COPD GUIDE
COPD Treatment: What Is Done, Step by Step?
Prof. Dr. Yalçın Karakoca · Last updated: 25 September 2026
SHORT ANSWER
There is no COPD treatment that reverses damage that has already occurred. But COPD is a treatable disease. Stopping smoking, using an inhaler regularly, getting vaccinated and exercising reduce symptoms. Oxygen is also used if needed. Preventing flare-ups is also important. These make flare-ups less frequent and improve quality of life. If shortness of breath persists despite medicines, there are other options too. In selected patients at an advanced stage, treatments performed with a bronchoscope are considered. A bronchoscope is a tube with a camera at its tip. It is passed through the mouth into the airways. In COPD in which cough and phlegm predominate, balloon treatment is one of these treatments. In emphysema, on the other hand, a lung valve is used.
Step 1: Stop the cause — smoking and smoke
Stopping smoking is the most important step for slowing the loss of lung function and prolonging life. Medication combined with counselling markedly increases the chance of quitting. These medicines include nicotine patches or gum, varenicline, cytisine and bupropion. Protecting yourself from dust and chemicals at work is also necessary. Stay away from wood and coal smoke too. → Smoking and COPD
Step 2: Inhaler medicines
The main medicines for COPD are long-acting bronchodilator inhalers, which widen the airways. There are two types of these medicines (LABA and LAMA). In most patients, both are used together. In some patients, a steroid inhaler is also added. These are patients who have frequent flare-ups and a high eosinophil count in their blood. Eosinophils are a type of white blood cell.
| Situation | Initial treatment | If symptoms persist |
|---|---|---|
| Few symptoms, few flare-ups | A single long-acting bronchodilator | A second bronchodilator is added |
| Many symptoms, few flare-ups | Two long-acting bronchodilators | Inhaler technique is checked and an exercise programme is added |
| Frequent flare-ups, or hospital admission because of a flare-up | Two bronchodilators; if the eosinophil count is high, a steroid inhaler as well | If flare-ups continue, triple therapy (two bronchodilators and a steroid inhaler combined); roflumilast for those with cough and phlegm, azithromycin for patients who have stopped smoking, biologic medicines given by injection (dupilumab, mepolizumab) for patients with a high eosinophil count |
Inhaler technique should be reviewed at every follow-up visit. The most common reason for the complaint “the medicine isn’t working” is incorrect use of the medicine. You should always have your short-acting reliever medicine with you.
Step 3: Vaccines and protection against infection
Have a flu vaccine every year. Pneumococcal (pneumonia) and whooping cough vaccines are also recommended. If you are aged 60 or over, ask your doctor about the RSV (a respiratory virus) vaccine as well. The international guideline also recommends COVID-19 and shingles vaccines.
Step 4: Pulmonary rehabilitation
Pulmonary rehabilitation is a breathing exercise programme that lasts 6–12 weeks. It includes exercise, education and breathing techniques, and it is carried out under supervision. It reduces shortness of breath and increases exercise capacity. It also lowers the risk of being admitted to hospital again after a flare-up. Programmes done at home also work. → Breathing exercises and daily life
Step 5: Oxygen and breathing support
In some patients, the oxygen level in the blood at rest is below a certain threshold. In these patients, long-term oxygen prolongs life if it is used for at least 15 hours a day. If carbon dioxide in the blood is persistently high, a breathing machine used at home with a mask may be needed. The decision is based on a blood gas test. → Oxygen therapy
Step 6: Prevent flare-ups and treat them early
Prepare a written action plan together with your doctor. Your doctor decides which medicine to use at the start of a flare-up. Protect yourself from infections and polluted air. Once the flare-up has passed, go back to your exercise programme. → COPD exacerbations
Step 7: If shortness of breath persists despite medicines
| Situation | Option |
|---|---|
| Cough, phlegm and airway narrowing predominate; severe or very severe stage | Balloon treatment (Karakoca Resector Balloon) |
| Emphysema and air building up in the lungs predominate; the part of the lung to be treated is clearly identified | Lung valve (Karakoca Valve and others) |
| Not suitable for a valve (there is air flow between the lobes of the lung) | Coils (endobronchial coils) or vapour treatment (methods examined in research studies) |
| Emphysema concentrated in the upper lobes, suitable for surgery | Lung volume reduction surgery |
| End-stage disease, selected young patients | Lung transplant |
Comparison: Bronchoscopic and surgical treatments. None of these options replaces the first six steps.
PRELIMINARY ASSESSMENT
Is it suitable for you?
Book an appointment and bring your breathing test and chest CT scan reports. We decide together at the consultation. If you are coming from outside Istanbul, an online preliminary consultation can be held first.
Please bring: your breathing test, your chest CT scan report and images (CD/USB), your list of medicines and, if you have one, your blood gas test result.
HAVE A QUESTION?
Frequently asked questions
The questions our patients and their relatives ask most often, with answers. We discuss questions about your own situation together at the consultation.
APPOINTMENT
Book an appointment for a preliminary assessment
To find out whether you are suitable, book a preliminary assessment appointment. Bring your breathing test, chest CT scan report and list of medicines with you.
info@yalcinkarakoca.com · Rüzgarlıbahçe Mah. Cumhuriyet Cad. Hasoğlu Plaza Kat:3, Kavacık / Beykoz, İstanbul
REFERENCES
- International COPD guideline (GOLD 2026 report); Turkish Thoracic Society COPD Diagnosis and Treatment Consensus Report.
This page is for general information purposes. It does not replace a medical examination or diagnosis. Treatment decisions are made during an examination, on an individual basis. In an emergency, call 112.
Medical content review: Prof. Dr. Yalçın Karakoca, Pulmonologist · Last updated: 25 September 2026