scheduled doses, short-acting bronchodilators can be used as-needed throughout the day. That's because they work almost immediately (within seconds or minutes) and their effects usually wear off within just a few hours after use.

The quick-yet-temporary nature of short-acting bronchodilators makes them ideal for treating incidental COPD symptom flare-ups, such as the temporary bouts of increased breathlessness that most people with COPD experience occasionally, if not often. At the same time, rescue inhalers are not effective for long-term symptom management due to the short length of their effects.

How Short-Acting Bronchodilators are Used in COPD Treatment

Short-acting bronchodilators are often prescribed along with long-acting bronchodilators in a kind of dual therapy that works like this: The long-acting bronchodilator manages the baseline symptoms of COPD, reducing the risk of exacerbations and offering stable, long-term symptom relief. The short-acting bronchodilator is used for additional symptom relief, particularly for stopping sudden symptom flare-ups that inevitably occur.

However, some people with COPD are only prescribed short-acting bronchodilators and use them as the primary means to manage their symptoms.

This is most common in the early stages of the disease, when many patients only experience intermittent symptoms and thus don't need long-term symptom control. At this stage, COPD symptoms can sometimes be adequately spot-treated with quick-acting rescue inhalers whenever they occur.

Rescue inhalers are very effective at stopping sudden, severe symptom flare-ups, which can show up without warning and even be life-threatening in some situations. Because of this, if you've been prescribed a quick-relief inhaler, you should do your best to take it with you everywhere you go.

But though some flare-ups happen unpredictably without an obvious cause, many symptom flare-ups are at least somewhat predictable. For example, it's common to experience sharp increases in breathlessness during physical exertion or after breathing in lung irritants like allergens and smoke; when this happens, you'll definitely want to have your rescue inhaler nearby.

Most of the time, rescue inhalers are meant to be used during a symptom flare, especially ones that won't go away on their own. This can be particularly helpful when usual coping techniques—such as stopping to rest and using breathing technique

Whether you've tried to stop smoking before or you're just now considering it, it's often difficult to quit on your own. Fortunately, you don't have to go it alone; there are tons of quit-smoking experts, techniques, resources, and programs that can help you quit.

About 1.3 million people in the US are able to quit smoking every year, and with the right tools and support, you could be one of them! Even if you're not trying to quit cold-turkey yet, it's good to know what kind of help is out there in case you ever decide that you're ready to quit in the future.

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Utilizing public programs and other smoking cessation tools can give you the extra boost that makes all the difference in success, whether it's your first quit attempt or you've tried and failed before. For people with chronic health conditions that can get much worse when you smoke (e.g. heart disease, asthma, and COPD), an effective quit-smoking strategy could even mean the difference between life and death.

Even though it's far from easy, stopping smoking is one of the best things you can do to improve your health and prevent chronic diseases. Because of this, it's worth it to take advantage of any and all options that can improve your chances of quitting for good.

How to Use This Quit Smoking Guide

This is part one of a comprehensive, three-part guide on how to quit smoking for good. Our goal is to touch on all the important tools and strategies you need to create a successful quit-smoking plan, and to help you tackle your next attempt to quit smoking with confidence and finesse.

In this first post, we're going to introduce you to the wide variety of both public and private resources designed specifically to help smokers quit. We've included a large number of free smoking cessation tools and programs as well as some that are paid, including online support groups, counseling, mobile accountability apps, educational resources, and more.

In parts 2 and 3, we'll cover other important quit-smoking strategies and tools, including how to cope with withdrawal, how to choose a nicotine replacement therapy, and how to put together a personalized quit-smoking plan. We'll even walk you through the first steps of quitting and show you how to utilize a variety of everyday strategies to keep yourself on track.

If you are a smoker who's thinking about quitting, or you know someone who is, then the information in this guide could be a valuable resource on your journey to stop smoking.

Here are some ways you can use this guide:

• As a reference for smoking cessation programs, resources, and support
• To compare and contrast different types of quit-smoking medications and tools
• To learn what you can expect after you quit smoking
• To remind yourself of the benefits of quitting smoking
• To learn how to put together an effective and comprehensive quit-smoking plan
• To prepare for and make it through your quit day
• As a reference to a variety of different practical strategies and techniques you can use in everyday life to resist cravings and stay smoke free

But before we get started with programs and resources to help you stop smoking, let's first take a moment to address some of the things that might be holding you back. It's normal to have doubts and apprehensions about quitting, and dispelling them might make you feel better about the idea and help you strengthen your resolve to quit.

Frequently Asked Questions About Quitting Smoking

Even when you have the right tools to quit smoking, there are lots of little questions and concerns that can get in the way. Can I do it? Is it worth it? Will it even make that big of a difference in my health?

It can be difficult to plan for a major lifestyle change with all these apprehensions rolling around in your brain. That's why, in this first section, we're going to answer these and other common concerns that people have about quitting smoking.

Once you put your worries to rest, you can approach the challenge with a clearer head and open mind. Instead of dwelling on reservations, you can focus instead on the positive ways that quitting smoking can improve your life.

What if I've Tried to Quit Before, But Couldn't?

Just about everyone who smokes knows that it is not good at all for their health, and research shows that more than half of smokers have tried to quit at least once in the past year. In spite of this, most quit attempts fail, and more than 34 million people in the US continue to smoke every day.

While this might seem discouraging at first, it's important not to let the possibility of failure discourage you from trying to quit. Studies also show that at least forty percent of all adults who have ever smoked have quit, and that most people fail at least several times (or up to 30!) before it eventually sticks.

You can't ignore the fact that it's hard to quit smoking, but you can realize that failure is a normal, and potentially necessary, step on the way to success. Just because you didn't succeed last time, or even if you don't succeed this time, it definitely doesn't mean that any future attempts are doomed.

For many people, quitting smoking is a game of persistence; if you just keep at it for as long as it takes, you're bound to eventually win. The main challenge is not losing hope, and not letting slip-ups and failures derail your efforts for good.

Is it Even Worth Quitting When I've Been Smoking for Such a Long Time?

All experts agree that quitting smoking is pretty much always a good idea, no matter how old you are or long you've been smoking. Whether you're 25 or 65, you can gain a wide range of health benefits once you successfully quit.

When you stop smoking, your heart, your lungs, your skin, your nose, and many other parts of your body will benefit. It can also make you feel better in general by reducing anxiety and improving your overall mood.

In part 3 of this guide, we will discuss these benefits in more detail and give you a timeline you can use to estimate when certain benefits will appear. If you keep that section handy, or take notes on the benefits that mean the most to you, you can look over them again to remind yourself whenever you find yourself doubting whether or not it's worth it to quit.

As soon as you find the resolve to stop smoking, don't let it fade by putting it off; stopping sooner is always better because it reduces your chances of developing a smoking-related disease.

If that sounds like too much pressure, try to think of it this way: the earlier you quit, the longer you get to enjoy the benefits of living a smoke-free life!

What if I Gain Weight After I Quit?

Weight gain is a relatively common side effect of quitting smoking, usually due to an increased appetite and slower metabolism (because of the absence of nicotine). This makes some smokers apprehensive about quitting, and even turns some smokers away from the idea altogether.

It's common—and natural—to worry about gaining weight when you quit smoking, but you shouldn't let it discourage you from trying to stop. While some ex-smokers end up gaining some weight, it's far from guaranteed to happen to you.

In fact, some research suggests that the majority of ex-smokers don't gain weight after they quit. One study, for instance, found that only about 32-42 percent of study participants who quit smoking gained any weight at all.

Even those that do struggle with weight gain, however, still have many opportunities to prevent it and to lose any extra pounds they put on. As long as you think ahead, you can put a plan and support system in place to help you maintain your current weight.

For example, using a nicotine replacement therapy can prevent you from gaining weight after you quit—at least until you stop using the medication. However, this gives you some extra time to develop healthy eating and exercise strategies as you gradually taper down your nicotine dosage.

You can also reduce your risk of weight gain by working with your doctor or a quit-smoking counselor. These professionals can help you manage your weight-related anxiety and develop healthy skills and habits for maintaining your current weight.

Even if you do gain a few extra pounds, remember that it doesn't have to be permanent. The good thing about weight is that you can always lose it eventually with the right diet and exercise changes.

