Injectable Medications for COPD
There are no injectable medications approved for maintenance therapy in COPD; all maintenance treatments are delivered via inhalation or oral routes. For acute exacerbations, intravenous corticosteroids are the primary injectable therapy used, though oral administration is equally effective and preferred when possible.
Maintenance Therapy: No Injectable Options
The inhalation route has been the standard for COPD maintenance therapy for over 30 years, as it enables drugs to act directly on the airways with better tolerability and safety profiles compared to systemic administration 1.
Current maintenance therapy options include:
- Inhaled long-acting anticholinergics (LAMAs) - recommended as first-line monotherapy (Grade 1C) 2
- Inhaled long-acting β-agonists (LABAs) - effective for symptom control 1
- Combination LAMA/LABA therapy - recommended for moderate to severe COPD (Grade 1C) 2
- Inhaled corticosteroid/LABA combinations - for patients with frequent exacerbations (Grade 1C) 3
- Triple therapy (LAMA/LABA/ICS) - for severe disease with ongoing exacerbations 3
The only oral maintenance option with guideline support is long-term macrolide antibiotics (e.g., azithromycin 250 mg daily) for patients with moderate to severe COPD who have had ≥1 exacerbation in the previous year despite optimal inhaled therapy (Grade 2A) 1.
Injectable Therapy During Acute Exacerbations
Systemic corticosteroids are the primary injectable medication used during COPD exacerbations, though oral administration is equally effective and preferred 3.
Corticosteroid Administration
- Oral prednisolone is equally effective as intravenous administration and should be used when possible 3
- Recommended dosage: 40 mg prednisone daily for 5 days 3
- Systemic corticosteroids improve lung function, oxygenation, shorten recovery time, decrease hospitalization length, and prevent subsequent exacerbations within 30 days 1, 3
- Intravenous administration is reserved for patients who cannot take oral medications (e.g., severe respiratory distress, altered mental status, intubated patients) 1
Important Clinical Considerations
Duration should not exceed 5-7 days to minimize adverse effects including hyperglycemia, weight gain, infection risk, osteoporosis, and adrenal suppression 3.
Patients with increased sputum or elevated blood eosinophils may be more responsive to systemic steroids, while those with lower eosinophil levels may show reduced efficacy 3.
Bronchodilator Therapy During Exacerbations
While not injectable, nebulized bronchodilators are the standard for acute exacerbations:
- Nebulized salbutamol (2.5-5 mg) or terbutaline (5-10 mg) given 4-6 hourly for 24-48 hours 1
- Nebulized ipratropium bromide (500 μg) can be added 1
- Combined nebulized treatment (β-agonist with ipratropium) should be considered in severe cases with poor response to monotherapy 1
Critical Pitfall to Avoid
Do not use inhaled corticosteroids alone for maintenance therapy in COPD - this approach is not supported by guidelines and provides inferior outcomes compared to combination therapy 1, 3. Inhaled corticosteroids should always be combined with long-acting bronchodilators when used for COPD maintenance.