Medication for COPD

Photo of two women talking

If other measures such as quitting smoking, breathing exercises and physical exercise aren’t enough to help with , medication is also available. It can't cure the disease, it can help relieve the symptoms and prevent acute breathing problems.

Chronic pulmonary obstructive disorder () develops gradually over many years. Its symptoms include shortness of breath and coughing with sputum (coughed-up phlegm). It is usually caused by smoking. The kind of medication used to treat depends mostly on the severity of the disease. If the symptoms of the are mild or moderate, people usually only need to take medication when they have acute breathing problems. If the symptoms become more frequent and more severe, doctors recommend using certain medications regularly. People who have advanced often take several medications at the same time.

The following medications are typically used:

  • Drugs that open up the airways (bronchodilators): beta-2 agonists and anticholinergics
  • Anti-inflammatory drugs: medications containing steroids (corticosteroids) and phosphodiesterase (PDE) 4 inhibitors

Other drugs called mucolytics are used to dissolve mucus in the and make it easier to cough it up as phlegm. In rare cases, are temporarily used for prevention. Flu, COVID-19 or pneumococcal vaccines can prevent additional infections that may make the breathing problems worse.

What kinds of bronchodilators are available?

There are various kinds of bronchodilators, including beta-2 agonists and anticholinergics. These medications are usually inhaled. They relax the muscles in the , allowing the narrowed airways to open up, making it easier to breathe.

Beta-2 agonists

Beta-2 agonists form the basis of treatment for . These medications can be divided up into two groups: short-acting beta-2 agonists and long-acting beta-2 agonists. The short-acting group includes fenoterol, salbutamol and terbutaline, and the long-acting group includes formoterol and salmeterol. The short-acting beta-2 agonists (SABAs) are used when needed, such as during acute breathing difficulties. They work fast, but the effect only lasts for four to six hours. Long-acting beta-2 agonists (LABAs) are taken regularly. It takes longer for them to start working, but the effect lasts for about 12 hours.

If the is only causing mild symptoms, it is usually enough to use a short-acting beta-2 agonist as needed. Sudden shortness of breath can usually be quickly relieved by inhaling this medication. It is important to always carry the inhaler with you. If the symptoms get worse over time, using a long-acting beta-2 agonist over the long term can help. The medication is inhaled once in the morning and once in the evening. This relieves breathing problems and prevents acute episodes of shortness of breath (flare-ups or exacerbations).

Studies have shown that beta-2 agonists can improve people's lung function and quality of life.

The medications prevented flare-ups too.

  • Without beta-2 agonists, 7 out of 100 people had to go to the hospital in the space of six months because of severe breathing difficulties.
  • This was the case in 5 out of 100 people who took beta-2 agonists.

Normal doses of beta-2 agonists are usually well tolerated, but high doses can cause side effects such as a rapid pulse, palpitations or tremors.


Anticholinergics are about as effective as beta-2 agonists. They also come in short-acting and long-acting forms. Short-acting anticholinergics only start working after 20 to 30 minutes, but the effect then lasts up to eight hours. The effects of long-acting anticholinergics like tiotropium bromide last for about 24 hours, which is longer than most beta-2 agonists do. This means that they only need to be inhaled once a day.

Anticholinergics can also reduce the risk of flare-ups. As a result, people who use anticholinergics need to go to the hospital less often and their quality of life improves.

One possible side effect of anticholinergics is a dry mouth. They are otherwise regarded as well-tolerated.

What can you expect from using steroid medications?

Steroid inhalers

Steroid medication is taken as needed in addition to bronchodilators. It doesn't have much of an effect on daily symptoms, but can lower the risk of flare-ups. For this reason, steroid inhalers are usually only used in the long term by people with severe and frequent breathing problems. Previous research has shown that steroid inhalers are only effective at doses of over 1,000 micrograms per day. But such high doses of steroids also increase the risk of . Within one year, inhaled steroids

  • prevented one or more flare-ups in about 5 out of 100 people, and
  • caused in about 1 out of 100 people.

Another side effect of steroid inhalers is oral fungal infections, which occur in about 5 out of 100 people per year. Hoarseness also occurs in about the same number of people. So it's recommended that you rinse your mouth or brush your teeth after using the inhaler.

Steroid tablets

If severe symptoms don’t improve, steroids can also be temporarily taken in tablet form. Then it’s important to use the lowest possible dosage.

The possible side effects of taking steroid tablets over a longer period of time include weight gain, increased blood sugar levels and trouble sleeping. If the tablets are taken for a very long time, your skin, muscles, and bones may be weakened, too. So long-term treatment with steroid tablets is not recommended.