However, even if you gain a little bit of weight and keep it, you'll still be much healthier living a smoke-free lifestyle than you were before you quit. Instead of focusing on the potential negative side effects, think instead about all the guaranteed health benefits you will get if you quit smoking for good.

Is it Worth Quitting if I Already Have COPD or Another Lung Disease?

Quitting smoking is always worth it, at any age and in any health condition. There is pretty much no situation you could be in that continuing to smoke would ever be a good idea.

Even if you have already been diagnosed with COPD or another lung condition, your lungs will still be significantly better off if you stop smoking. Frankly, COPD makes it incredibly important and especially urgent to quit, since continuing to smoke can worsen your symptoms, cause life-threatening exacerbations, and increase your risk of dying from the disease.

While it cannot heal the damage you've already done to your lungs, stopping smoking can reduce further lung tissue damage and allow you to keep the breathing function you still have for longer. In fact, smoking cessation is one of the only known treatments that can slow down the progression of COPD.

Research shows that there are many other tangible benefits of quitting for people with COPD, including fewer symptom flare-ups, fewer hospitalizations, and a reduced risk of death. Quitting smoking can also improve your quality of life by making it easier to manage your symptoms in general

The health benefits of living a smoke-free lifestyle are simply too great to give up on, especially if you suffer from a chronic lung condition like COPD. You shouldn't let anyone or anything—including your own reservations—discourage you from trying to quit.

Quit-smoking Programs and Resources

When you decide to try to stop smoking, you don't have to start from scratch and you don't have to do it alone. Quitting for good takes a lot effort and planning, but you'll always have access to a wide variety of quit-smoking programs, support groups, and other helpful resources at every step along the way.

After all, there's no reason to re-invent the wheel when you can utilize all kinds of effective tools and resources that have already been established to help smokers quit. Between quit-smoking counseling, phone hotlines, mobile apps, online support communities, and more, you can get the advice and support you need both before, during, and long after the day you quit smoking.

In fact, there are so many quit-smoking programs and resources out there you can use, it can be hard to narrow them down! That's why we've collected some of the best quit-smoking resources from every category and put them together in this easy-to-reference guide.

There are several main types of quit-smoking programs we will cover: quit-smoking counseling, quit-smoking hotlines, online communities and support groups, structured online quit-smoking programs, and both text- and app-based programs you can complete on your mobile phone.

Text and App-Based Mobile Quit-Smoking Programs

Mobile-based quit smoking programs are a great way to get information and motivation delivered to you on-the-go. Most of them involve either receiving daily text messages or accessing quit-smoking tools and advice via a mobile application.

Here are some app-based quit smoking programs you can try:

• The QuitGuide app from Smokefreegov: This is a free application (available for both android and iPhone) packed with seriously useful tools for quitting smoking. It allows you to track things like your mood, cravings, slip-ups over time, and journal about your experiences. You can also use the app to keep track of your goals, triggers, and progress staying smoke-free, and to get tips for motivating and distracting yourself whenever you have a craving.
• The QuitStart app from Smokefree.gov: This is another free application (available for both android and iPhone) that you can use to help you quit. It provides tips for staying smoke-free, tools for tracking your progress over time, and rewards you with badges for achieving certain milestones and goals.
• QuitNet: This is a community-based support app for ex-smokers and smokers who want to quit. The free version lets you participate in the social community, where you can share advice and encouragement with others like you anywhere you go. It also provides a range of paid services including personal counseling and medical advice.

Here are some text message-based quit smoking programs you can try:

• SmokefreeTXT from Smokefree.gov: This 6-week program helps you quit for good by giving you advice and encouragement via 3-5 text messages every day (Available in English and Spanish).
• Specially Tailored SmokefreeTXT programs: Smokefree.gov offers it's quit-smoking text support program in several different versions, each tailored for different needs. You can visit their website here to sign up for one of these programs, including: SmokefreeMOM for women who are pregnant, SmokefreeTeen for young adults, SmokefreeVET for veterans with VA benefits (available in English and Spanish), and DipfreeTXT for young adults who want to stop using smokeless tobacco.
• Smokefree Daily Challenge from Smokefree.gov: If you're not quite ready to quit yet, you can try these daily text-message challenges to start building skills that can help you stop smoking.
• Smokefree Practice Quit from Smokefree.gov: If you're not ready to quit forever yet, you can use this text message program to do a “practice quit” (abstaining from smoking for just 1-5 days at a time) to help you build up resilience and work on coping mechanisms.
• You can get on-demand help by texting a specific keyword to the SmokefreeTXT program number: 47847. Text CRAVE for help getting through a craving; text MOOD for help improving your emotional state; or text SLIP if you slip up and need support to help you stay smoke free.

Online Quit-Smoking Programs and Support Groups

There are a variety of structured quit-smoking programs and support groups you can access online. These programs are open to everyone, and all you need is a computer and internet access to participate from anywhere in the world.

Most of these programs cost money, but they are sometimes cheaper than in-person classes and counseling. You might also be able to get your health insurance to pay for your online class, or you can check to see if your workplace offers any health incentives that would cover the costs of your quit-smoking program.

Here are some online quit-smoking programs you can participate in:

• The Quit For Life Program from the American Cancer Society: This is a paid online program that gives you one-on-one support to help you quit smoking. It includes an email support system, an on-demand online chat service with quit-smoking counselors, and more. You can also use their website to track your progress and network with other smokers who are participating in the program.
• Freedom from Smoking Plus Program from The American Lung Association: This is a paid online course ($99.95) that you can complete on your computer, tablet, or smartphone over the course of six weeks. It consists of nine sessions that teach you how to quit smoking with evidence-based strategies and techniques. The program also hosts an online community you can use to socialize with other participants.
• LiveHelp from cancer.gov: You can visit the LiveHelp website to get on-demand support from specialists who are trained to offer advice on how to quit smoking. (service available Monday-Friday between 9am and 9pm Eastern Time)

Quit-Smoking Phone Hotlines

Quit-smoking phone hotlines connect you instantly to experts and counselors trained in providing support to smokers who want to quit. They can help you create a quit-smoking plan, give you great tips for staying quit, and help you find other quit-smoking resources to meet your needs.

Quitlines are also a great source for in-the-moment advice and support when you need a little help or motivation to stay smoke free. If you're feeling overwhelmed or need help riding out a craving, the volunteers on the other end of the quitline are always ready to help.

Here are some quit-smoking hotlines you can use to help you quit:

• Connect to the quitline for your state: 800-QUIT-NOW (800-784-8669)
• The National Cancer Institute's Hotline (English and Spanish): 877-44U-QUIT (877-448-7848) Available between 9am and 9pm eastern time
• The American Lung Association's Tobacco Quitline: 1-800-LUNGUSA (1-800-586-4872) Available Monday-Friday between 1am and 9pm, and on Saturday-Sunday from 9am to 5pm

Quit-Smoking Counseling

Quit-smoking counseling is a great way to start your quit-smoking journey, whether you've already decided to quit or you're still struggling to make the commitment. In counseling, you'll have a trained guide to help you through the quitting process and provide you with advice and support to help you succeed.

Quit-smoking counselors can help you work through worries and other roadblocks that make it difficult to quit. They can also walk you through the process of making an effective quit-smoking plan and support you through the first steps.

Once you finally quit, your counselor can help you cope with difficulties like cravings, anxiety, and nicotine withdrawal in healthy ways. Even months after you quit, long-term counseling can help you stay on track and avoid common pitfalls and mistakes.

There are a few different types of quit-smoking counseling you can choose from:

• One-on-one therapy
• Group therapy
• Phone counseling (via quitlines or through a long-term provider)
• Online counseling (via online chat service or through a long-term provider)

Group therapy is a great way to get advice, support, and learn from other smokers and ex-smokers under the guidance of trained counselors. One-on-one therapy, on the other hand, allows you to get more personalized therapy in a much more private setting.

Phone counseling and online counseling give you access to quit-smoking therapy from the comfort of your own home. While these methods tend to be less effective than in-person counseling, they are often cheaper, more convenient, and they can still increase your chances for success.

If you want to give counseling a try, you can always talk to your doctor to learn more about counseling and other quit-smoking programs available in your area. You may also be able to find information about local quit-smoking options on the official website for your county, city, or state.

