For COPD Flare-ups: Stop Smoking, Pulmonary Rehab, and Medications

Preventing COPD Flare-ups or Exacerbations  In the April 2015 issue of the journal CHEST (volume 147; pages 883-893), Criner and co-authors summarize available treatments that can help to reduce the chances of a COPD flare-up, also called an exacebation.
Dr. Criner wrote about preventing COPD flare-ups

Gerald Criner, M.D., Chair and Professor, Thoracic Medicine and Surgery at Temple University

The authors divided the types of treatment into three categories. These recommendations are based on studies for preventing a flare-up (exacerbation), but these treatments may also improve shortness of breath and quality of life. Non-pharmacologic and vaccinations 
  1. flu vaccine
  2. stop smoking (counseling and treatments)
  3. pulmonary rehabilitation if the flare-up was within the past 4 weeks
  4. case management with direct access to a health care specialist at least monthly
  5. education about flare-ups with a written action plan and case management
 Inhaled medications (both beta-agonist and muscarinic antagonists are types of bronchodilators)
  1. long-acting beta-agonist
  2. long-acting muscarinic antagonist
  3. short-acting beta-agonist plus a short-acting muscarinic antagonist
  4. inhaled corticosteroid and long-acting beta-agonist combination
  5. long-acting beta-agonist and long-acting muscarinic antagonist
Oral medications
  1. long-term macrolide antibiotic (dose and duration of treatment are unknown)
  2. roflumilast (for those with chronic bronchitis form of COPD and a history of at least one flare-up in the previous year)
  3. theophylline
  4. N-acetylcysteine
If you have recently experienced one or more COPD flare-ups, you may wish to ask your doctor about these treatments to help reduce the chances of having another flare-up. For the inhaled medications, the different generic types are listed with the understanding that there are many specific brand names.  

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.