How effective are PDE4 inhibitors?

PDE4 inhibitors such as rolflumilast can be taken as tablets in addition to bronchodilators. They reduce the in the . This can make it easier to breathe and prevent flare-ups. Rolflumilast is only recommended if the symptoms suddenly get worse again and again.

Studies have shown that PDE4 inhibitors can somewhat improve breathing and quality of life:

  • These medications prevented flare-ups with worse breathing difficulties in about 5 out of 100 people.
  • About 5 to 10 out of 100 people had side effects such as nausea and diarrhea, loss of appetite, weight loss, sleep problems and headaches.

It is still not clear how well PDE4 inhibitors work compared to steroids, so they are currently rarely used.

Can you combine the medications?

Yes. Depending on the stage of the it can be helpful to combine two bronchodilators (like a beta-2 agonist and an anticholinergic). These kinds of combinations are often more effective and have fewer side effects than a higher dose of one of the medications alone. If there are still frequent exacerbations, then a triple combination with a steroid or with roflumilast is possible.

What other options are there?


Mucolytics are supposed to dissolve the phlegm in the airways, making it easier to cough it up. Studies have shown that mucolytics lower the risk of flare-ups with worse breathing difficulties in people who have a cough with a lot of phlegm. Mucolytics prevented flare-ups in about 52 out of 100 people.

But they do not improve breathing otherwise. They are not often used in the treatment of .


People who have are especially susceptible to complications caused by the flu. They can get a flu vaccine every year in the fall. Studies have shown that this decreases the risk of flare-ups and respiratory infections such as bronchitis or pneumonia.

The flu vaccine is given as an injection. The most common side effects are redness and swelling where the vaccine was injected. Temporary tiredness, headaches and a mild fever are possible too.

Vaccinating against pneumococcus is also an option. These germs can cause inflammations in the lungs, the middle ear, the sinuses and other places. People with are more likely than others to get and have acute breathing problems if they are infected with pneumococcus . The pneumococcal vaccine can lower this risk somewhat. The vaccine has a protective effect for about five years and then it needs to given again ("booster shot").

Experts also recommend getting a COVID-19 .


Respiratory infections can cause acute shortness of breath in people with . If the was caused by and the symptoms are very severe, can help. One sign of a bacterial is sputum that is greenish-yellow in color or contains pus.

Antibiotics won't help if the infection is caused by viruses. They may also cause diarrhea and other side effects.

In rare cases may be considered as a preventive measure to lower the number of exacerbations.

Agarwal R, Aggarwal AN, Gupta D et al. Inhaled corticosteroids vs placebo for preventing COPD exacerbations: a systematic review and metaregression of randomized controlled trials. Chest 2010; 137(2): 318-325.

Bundesärztekammer, Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie COPD. AWMF-Registernr.: nvl-003. 2021.

Chong J, Leung B, Poole P. Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; (9): CD002309.

Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Deutsche Atemwegsliga, Österreichische Gesellschaft für Pneumologie (ÖGP). S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD). AWMF-Registernr.: 020-006. 2018.

Dobler CC, Morrow AS, Farah MH et al. Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review. (AHRQ Comparative Effectiveness Reviews; No. 221). 2019.

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2022 Report. 2022.

Horita N, Goto A, Shibata Y et al. Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2017; (2): CD012066.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Tiotropium bromide in the treatment of chronic obstructive pulmonary disease: Final report; Commission A05-18. 2012.

Janjua S, Fortescue R, Poole P. Phosphodiesterase-4 inhibitors for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2020; (5): CD002309.

Karner C, Chong J, Poole P. Tiotropium versus placebo for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; (7): CD009285.

Kew KM, Mavergames C, Walters JA. Long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2013; (10): CD010177.

Kopsaftis Z, Wood-Baker R, Poole P. Influenza vaccine for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2018; (6): CD002733.

Ni H, Moe S, Soe Z et al. Combined aclidinium bromide and long-acting beta2-agonist for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2018; (12): CD011594.

Oba Y, Keeney E, Ghatehorde N et al. Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis. Cochrane Database Syst Rev 2018; (12): CD012620.

Poole P, Sathananthan K, Fortescue R. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; (5): CD001287.

Ram FS, Jones P, Castro AA et al. Oral theophylline for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2002; (3): CD003902.

Vollenweider DJ, Frei A, Steurer-Stey CA et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2018; 10: CD010257.

Walters JA, Tan DJ, White CJ et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; (9): CD001288.

Walters JA, Tang JN, Poole P et al. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; (1): CD001390.

Yang IA, Clarke MS, Sim EH et al. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; (7): CD002991.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on December 28, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.