Here are some quit-smoking counseling resources to consider:

• The American Lung Association's Freedom from Smoking Clinics: These clinics offer structured, in-person group therapy courses that last for eight weeks. (Call 1-800-LUNGUSA to find a clinic near you)
• Nicotine Anonymous: Borrowing a similar format to alcoholics anonymous, nicotine anonymous hosts quit-smoking support group sessions for people all across the country. You can attend meetings in-person, online, and by phone.
• You might be able to get free or discounted quit-smoking counseling through your employer or your health insurance provider

Counseling for Other Psychiatric Problems

Many people smoke as a way to cope with other psychological issues, like anxiety, depression, and ADHD. Even smokers without a diagnosed mental disorder often depend on smoking to relieve stress, boost their mood, and cope with negative emotions.

Unfortunately, smoking is not a healthy coping mechanism, and it's important to find new, healthier strategies to get you through the day. This is especially important because withdrawal can cause your psychological problems to get worse temporarily once you quit.

If you use smoking to cope with negative moods and emotions, it's important to treat any underlying psychological issues before you try to quit. If you find a counselor who can help you both before and after you stop smoking, you'll be much more likely to succeed and you'll have better mental health.

Online Educational Resources

There are a variety of websites and guides you can access online that provide a wealth of information and practical advice to help you quit smoking. You can use them to learn more about smoking addiction, what it's like to quit smoking, and how to successfully stay smoke free.

Here are some links to some of the most useful

Antibiotics are a special class of medications that specifically target, weaken, and kill bacteria. They're one of the best tools that modern medicine has to fight bacterial infections, and they're also an important tool for COPD treatment.

Unfortunately, people with COPD get respiratory infections much more easily and more often than people with healthy lungs. Lung infections also tend to be more severe in people with COPD because they worsen already-dangerous breathing problems and elevate the risk for severe respiratory complications.

Because of this, antibiotics are a regular and familiar part of many COPD patients' treatment routines. They're used to treat lung infections like pneumonia, to manage COPD exacerbations, and even to prevent future infections and exacerbations before they occur.

That's why, in this post, we're going to tell you all about antibiotics and the role they play in COPD treatment. We'll explain how antibiotics work, how they can improve exacerbations, and discuss the various uses and benefits that antibiotics can for managing COPD.

We'll also discuss how to take antibiotics responsibly and look at some of major risks and concerns that come with frequent antibiotic use among people with COPD. Our goal is to help you better understand your COPD medications and better picture how antibiotics fit into COPD treatment as a whole.

If you'd like to learn more about other COPD medication and how they work, you can find all kinds of helpful information in our other medication guides posted to our blog's Respiratory Resource Center.

Why are People with COPD Prone to Airway Infections?

People with COPD are more prone than most other people to catching all kinds of illnesses that affect the respiratory system. This includes common viruses like the cold and flu, but also more serious lung infections like pneumonia.

At the same time that COPD patients are more likely to catch these illnesses, they are also more vulnerable to serious and life-threatening symptoms if they get sick. Because lungs affected by COPD already struggle to function effectively, they are unable to compensate adequately when a respiratory illness comes along and impairs them even more.

In fact, respiratory illnesses and infections are the main cause of COPD exacerbations, which are days-to-weeks-long episodes where COPD-related breathing problems and other symptoms get worse. Although exacerbations are sometimes mild, moderate exacerbations often require hospitalizations, and severe exacerbations can cause life-threatening breathing problems and permanent lung function decline.

Even a mild cold can cause an exacerbation, but the biggest danger often comes from the risk of secondary respiratory infections. Secondary infections happen when the respiratory system has been so weakened and overwhelmed with the first illness that it makes it significantly easier for a second illness—e.g. a bacterial illness like pneumonia—to evade the body's defense systems and start another infection.

This vulnerability is, in large part, a direct result of the disease causing damage to important disease defense mechanisms in the lungs.

One of these defense mechanisms is mucus, in particular the movement of mucus up and out of the airways. This process traps and physically removes pathogens (like viruses and bacteria) that make it into the lungs.

Unfortunately, people with COPD have narrowed, blocked-up airways that make it more difficult to expel this mucus by coughing. Their mucus also tends to be thick, sticky, and more likely to cling to airway walls than healthy mucus, which is thinner, more fluid, and moves more easily out of the lungs.

Additionally, lung damage and inflammation caused by COPD significantly hinders the function of cilia, which are important hair-like structures covering the inner walls of your airways. Healthy cilia move together in coordinated, rythmic beats, a motion that pushes mucus up and out of the lungs to get expelled.

In airways affected by COPD, many of these cilia become paralyzed so that they are no longer able to effectively move mucus out of the respiratory system. This causes mucus to stay trapped within the lungs and airways where it not only obstructs airflow, but also allows pathogens to continue growing and multiplying inside the lungs.

Because of this, people with COPD have a higher chance of getting sick from any viruses, bacteria, and other pathogens that make it into their lungs and airways. It also makes them more prone to secondary respiratory infections, as the lungs' natural defense mechanisms are further impaired by the increase in COPD symptoms.

It's also important to mention bacterial colonization, a phenomenon where some people with COPD always have a small amount of infectious bacteria in their lungs. These bacteria are not as numerous as they are during an active infection, and they usually don't cause any symptoms or actual infections most of the time.

However, colonized bacteria still have the potential to multiply out of control and trigger illness and exacerbation. In fact, research shows that COPD patients with bacterial colonization have more frequent and more severe COPD exacerbations.

When Does Someone With COPD Need to Take Antibiotics?

In general, you usually only need to take antibiotics when you have an exacerbation caused by a bacterial infection. However, since it's difficult to know the cause of an exacerbation for sure, your doctor will likely prescribe you antibiotics anytime you have an exacerbation that seems likely to have a bacterial cause.

Some doctors prescribe antibiotics for people with COPD as soon as an exacerbation starts, even when the patient doesn't have a verified infection yet. This helps stop any current infection in its tracks while also reducing the chances of a secondary respiratory infection popping up later.

In this way, the benefits of taking antibiotics during an exacerbation include reducing symptoms caused by bacterial infections and preventing more serious complications that could arise from secondary infections (even the original cause of the exacerbation is a virus). This can reduce the length of an exacerbation and increase your chances to make a full and quick recovery.

Some COPD patients take antibiotics on a regular basis, even when they're not sick or exacerbating, to help prevent future COPD exacerbations. However, this type of preventative treatment is usually reserved for COPD patients with an especially high risk for infection, such as those who are hospitalized and those who have bacterial colonization in their lungs.

How Do Antibiotics Work?

One way that antibiotics treat and prevent infections is by directly killing bacteria, usually by targeting and destroying the bacteria's protective outer walls. They can also inhibit bacteria in other ways, including by interfering with their metabolism or making them unable to reproduce.

Here are some of the main methods antibiotics use to fight bacteria:

• They can injure the bacteria's outer cell wall, which causes the bacteria to burst open and die.
• They can prevent the bacteria from absorbing nutrients, which stops them from growing and multiplying (giving your immune system the upper hand in the fight).
• They can prevent bacteria from making copies of its DNA, which stops them from multiplying.

There are many different types of antibiotics, and each works in a slightly different way. Different antibiotics also have different strengths and weaknesses against different types of infections.

Some antibiotics are very specialized and only work against a few different types of bacteria, while others—known as broad spectrum antibiotics—are effective against a much wider range of bacteria types. Which antibiotic works best for a particular kind infection depends on a variety of different factors that only your doctor can know for sure.

Here are some of the most common types of antibiotics prescribed to COPD infections and exacerbations:

• Antibiotics for mild to moderate exacerbations:
• Doxycycline (Vibramycin)
• Trimethoprim-sulfamethoxazole (Bactrim DS, Septra DS)
• Amoxicillin-clavulanate potassium (Augmentin)
• Clarithromycin (Biaxin)
• Azithromycin (Zithromax)
• Levofloxacin (Levaquin)
• Gatifloxacin (Tequin)
• Moxifloxacin (Avelox)
• Antibiotics for Severe Exacerbations:
• Ceftriaxone (Rocephin)
• Cefotaxime (Claforan)
• Ceftazidime (Fortaz)
• Piperacillin-tazobactam (Zosyn)
• Ticarcillin-clavulanate potassium (Timentin)
• Levofloxacin (Levaquin)
• Gatifloxacin (Tequin)
• Tobramycin (Tobrex)

Most antibiotics work fairly quickly; once you start a course of antibiotics, a large amount of the bacteria that cause the infection get destroyed within a couple of days. Because of this, you might start to feel better after taking just a few doses of the medication.

