Your doctor should try out different treatments to see which ones suit you best and have the fewest side effects. Your doctor will see how well your treatment is working by assessing whether your symptoms are getting better or worse. They may also ask you what activities you can do now that you couldn't before and how well you can exercise to see how well your lungs are working.
If your doctor thinks that your treatment is not working, they may change it or stop it. When your doctor gives you your medication, they may call it by a different name to those listed below. Medicines can have several names and inhaled medication can also come in different coloured inhalers. Always ask if you are unsure.
Exacerbations or flare-ups
Despite even the best management, exacerbations (also known as flare-ups) are common in COPD, but taking your treatment regularly may help to reduce how often they happen. Always seek treatment for any exacerbation as soon as you can.
Inhalers are used to take inhaled medication. Inhaled medicine may include bronchodilators or steroids. If your GP gives you an inhaler, you may want to ask some of the following questions.
What do my inhalers do?
What types of inhalers are available to me?
Why will these help?
How long will I need to use it for?
How often will I have to take it?
How do I use my inhaler properly? (It can be difficult to take in the instructions the first time, so don't worry about asking for a second or third demonstration.)
Why do I feel no effect from some of the inhalers, and others make me feel better?
Why should I use the ones that don't seem to work?
What will happen if I use the inhaler more often than I'm told to?
If your main symptom is breathlessness, then you may benefit from a bronchodilator. A bronchodilator is an inhaler that delivers medicine to help make your airways more open. There are different types of bronchodilators which work in different ways and these are prescribed dependant on how bad the airway narrowing is and how often flare ups occur.
Inhalers are just as effective as nebulisers, but nebulisers are particularly helpful if you are very short of breath.
Most people have to buy their own nebuliser. These are not generally available on the NHS.
Medications used in nebulisers
Nebulisers are used when people are acutely unwell or exceptionally breathless as an easier a way of taking in reliever medication, such as salbutamol, terbutaline or ipratroprium (Atrovent).
Generally, you can get the same effect by taking four to six puffs from an inhaler with a large volume spacer (a large plastic or metal container, with a mouthpiece at one end and a hole for your aerosol inhaler at the other - it helps the inhaler get more medicine into your lungs).
It's rare for a nebuliser to be more effective than an inhaler-spacer combination - unless you find spacers very difficult to use.
Steroids Your GP or specialist may prescribe oral steroids if you are having an 'exacerbation' or flare up that leads to an acute onset of shortness of breath. These would usually be prescribed for a few days.
Mucolytics These help loosen the phlegm allowing it to be coughed up more easily.
Antibiotics If your phlegm changes colour, becomes stickier, or there is more of it, your doctor may give you a course of antibiotics.
Vaccinations A flu vaccination every autumn is also essential for people with COPD, as flu can cause exacerbations. The pneumonia vaccination is also essential, although this is not required every year.
Oxygen A few people with COPD develop low oxygen levels in their blood. Oxygen treats this lack of blood oxygen, but does not treat breathlessness. As part of your routine check up with your GP, they should check your oxygen blood levels. If these are low, you will be sent for further assessment. If you have consistently low blood oxygen levels you will be referred for a thorough assessment to assess your suitability for oxygen at home.
Oxygen at home If required, you will be prescribed an oxygen concentrator. This is an electrically operated machine that takes oxygen from the air in your home, which you will breathe in through nasal 'cannulae' (small, soft plastic tubes that fit just inside your nostril) or a mask. The oxygen supply tube from the concentrator may be many feet long, so you can move around the house while having your oxygen treatment. Some people will be given portable oxygen as well as their concentrator, which last for a few hours and make shopping or travelling easier if their condition warrants this.