Less Common Medication For COPD Management

We talked about common COPD medications. They are first-line medications. And they’re used more often to manage your COPD. But they aren’t always effective. So what do you do? You use other medications. They’re not used as often. So they’re technically less common medications. This makes them second- and third-line treatments.


Some of you may have a steroid resistance. In essence this means that corticosteroids don’t work for you. They don’t work in high doses. And they don’t work in low doses. This creates a problem. What do you do? You need to manage your symptoms. But how? What can you use? Theophyllines! True, theophyllines are a less common COPD medication. In fact, they’re considered a third-line medication. This means they’re used more as a last resort. Much like with asthma. But that doesn’t mean they don’t work. Nor does it mean they won’t work for you.

How Theophyllines Work

Theophyllines are an anti-inflammatory medication. They’re often used for moderate-to-severe cases that are unresponsive to other treatments. COPD causes swelling and inflammation of your airways. This results in airway obstruction. And airway obstruction makes it hard for you to breathe. Theophyllines help with this. They reduce inflammation. This opens or dilates your airways. And helps with your breathing.


  • Theophyllines cause bad side effects
  • Theophyllines have more side effects than other COPD medications
  • Side effects affect your different systems. Like musculoskeletal, gastrointestinal, and neurological effects
  • Theophyllines can be toxic
  • Complications from toxicity. For instance, seizures, heart failure, and cardiac arrhythmia
  • They interact with other drugs. This causes side effects or makes other drugs ineffective
  • Theophyllines have small effects. That is to say, they’re not as effective as other medications

Phosphodiesterase-4 (PDE4) Inhibitors

Finally, there are phosphodiesterase-4 (PDE4) inhibitors. That’s a mouthful. Before we discuss the medication, let’s talk about what a PDE4 is. PDE4s are enzymes. They’re in different cells. Like immune cells and brain cells. The PDE4 enzyme contributes to inflammation.

They’re not really a common COPD treatment. Actually, they’re a new medication with two properties. One, they dilate your airways. Two, they reduce inflammation. They’re used to treat inflammatory conditions. Like mucolytics, PDE4 inhibitors have a number of benefits. First, they reduce COPD exacerbations. Next, they have some improvement on your lung function. However, improvement is small. Finally, they reduce systemic inflammation associated with COPD.

Complications Of PDE4 Inhibitors

  • They’re associated with high risk of negative effects. Some effects are serious and result in discontinuation or non-compliance
  • GI problems. Such as nausea, vomiting, weight loss, and diarrhea
  • Sleep problems or mood disorders

Oxygen Therapy

Oxygen therapy and other forms of noninvasive ventilation are necessary in some cases. Many of you won’t require either. But those of you with severe COPD do in life-threatening instances. When there’s an obstruction in your airways, you have limited airflow. As the result, you don’t have enough oxygen circulating through your body. This often results in a condition called hypoxia. Untreated, hypoxia can have serious complications. Enter oxygen and noninvasive ventilation.

Their roles are simple: supplement oxygen in your body to help you breathe better. Both deliver oxygen to your body through nose or mouth tubes or face masks. Ventilation is a lifesaving but invasive procedure. It has many risks. However, all ventilation isn’t bad. And in some cases, it’s absolutely necessary. Thus, noninvasive ventilation is a safer alternative with fewer risks.