However, feeling better does not mean that you're cured. Until you finish the full course of antibiotics, there's a good chance that there's still some bacteria remaining, and it doesn't take much to start up the infection all over again.

That's why it's so important to complete your entire course of antibiotics down to the very last dose. As with any medication, you should take your antibiotics exactly as your doctor instructs; that means taking your medication on time, not missing doses, and resisting the temptation to stop taking the medication after your symptoms go away.

Most antibiotic treatments last anywhere from 5 days to two weeks, depending on the type of antibiotic and the type of infection it's prescribed to treat. Once you complete the full course as directed, the infection and the bacteria that caused it should be thoroughly snuffed out (with the exception of “colonized” bacteria in the lungs of some people with COPD).

Sometimes antibiotics are also used as a preventative measure, in which case the antibiotics work in very much the same way. During the time that you're taking the medication, the antibiotics attack invading bacteria as they come, thwarting any potential infection before it has a chance to take hold.

How Antibiotics are Used to Treat COPD

As we've discussed briefly so far, antibiotics are used quite often in COPD treatment, especially when someone with COPD is hospitalized or has a severe exacerbation. We've mentioned their use as a preventative treatment, as well, to prevent exacerbations and infections before they ever occur.

Now, let's take a closer look at each of these different antibiotic treatments to better understand how they're administered and how they work. Then, we'll discuss some of the major risks and side-effects of using antibiotics to treat COPD, and how frequent antibiotic use can contribute to antibiotic-resistant infections.

Treating Bacterial Respiratory Infections

Antibiotics are pretty much always used to treat illnesses caused by bacteria, including respiratory infections like pneumonia that are common in people with COPD. If you develop such an infection, taking antibiotics directly treats the cause and gives you the best chance of recovery.

However, figuring out whether or not a respiratory illness is caused by bacteria is not exactly simple; it can be difficult and expensive to test for the cause of an illnesses that's deep inside the lungs. Because of this, when COPD patients get sick, doctors often have to rely on making educated guesses about whether the exacerbation is more likely caused by a virus or bacteria.

This determination is based on a variety of different factors, including specific symptoms, exacerbation history, and changes in sputum color. In general, you're more likely (but not guaranteed) to have a bacterial infection if you have the following symptoms: a fever, a COPD exacerbation that doesn't improve with time, sputum that is yellow, green, and if your symptoms don't improve or continue to get worse over time.

Sometimes, these signs are enough to show that a bacterial infection is very likely and that antibiotics are needed. In other cases, if your doctor's not sure, he may run additional tests to look for evidence of infection, including chest x-rays and testing for bacteria in your sputum.

Here are some of the most common types of bacteria that cause lung infections in people with COPD:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
• Enterobacteriaceae
• Staphylococcus aureus
• Mycoplasma pneumoniae
• Pseudomonas bacteria

Treating COPD Exacerbations

Research shows that majority of COPD exacerbations are caused by respiratory illnesses (either viral or bacterial), with bacterial infections accounting for about half of COPD exacerbations. But without further testing, it's difficult to know whether a particular exacerbation has a viral or bacterial cause.

It's important to emphasize that antibiotics only work against illnesses and infections caused by bacteria; they can't cure anything caused by a virus or a non-bacterial cause. Because of this, doctors will usually only prescribe them to sick patients who show clear signs of a bacterial infection.

However, doctors often make exceptions for people with COPD, who are both more prone to getting respiratory infections and also more prone to developing severe complications if they do. So instead of waiting to confirm that an illness is bacterial (at which point it has already taken hold), some doctors will often prescribe antibiotics at the beginning of an exacerbation “just in case.”

However, this practice is somewhat controversial, and some experts believe that people with COPD should only take antibiotics after an infection is strongly suspected or confirmed. Limiting the frequency of antibiotic use in this way reduces the risk of antibiotic resistance (a phenomenon that we will discuss more in the following sections).

Others believe that it's helpful to prescribe antibiotics for exacerbations more generally, as a precautionary measure. This may be especially effective for patients who have a high likelihood of infection due to risk factors like bacterial colonization or a history of bacterial infections.

Some doctors will even give some patients an extra course of antibiotics to keep at home until the next time they need them, at start of their next COPD exacerbation. This allows patients to start the course as early as possible while avoiding the hassle (and potential delay) of needing to go to the doctor or pharmacy after they get sick.

Studies show that beginning antibiotics soon after the beginning of an exacerbation can have several benefits, including a higher chance for symptom improvement and even a reduced chance of death. However, some patients are more likely to benefit than others; patients who are hospitalized or have moderate to severe exacerbations seem to receive more benefits from antibiotics than those with milder exacerbations.

If your doctor prescribes you preventative antibiotics, it's important to make sure understand exactly how and when to use them, and never use them for any reason other than what your doctor prescribed them for. Make sure you know the correct medication dosage, timing, and any potential risks, and seek out your doctor or pharmacist if you have any questions or concerns.

You should also ask your doctor to write down clear instructions for all your medications in your COPD action plan. This plan should tell you exactly what to do when you notice your symptoms flaring up, including how to recognize an exacerbation, what steps (and medications) you should take when you feel sick, and when you should call your doctor if your symptoms don't improve.

Preventing Exacerbations: Prophylactic Antibiotics

Some doctors use a treatment known as prophylactic antibiotic therapy (also known as long-term, continuous, or intermittent antibiotic therapy), in which COPD patients take antibiotic medications for extended periods of time. Unlike most antibiotic courses, prophylactic antibiotics are meant to be taken even when you're not sick or experiencing an exacerbation.

The main purpose of this treatment is to reduce the risk of future exacerbations by preventing bacteria from getting the chance to multiply and infect the lungs. Of course, prophylactic antibiotic therapy cannot prevent all exacerbations, since many are caused by viral infections like the flu or common cold.

However, by helping to prevent bacterial infections, continuous antibiotics can still reduce the total number of illnesses and exacerbations a COPD patient experiences.

Research on long-term antibiotic treatment (PDF link) confirms that it can be a viable way to prevent exacerbations in people with moderate to severe COPD. Studies show that prophylactic antibiotics can increase the time interval between exacerbations, reduce the overall frequency of exacerbations, and even shorten the length of exacerbations when they do occur.

As we discussed already, however, taking antibiotics for any reason except to treat an existing bacterial infection is controversial in the medical community. Many experts believe that antibiotics should be used as sparingly as possible, since the risk of antibiotic resistance increases the more often they are used.

Because of this, most doctors avoid prescribing antibiotics for prophylactic use except in special cases where a patient shows a particular need for that extra protection. This sometimes includes “frequent exacerbators” that don't respond to other treatments meant to reduce the frequency of exacerbations.

Other COPD patients who might need continuous antibiotics include those with a higher-than-usual risk for infection, such as those with a history of exacerbations caused by bacterial infection. This also includes people who have an “infective phenotype,” meaning they show signs of long-term bacterial colonization in their lungs.

There are several different methods for prescribing prophylactic antibiotics that differ mainly on how the medication doses get spread out. Some patients take antibiotics daily (the continuous method), some take them just a few days out of every week (the intermittent method), while others take breaks for several weeks in between antibiotic treatments that last for several days (the pulsed method).

Benefits and Risks of Antibiotics to Treat COPD

There is no question that antibiotics are effective against many types of bacterial infections as long as the bacteria hasn't developed antibiotic resistance. If you have COPD and develop a respiratory infection for any reason, your doctor will almost certainly prescribe antibiotics to help you get better.

However, the role of preventative antibiotics for COPD patients are mixed, even though research shows that antibiotics can both prevent COPD exacerbations (when taken continuously), and treat COPD exacerbations (when taken soon after one begins). The main topic of dispute is not whether preventative antibiotics work, but whether or not their benefits are worth their risks.

