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Chronic Obstructive Pulmonary Disease (COPD) (cont.)

Oral Steroids, Antibiotics, and Pulmonary Rehabilitation

Oral Steroids

Corticosteroids are used for people who do not improve sufficiently after trying other drugs or for those who develop an exacerbation (an increase in the severity of COPD and its symptoms).

Oral steroids have been used successfully to treat acute exacerbations, and improve symptoms and lung function in this circumstance. Oral corticosteroids are generally not recommended for long-term use because of their potential side effects.


In people with COPD, chronic infection of the lower airways is common. The goal of antibiotic therapy is not to eliminate organisms, but to treat acute exacerbations.

This therapy is most beneficial for people whose exacerbations are characterized by at least two of the following (for example, Winnipeg criteria):

  • increased shortness of breath,
  • increased sputum production, and
  • increased sputum purulence.

First-line treatment choices include amoxicillin, cefaclor (Raniclor), or trimethoprim/sulfamethoxazole (Bactrim DS, Septra, Septra DS, SMZ-TMP DS, Sulfatrim Pediatric). Second-line treatment choices include azithromycin (Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax, Zithromax TRI-PAK, Zithromax Z-Pak, Zmax), clarithromycin (Biaxin, Biaxin XL, Biaxin XL-Pak), and fluoroquinolones.

Recent data suggest that for select COPD patients chronic use of azithromycin may reduce exacerbations, and improve quality of life. But in some patients, significant hearing loss was noted. Resistant strains of certain bacteria may occur with chronic antibiotic therapy, especially strains of non-tuberculous mycobacterium (atypical mycobacteria).

Mucolytic Agents

Mucolytic agents can reduce sputum viscosity (resistance to its flow), but may also improve sputum clearance. Some have prescribed dornase alpha (Pulmozyme) for use in COPD but it is only approved for use in cystic fibrosis. Currently, there is no proven benefit.

PDE4 Inhibitors

This new class of agents inhibit the enzyme phosphodiesterase type 4 involved in some of the inflammation associated with COPD. Roflumilast (Daliresp) has been shown to reduce exacerbations of COPD in select individuals, primarily those with more chronic bronchitis symptoms.

Pulmonary Rehabilitation

Many people with COPD are unable to enjoy life to the fullest because of shortness of breath, physical limitations, and inactivity. Pulmonary rehabilitation programs are designed to improve quality of life by decreasing airflow limitation, preventing secondary medical complications, and alleviating respiratory symptoms.

Pulmonary rehabilitation programs are first conducted in an outpatient setting and then can be continued at home. Guidelines for continuing this program at home will be provided to the patient. A rehabilitation program may include a number of components and will be tailored to the patient's needs. .It is important to note that the exercises associated with pulmonary rehabilitation do not increase lung function. With routine exercise, patients improve the efficiencies of their muscles allowing them, along with proper breathing techniques, to increase their activity.

Medically Reviewed by a Doctor on 12/29/2015

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