This is a question that, for now, can only be answered on a case-by-case basis. It's up to you and your doctor to decide—based on your disease severity, infection risk, and other personal health factors—if taking continuous or preventative antibiotics is right for you.

One of the main risks of taking antibiotics is antibiotic resistance; this happens when bacteria mutate and become less susceptible to the effects of an antibiotic medication. This is a problem that affects everyone—not just those currently taking antibiotics—which is why antibiotic resistance is such a serious public health concern.

Antibiotic-resistant bacteria cause antibiotic-resistant infections, which can be very difficult to treat and recover from. In severe cases, bacteria can become resistant to multiple types of antibiotics, causing infections that are deadly or impossible to cure.

The more that people use antibiotics in general, the more prevalent antibiotic-resistant bacteria become, which increases everyone's

The primary purpose of most COPD medications is to help relieve the normal, everyday symptoms of COPD, such as coughing and shortness of breath. Steroid medications, however, contribute to COPD treatment in an entirely different way.

Corticosteroids, the main type of steroid medication used to treat COPD, are mainly used to treat COPD exacerbations, which occur when COPD symptoms temporarily get worse. Steroids don't help much with daily, baseline COPD symptoms, but they are effective for managing the episodes of abnormally severe symptoms that occur during exacerbations.

That's not to say that steroids aren't an important part of COPD treatment, because they are; managing exacerbations is an integral part of controlling COPD symptoms and slowing lung function decline. Steroid medications play a vital role on this front, as both a treatment for exacerbations and as a preventative to reduce the risk of future exacerbations.

There are two main types of steroid medications used in COPD treatment: inhaled corticosteroids (the kind you take via inhaler or nebulizer) and systemic corticosteroids (the kind you usually take as a pill). Using systemic steroids during an acute exacerbation can help you recover faster, while using inhaled steroids daily can reduce how frequently you experience acute exacerbations of COPD.

In this post, we're going to tell you all about steroid medications and COPD so you can better understand the role that they play in COPD treatment. We'll discuss how inhaled and systemic steroids differ, how they help stabilize COPD symptoms, and explain how they work in the body to combat inflammation and keep exacerbations under control.

COPD & Inflammation: An Inflammatory Disease

The main purpose of corticosteroid medications in general is to fight inflammation, and inflammation just so happens to be inextricably intertwined with COPD. Because of this, you won't be able to fully appreciate the importance of steroids in COPD treatment until you first understand the massive role that inflammation plays in the disease.

Research shows that inflammation is a defining characteristic of COPD; people with COPD have inflammation in their lungs, in their airways, and even in their bloodstreams. In fact, COPD is defined by some researchers as an “inflammatory airway disease,” and exerts believe that unchecked inflammation might be a fundamental cause of the disease.

Let's take a closer look at the relationship between COPD symptoms and inflammation to help you better understand how steroid medications help people with COPD.

Lung and Airway Inflammation

Inflammation affects many aspects of COPD, but perhaps the most obvious is the way it triggers respiratory symptoms like coughing, shortness of breath, and excess mucus build-up in the airways. In fact, many of the respiratory symptoms associated with COPD are related in some way to inflammation.

Inflammation, also known as the inflammatory response, is part of the body's natural immune response. Its purpose is to help your body recover and repair itself whenever cells are harmed by injury, irritation, or infection.

Usually, the inflammatory response is only temporary, and eventually shuts down on its own—this is known as acute inflammation. However, it can be harmful if it goes on too long—causing a condition known as chronic inflammation—and even cause serious damage to healthy tissues and cells in your body.

People with COPD have lungs and airways that stay continually inflamed, even when there's no external “reason” for the inflammation such as breathing in an irritant like tobacco smoke. This is one of the reasons why COPD symptoms don't go away even if you quit smoking (though it does have many other benefits); the inflammation—and the lung damage caused by inflammation—continues to persist even after you remove any obvious sources of lung irritation.

This chronic inflammation triggers a variety of different changes in the lungs and airways that cause COPD symptoms to appear. Many of these changes occur on the insides of the small airways in your lungs, which are called your bronchial tubes.

When the bronchial tubes get inflamed, they respond by secreting more mucus than usual. This is a defense mechanism meant to trap and neutralize any pathogens (e.g. viruses and bacteria) or other particles that make it into the lungs to prevent them from causing any further damage to lung and airway tissues.

Usually, that mucus and anything trapped in it gets moved up and out of the airways, where it eventually leaves the body as sputum: the mucus-saliva mixture that comes up when you cough. However, COPD—and the constant inflammation that comes with it—causes additional problems that make it difficult to get this extra mucus out of the airways.

First, COPD damages tiny hair-like structures (called cilia) that line the insides of your airways, which are usually responsible for moving mucus up and out of the lungs. Second, inflammation causes your airways to swell, which narrows the space inside; this causes mucus to get stuck inside the airways, causing even more obstruction that prevents air from flowing through.

All of this together results in the classic airway obstruction associated with COPD: narrowed airways and excess mucus block the flow of air, limiting how much can flow in and out of your lungs at a time. This, in turn, is a major reason for COPD symptoms: shortness of breath, chronic cough, and excess sputum production.

Inflammation also makes the airways hyper-sensitive, causing them to over-react to any irritants breathed into the lungs. This is why people with COPD are so vulnerable to pollution and other airborne irritants; even slight exposure can trigger elevated inflammation that worsens respiratory symptoms.

While inflammation is part of your immune system's defensive response, chronic, unchecked inflammation—like that caused by COPD—can actually do serious harm, causing permanent scarring and other damage to healthy tissues over time. In people with COPD, chronic lung inflammation causes permanent lung and airway damage that is largely responsible for the inevitable and irreversible lung function decline that occurs as the disease progresses.

Systemic Inflammation

Research shows that COPD-related inflammation is not just limited to the lungs and airways; COPD causes chronic inflammation all throughout the body. This type of inflammation, known as systemic inflammation (“systemic” meaning “affecting the entire body"), is measured by looking for specific substances called inflammatory markers in the blood.

Long-term, systemic inflammation can have many negative health effects, and it's associated with a wide range of chronic diseases, including cancer, diabetes, cardiovascular diseases, and autoimmune disorders. There's even some evidence that the chronic inflammation associated with COPD can raise your risk for other diseases that are characterized by chronic inflammation, including heart disease.

The severity of systemic inflammation can vary from person to person, though it tends to increase during COPD exacerbations. Systemic inflammation also tends to increase as COPD gets worse (PDF link), as patients with more severe symptoms and more advanced disease tend to have more inflammatory markers than those with mild disease.

However, researchers are not exactly sure why COPD causes systemic inflammation, or how it fits into the mechanisms of the disease as a whole. It is clear, however, that systemic inflammation is closely related to COPD symptoms, and particularly to COPD exacerbations.

Research on inflammatory markers in people with COPD shows that both airway inflammation and systemic inflammation increase during COPD exacerbations. Other studies find similar links between exacerbations and systemic inflammation, including that patients with higher levels of inflammatory markers in their bloodstream have a higher risk for COPD exacerbations along with a tendency to have exacerbations that are longer and more severe.

Inhaled Steroids Versus Systemic Steroids: A Major Difference

Before we dive into the details of how different steroid medications work, it's important to discus some very important differences between inhaled and systemic corticosteroids. Both types of steroids are used in COPD treatment, but they differ significantly in why they're used and how they work in the body.

Systemic steroids come in two different forms: the most common is an oral pill that you swallow, but in some cases doctors administer systemic steroids through an injection. Both routes cause the medication to get absorbed into your bloodstream, where it circulates through all your organs and tissues, having wide-reaching (“systemic”) effects on the whole body.

Inhaled corticosteroids, on the other hand, come in an inhaler so they can be breathed directly into the lungs and airways. This allows them to act directly on the surfaces of your lung and airway tissues, which results in much more localized effects.

Inhaled corticosteroids essentially work as topical medications; they primarily affect the lung and airway tissues that they physically come into contact with. Studies show that, unlike systemic steroids, only very small amounts of inhaled steroids actually make it into the bloodstream, significantly limiting their effects on other parts of the body besides the respiratory system.

Because systemic steroids affect the whole body, they can have a lot unintended, and potentially serious, side effects. On the other hand, inhaled corticosteroids tend to be less risky and have fewer side effects (PDF link) since they are limited mainly to the lungs.

Another major difference between these two types of steroid medications is what they're used for:

Inhaled steroids are used by many COPD patients long-term as a daily maintenance treatment to prevent exacerbations. In some, rare cases, some doctors will prescribe high-dose inhaled corticosteroids (PDF link) to patients during an exacerbation if their symptoms are not too severe.

Systemic steroids, however, are used to treat existing COPD exacerbations, and help patients recover from exacerbations faster. Unlike inhaled steroids, systemic steroids can have very serious side effects with prolonged use, which is why doctors only prescribe them for short periods of time and discontinue them as soon as the exacerbation is gone.

Inhaled Steroid Medications: For Daily COPD Maintenance and Exacerbation Prevention

Inhaled corticosteroid medications are used pretty frequently in COPD treatment because of their ability to prevent COPD exacerbations. They're almost always prescribed in combination with a long-acting bronchodilator, either in a separate inhaler or in a combination steroid-bronchodilator inhaler.

However, unlike bronchodilator medications, which are broadly used by people with COPD, steroid inhalers are typically prescribed much more selectively. Usually, they're reserved for COPD patients who show a particular need for protection from exacerbations, particularly those who have had exacerbations frequently in the past.

While bronchodilators have a direct, relaxing effect on bronchial tissues, steroid inhalers work indirectly by reducing inflammation in the lungs and airways. Over time, this can help reduce a variety of symptoms associated with airway inflammation, including coughing and shortness of breath.

Steroid inhalers can also reduce airway hyper-responsiveness, a common COPD ailment in which breathing in airborne irritants (like air pollution, allergens, and even common household cleaners) can easily trigger COPD symptoms. By inhibiting inflammation, inhaled steroids can make your airways less sensitive to these and other irritating airborne particles you inevitably encounter in daily life.

However, steroid inhalers aren't routinely prescribed for symptom relief alone, partially because they are not as reliable or effective at reducing COPD symptoms as broncodilators are, and partially because of their potential for side effects. What inhaled steroid are best at—and primarily used for—is preventing COPD exacerbations, and their ability to stabilize respiratory symptoms is more like an added bonus.

Common Steroid Inhaler Medications Used to Treat COPD (brand name in parentheses)

• Flunisolide (Aerospan)
• Ciclesonide (Alvesco)
• Mometasone (Asmanex)
• Fluticasone propionate (Flovent)
• Budesonide (Pulmicort Flexhaler)
• Beclomethasone dipropionate (Qvar Redihaler)

Using Inhaled Steroids to Treat COPD

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There are two main types of steroid inhalers used to treat COPD: steroid-only inhalers, and combination inhalers that contain both a steroid medication and a long-acting bronchodilator. Some patients use a nebulizer instead of an inhaler to take their steroid medications.

Which method or medication is best for you depends on a variety of factors, including whether the inhaled steroid treatment is meant to be temporary or a permanent addition to your daily treatment routine. It's also important to note that inhaled steroids can take up to several weeks to begin working, so you shouldn't expect any noticeable results right away.

The most common reason that doctors prescribe steroid inhalers to people with COPD is to reduce their risk for future exacerbations. Because of this, they're most often prescribed to “frequent exacerbators” and other patients who have a higher-than-usual risk for exacerbation,.

Steroid inhalers are also sometimes prescribed to patients who struggle more than others to keep their daily COPD symptoms under control. This includes patients with very severe disease symptoms as well as those who—for whatever reason—don't respond well enough to bronchodilators alone.

One of the main ways that doctors predict a patient's exacerbation risk—and thus their need for inhaled steroid medication—is by looking at the patient's exacerbation history. Research shows that past exacerbations are one of the strongest predictors of future exacerbations, though other factors also come into play.

One of those factors is a specific type of airway inflammation, known as eosinophilic bronchial inflammation, that is known to increase patients' risk for COPD exacerbations. Anyone with COPD can have this type of inflammation, but it's particularly common in those with a history of asthma.

The only way to confirm whether or not you have eosinophilic bronchial inflammation is to take a blood test that detects high levels of eosinophils in the bloodstream. Research shows that COPD patients with high blood eosinophil counts are more likely to see benefits (in the form of reduced exacerbations) from taking inhaled steroid medications.

For reasons that are not fully understood, some COPD patients respond better to oral steroids and inhaled steroids better than others. Because of this, your doctor might monitor you and your symptoms more closely for awhile after you begin using a steroid inhaler to ensure that the medication is having the desired effect.

Here is list summarizing the major risk factors associated with an increased risk for COPD exacerbations:

• Exacerbation History: The more exacerbations you have had in the past year, the higher your risk for exacerbations in the future.
• Exacerbation Recency: Because exacerbations tend to cluster, you're more likely to have a repeat exacerbation if you've had an exacerbation within the past two months.
• Exacerbation Severity: If you have had severe exacerbations in the past, you have a higher risk of experiencing severe exacerbations in the future.
• Disease Severity: Advanced COPD and severe COPD symptoms increase your risk for exacerbations.
• Asthma: People with asthma-COPD overlap syndrome (a diagnosis of both asthma and COPD) have a higher risk for COPD exacerbations.

How Inhaled Steroid Medications Work

We already know that the purpose of inhaled steroid medications is to reduce inflammation and reduce COPD exacerbations. In these next sections, we're going to dig just a little bit deeper to understand more about how inhaled steroids achieve their anti-inflammatory effects.

Inhaled steroids work by dampening the inflammatory response in the lungs, which is significantly elevated in people with COPD. This inflammatory response is controlled by the body's own immune system, and generally works like this:

The immune system triggers an inflammatory response in the lungs by telling the cells in the lung and airway tissues to produce inflammatory chemical signals. These chemical signals do two main things: they cause inflammatory immune cells to flock to the area and cause blood flow to the area to increase (causing swelling).

When you inhale a steroid medication, it absorbs into the cells of the same lung and airway tissues that produce those inflammatory signals. There, the medication essentially “turns off” the specific genes inside those cells that allow them to create inflammatory signals, reducing their ability to continue triggering the inflammatory response.

Inhaled steroids can also activate anti-inflammatory genes, which causes the cells to produce chemicals that directly suppress inflammation. Together, these effects help to reduce inflammation in the airways and make the the airways less sensitive to inflammation triggers (e.g. allergens, air pollution, and other respiratory irritants).

The reduced inflammation and reduced airway hyper-responsiveness both help to reduce COPD symptoms that stem (at least in part) from inflammation, including excess mucus production, coughing, and shortness of breath. This can help stabilize everyday symptoms and make the lungs less susceptible to increases in inflammation.

It's also important to note that airway inflammation tends to worsen significantly during COPD exacerbations, and reducing this inflammation (through oral steroids) can speed up exacerbation recovery time. This link could at least partially explain how inhaled steroids can prevent exacerbations; if using steroid inhalers continually keeps lung inflammation suppressed, it could prevent the sharp increases in inflammation that researchers believe are at least partially responsible for triggering COPD exacerbations.

However, it's important to note that COPD-related inflammation doesn't seem to respond to steroid medications as well as other inflammatory diseases like asthma (it still responds, but to a lesser degree). Because of this, there is some disagreement in the research literature about whether or not steroids can effectively reduce inflammation in people with COPD, especially those who don't have asthma-COPD overlap syndrome.

On the other hand, research suggests that using an inhaled corticosteroid might help COPD patients by directly increasing the effectiveness of long-acting bronchodilator medications. This would explain a phenomenon researchers have long observed—that combined steroid-bronchodilator therapy is generally more effective than either medication on its own.

Here's how researchers believe this phenomenon works: First, long-acting bronchodilators work by activating specific receptors in your cells called beta-2 receptors. Studies show that inhaled steroids can increase the total number of beta-2 receptors in your cells, which could allow long-acting bronchodilators to activate more receptors than they would otherwise be able to, amplifying their effects.

Unfortunately, researchers are still not sure exactly how inhaled corticosteroids reduce COPD symptoms and exacerbations on a fundamental level, though their anti-inflammatory and beta2-agonist effects of

Home oxygen therapy is a normal part of daily life for many people with COPD. But if you're new to oxygen therapy, or about to begin using it soon, having to make that change can seem daunting or even downright scary.

After all, home oxygen therapy is a big responsibility and having to use it can feel like a major intrusion into your life. There's a lot to learn and a lot to adjust to—but the good news is you don't have to do it completely on your own.

In this guide, you'll find all kinds of helpful tips and information that everyone using home oxygen therapy should know, including how to use oxygen safely, how to prepare for emergencies, and what kinds of side-effects you can expect. You'll also find lots of helpful advice for easing the transition to long-term oxygen therapy, including how to make your home more oxygen therapy-friendly, and how to make your oxygen equipment more comfortable to wear.

With all this information at your disposal, you'll be able to get a jump-start on learning the ropes and hopefully feel more confident about having to use supplemental oxygen. Our goal is to give you a good idea what to expect and how to prepare for oxygen therapy so it won't feel quite so difficult or overwhelming to do.

Throughout this guide, you'll find links to a variety of helpful online resources, including guides to related topics that we've published in the past. To see these and many of the other practical guides we've posted on oxygen therapy and COPD, check out our Respiratory Resource Center.

Using Oxygen Can Create a Serious Fire Risk

One of the first things you should know about oxygen therapy is that concentrated oxygen can be very dangerous if you don't handle it properly. The percentage of oxygen you get during oxygen therapy is much higher (up to 100 percent) than the oxygen in ambient air (about 21 percent), and at such high concentrations, it is a major fire risk.

Contrary to popular belief, oxygen itself isn't actually flammable; however, concentrated oxygen makes other substances that it comes into contact more flammable in a couple of different ways. First, it makes substances that are already somewhat flammable much easier to ignite; second, it causes fires to burn bigger and hotter, and can even cause explosions.

For example, petroleum jelly is not generally very flammable in normal situations, but, in the presence of concentrated oxygen, it can catch fire if exposed to an errant spark or flame. That's why doctors advise patients not to use petroleum-based products on their lips while using supplemental oxygen and to use water-based products (e.g. KY jelly) instead.

Because of this risk for fire, you need to be extremely careful about keeping your supplemental oxygen at least 10 feet away from flames, high heat, and other fire hazards. This applies to your oxygen tanks when they're in storage or in use, and to the concentrated oxygen that flows through the tubing and into your mouth or nose.

Even a small flame or spark can cause an accidental fire if it happens near the stream of oxygen coming from your oxygen supply. Even cooking over the stove while using oxygen is risky, as is using electronic devices that have the potential to produce sparks (this is why you should never use an electric shaving razor while using supplemental oxygen).

This is also why it's important to never, ever smoke (PDF link) while you're using oxygen; it could ignite the concentrated oxygen as it flows from your nasal cannula or mask and cause severe burns. Additionally, you should never allow anyone else to smoke near you while you're using oxygen nor anywhere inside your home.

You should be cautious about potential oxygen leaks, which can cause oxygen to build up in high enough concentrations in the air to pose a serious fire risk throughout your home. Leaks can come from oxygen tanks in storage or from your oxygen delivery system; that's why you should always assemble your oxygen delivery equipment carefully and never leave your oxygen running when it's not in use.

Experts also advise anyone who uses supplemental oxygen—or has an oxygen supply in their home—to put up warning signs in, around, and even outside their house. This helps remind household members and visitors to be cautious, but also to warn emergency personnel about the hazard in the case they need to enter your home during a fire or other emergency.

You also need to be careful about how any oxygen tanks you are using or keeping in storage are positioned and secured. You should always store oxygen tanks in a well-ventilated space (never in an enclosed area like a closet) where they will not be in danger of shifting, falling, or getting damaged in any way.

These are some of the most basic safety considerations, but there is much more you should know. Luckily, you can find much more detailed oxygen safety instructions and advice in our comprehensive oxygen safety guide.

You can also find many more resources online, including this one (PDF link) from the New York State Office of Fire Prevention & Control and this guide on oxygen cylinder safety (PDF link) from Intermountain Healthcare.

Whatever you do, make sure to learn everything you can about how to use your oxygen safely, ideally before you begin oxygen therapy at home. Make sure you understand their hazards and take the time to familiarize yourself with all the best practices for preventing accidents, leaks, fires, and burns.

Not Using Your Oxygen as Prescribed Can Be Detrimental to Your Health

If your doctor puts you on long-term oxygen therapy, it's because you actually need it. This might seem extremely obvious, but it's important to keep in mind anytime you're tempted to skip out on your oxygen therapy because it's difficult or inconvenient to do.

It's important to always do your best to use your supplemental oxygen exactly as your doctor prescribes, even if you don't want to and even if you don't feel like you need it that day. Home oxygen therapy isn't just about helping you breathe; it's also about protecting all the organs in your body from becoming oxygen deprived.

Unfortunately, research shows that only about 60% of COPD patients using supplemental oxygen actually use it for as many hours a day as their doctor prescribed. Most of the remaining 40% don't use their supplemental oxygen enough, and by doing so put their health at risk.

When someone with COPD has to use long-term oxygen therapy, it's because their lungs are too damaged to take in enough oxygen on their own. This results in hypoxemia, which happens when the amount of oxygen in your bloodstream falls below what's considered to be a healthy level (which can include blood oxygen saturation levels below 95 percent).

Usually, people with COPD don't need to begin long-term oxygen therapy until their blood oxygen saturation falls below about 90%. Having blood oxygen levels that low, especially over a long period of time, can cause a variety of serious health problems, including cognitive decline, cardiovascular disease, and pulmonary hypertension.

Severe hypoxemia also puts you at risk for tissue hypoxia, a serious condition that occurs when there's so little oxygen available in your blood that some parts of your body can't get the minimum amount of oxygen they need to function normally. In severe cases, tissue hypoxia can cause extensive, permanent organ damage and even death if it's left untreated for too long.

However, using supplemental oxygen helps reverse hypoxemia and return blood oxygen saturation to healthier levels, preventing tissue hypoxia and the various other health complications that hypoxemia can cause. And that is why using your supplemental oxygen exactly as you're supposed to is so important and so vital for your health.

Supplemental Oxygen Has Side-Effects and Risks

It's important to remember that supplemental oxygen is a drug that comes with some potentially serious risks. It might seem harmless because it's “just oxygen,” but, in reality, supplemental oxygen is a medicine just like any other and you should always treat it that way.

Supplemental oxygen works because it provides your lungs with air that has much more oxygen in it than the regular, ambient air you normally breathe. This makes it easier for your lungs to absorb oxygen from the air, raising your blood oxygen levels and making it easier to breathe.

However, breathing in highly-concentrated oxygen can, in some cases, cause dangerous respiratory imbalances, including oxygen toxicity, excess carbon dioxide build-up in the blood (a condition known as hypercapnia), and—in rare cases—an increased risk for death. These problems are most likely to happen if an error, such as incorrect dosing, causes you get an excessive amount of oxygen.

This can happen due to patient error (e.g. setting the flow rate on your oxygen tank too high or not following dosage instructions) or from doctor error (e.g. prescribing too high an oxygen concentration or too long a duration for therapy). To reduce this risk, most doctors start COPD patients on lower oxygen doses and increase them gradually as needed, while also carefully monitoring patients for signs of hypercapnea and other adverse effects.

That's why it's important to use your supplemental oxygen correctly and treat it with the same care and diligence that you would treat any other type of medication. That means always making sure you get your oxygen dosage right and follow your doctor's instructions for oxygen use exactly.

Luckily, serious adverse effects from home oxygen therapy are pretty rare, though the risk increases with higher oxygen concentrations and longer duration of use. However, there are some other more common—and much more mild—side-effects that can occur even if you use your oxygen 100 percent correctly.

Here are some of the more common side effects of using supplemental oxygen:

• Skin irritation
• Ear pain
• Nose bleeds
• Dry mouth, nose, and throat
• Dizziness
• Reduced sense of taste
• Reduced sense of smell

Many of these side effects (e.g. dryness and abraision) are essentially discomforts caused by the oxygen equipment itself or how the oxygen is administered to your lungs rather than the oxygen medicine itself.

You Can Make Oxygen Therapy More Comfortable

Unfortunately, many people experience discomfort when using supplemental oxygen, particularly after wearing the equipment for long periods of time (as many oxygen patients must do). This is one of the main reasons why some patients aren't consistent about using their oxygen therapy or simply don't use their oxygen as much as they should.

Some of these ailments are caused by pressure and skin chaffing where equipment (such as over-the-ear straps and tubing, nasal cannulas, or oxygen masks) touches the skin, particularly around the mouth, nose, and ears. Many patients also complain about the longer length of tubing that hangs down from their mask or nasal cannula, which can restrict movement and easily get snagged or pull on the ears.

Another common source of discomfort is the air that comes from the oxygen supply, which tends to flow faster and be less humid than breathing ambient air. Over time, this constant flow of dry air can dry out your lips, mouth, nose and throat, which can lead to nosebleeds and split lips.

While this all might sound very discouraging, there's no need to despair! You don't have to suffer without relief, because there are many different techniques you can use to reduce and mitigate all of these common discomforts and more.

For example, you can modify your oxygen delivery equipment to reduce ear pain and irritation by adding padding under the tubing on your ears. You can reduce skin chaffing by covering problem areas of tubing with fabric wraps or fabric tape.

You can prevent extension tubing snagging and keep it out of the way by clipping it to your back or running it under your clothes. You can also get specialized equipment designed specifically for better comfort, including nasal cannulae made from softer plastic tubing that's gentler on the skin.

To reduce nose and throat dryness, you can use a humidifier bottle to add moisture to the air coming from your oxygen delivery device. You can also use a variety of (non-petroleum) topical ointments, lip balms, and creams to treat dry skin on and around your lips, mouth, and nose.

While these techniques might not eliminate all your discomfort completely, they can make oxygen therapy much more comfortable and much more tolerable to use. These are also just a few of many possible solutions that you could experiment with and adapt to your personal needs.

For even more practical tips and suggestions, check out our comprehensive guide about how to make oxygen therapy more comfortable, which includes more detailed information about specialized oxygen products and comfort-improving techniques.

It Can Help to Clear Some Extra Space at Home

Home oxygen therapy requires a lot of equipment, and that equipment takes up space—and a lot of it. We're not just talking storage space (even though you'll need that too), but also space for you to move around with your equipment freely.

Using oxygen at home requires a good deal of lugging equipment and tubing around, and you don't want to feel restricted or at risk of getting tangled up everywhere you go. Because of this you might need more wide-open space in your home than you needed before after beginning home oxygen therapy.

To get the extra space you need, you might need to clear out some clutter, re-arrange your furniture, or even re-think the overall setup of your home. Try to do this with consideration for how you personally use and move through the space, looking for ways you can make it easier to navigate your home without running into obstacles that could crowd you, trip you up, or snag on your oxygen tubes.

You should also be thoughtful about where you run your oxygen tubing, especially anywhere it lies across the floor. Do your best to keep your extension tubing from running across main walkways and other places where it could cause you or someone else to trip.

Finding the best arrangement might take some trial and error, but it's worth taking the time to get it right. After all, a living space that's cramped or difficult to navigate is not only frustrating (and affects your quality of life), but it's also a potential safety hazard.

You'll Need to Work With a Medical Supply Company to Get Your Oxygen & Supplies

Getting a prescription for supplemental oxygen is just the first step to starting oxygen therapy; the next step is to actually get the oxygen and the rest of your oxygen delivery equipment. Unfortunately, you can't get what you need simply by visiting a regular pharmacy like you can with most other prescriptions.

The good news is that you can get all your oxygen and equipment delivered straight to your home, but the bad news is that you'll likely need to arrange that delivery yourself. This can be a bit tricky, since it requires working with your insurance company (or medicare provider) to find an eligible medical supply company that offers what you need.

Keep in mind that different medical supply companies often have different prices andd different selections of equipment. Before choosing a supplier, make sure you know exactly what kinds of products they have, including what oxygen supply devices they offer (e.g. home oxygen concentrators or portable oxygen tanks) and other oxygen delivery equipment (e.g. types of plastic tubing, oxygen masks, nasal cannulae, humidifier bottles, etc.).

If you're not sure exactly what you need or what to look for, that's okay; your doctor should help you begin the process and prepare a detailed order (PDF link) for you to give to your insurance company and oxygen supplier. Your doctor can also walk you through the different equipment you will need and why you need them; for example, if you need high-flow or high-concentration oxygen, you might need to use an oxygen mask rather than a nasal cannula.

Most oxygen supply companies rent their oxygen equipment for 36-month (3-year) periods, at which point you can continue renting the equipment (for up to two more years) or switch to another supplier. During that 3-5 years, the company agrees to supply you with an adequate amount of oxygen, along with all other necessary supplies, and perform any required maintenance that your oxygen equipment needs during that period.

It's important to keep track of when your rental agreement starts and when you need to renew your contract (or find a new oxygen supply company), that way you can take care of it before the rental period expires. Being pro-active will help ensure that you don't have any gap or delay in your oxygen supply.

For more information and instructions for how to order your oxygen supplies, check out the following links:

• This article from Verywell Health tells you how to order oxygen through Medicare.
• This guide for choosing and ordering oxygen supplies (PDF link) from The LAM Foundation and COPD Foundation, which includes a helpful breakdown of the benefits and risks of 3-year versus 5-year contracts.
• Information about Medicare coverage for oxygen equipment from medicare.gov.
• This guide from our Respiratory Resource Center explains what you need to know about health insurance and oxygen equipment.

Keeping Your Equipment Clean and Maintained is Key

Unfortunately, your oxygen equipment won't stay in good shape all on its own. You'll need to perform some degree of regular cleaning and maintenance to keep your equipment working, clean, and safe.

First, you'll need to sanitize your oxygen mask, nasal cannula, and connector tubing regularly—at least once per week. You can do this by washing the equipment in warm, soapy water (to get off any mucus or grime), dunking it into a vinegar solution (to kill bacteria), and then setting it out to dry.

You should also clean your equipment (and possibly even replace your mask or nasal cannula) anytime you get sick with any kind of respiratory virus or infection. Failing to do so—or simply not cleaning your equipment often enough—allows dangerous viruses and bacteria to multiply and potentially get you sick.

You will also need to replace your nasal cannula or oxygen mask with a new one on a regular basis, usually about every two weeks. You will also need to replace your extension tubing about every 3-6 months, though you should always follow the instructions for the specific equipment you use.

You may also need to perform other cleaning and maintenance tasks, such as wiping down the outside of your equipment, replacing a home oxygen concentrator's filter, or checking oxygen tanks regularly for damage or leaks. Make sure you know what kind of maintenance you're responsible for and what kind of maintenance your oxygen supplier provides.

For more detailed information and instructions for taking care of your oxygen equipment, check out our how-to guide on Oxygen Equipment Cleaning and Maintenance.

You Need to Be Prepared for Emergencies

When you're dependent on supplemental oxygen to breathe and stay healthy, it's very important to make sure you always have access to your oxygen. That requires planning for emergencies like power outages and other situations that could affect your ability to use oxygen.

First, you should always keep an extra supply of backup oxygen in your home just in case you can't use your primary supply for some reason (e.g. if it's empty or malfunctioning). While you should never run out of oxygen in a normal situation, you should always be prepared for natural disasters and other emergency situations that could delay the delivery of your oxygen supplies.

If you use an oxygen concentrator that relies on power to work, you'll specifically need a backup supply that doesn't need electricity, such as a liquid or compressed-gas oxygen tank. That way, if there's ever a power outage, you'll always have a source of oxygen hold you over until the power comes back on.

You should also notify your electricity utility company once you begin oxygen therapy, especially if you have an oxygen concentrator plugged in at home. This gives you the opportunity to get on a priority service register, which can make you eligible for certain safety benefits like giving your home priority when restoring power after an outage; however, whether or not you can get any extra benefits depends entirely on your particular power company, so make sure to ask your local utility what they offer to be sure.

For a more detailed guide on how to prepare for emergencies when you rely on oxygen therapy, check out the Comprehensive guide to emergency preparedness for people with lung diseases from the American Thoracic Society

You Can Still Go Out & Stay Active on Oxygen