Older man with an Oxygen hose to provide supplemental O2 due to a breathing disability such as emphysema or COPD.

Chronic obstructive pulmonary disease (COPD) is a very serious lung condition. People with COPD often complain of a constant cough, wheezing, difficulty breathing, chest tightness, mucus and fatigue. Health professionals often blame COPD on a long history of cigarette smoking. But COPD can occur in nonsmokers. Genetics, air pollution, occupational exposure to chemicals, fumes and dust, as well as long-standing asthma can also play a role (Respirology, Aug., 2012). Treatment often involves inhaled corticosteroids such as fluticasone (Flovent) or budesonide (Pulmicort), bronchodilators like albuterol (ProAir HFA, Ventolin HFA) salmeterol (Serevent) or ipratropium (Atrovent). There is a growing controversy about some COPD drug side effects.

COPD Drugs

Because people with COPD, have a hard time breathing doctors frequently treat them with long-acting drugs to open their airways for many hours. The two mainstays of treatment are called LABAs (long-acting beta2-agonists) and LAMAs (long-acting muscarinic antagonists). The latter are anticholinergic medications.

Examples of LABAs are: arformoterol (Brovana), formoterol (Foradil) and salmeterol (Serevent). LABAs are often included with corticosteroids in combination inhalers such as Advair (salmeterol plus fluticasone), Breo Ellipta (vilanterol plus fluticasone) or Symbicort (formoterol plus budesonide).

Examples of LAMAs are: Spiriva (tiotropium), Incruse Ellipta (umeclidinium) and Tudorza Pressair (aclidinium).

COPD Drug Side Effects & Cardiovascular Complications:

Researchers have asked whether LABAs and LAMAs might pose a risk to the cardiovascular system. In 2013 an epidemiological study conducted in Canada reported that older people who had just started taking long-acting bronchodilators were at greater risk of cardiovascular emergencies (JAMA Internal Medicine, July 8, 2013).

The authors concluded that older people with COPD needed to be carefully monitored if they were prescribed LABAs or LAMAs.

New COPD Drug Side Effects:

Fast forward several years. Now another large observational study has reinforced that old concern. Epidemiologists used the national medical records of Taiwan to determine whether people were more likely to suffer a stroke, heart failure, coronary artery disease or arrhythmia when they began taking such LABAs or LAMAs.

The results, published in JAMA Internal Medicine (Jan. 2, 2018) showed that people who start a long-acting bronchodilator are 1.5 times more likely to suffer a cardiovascular complication.

Although such case-control studies cannot prove causation, the authors caution their colleagues to be very vigilant when first prescribing such medications:

“We caution physicians to closely monitor new users of LABAs or LAMAs for cardiovascular symptoms.”

Once people get past a month or longer, the cardiovascular risks seem to diminish. That’s good news. What this means, though is that both patients and physicians need to be alert for side effects that might suggest heart problems (irregular heart rhythms, heart failure or chest pain) or stroke-like symptoms.

Other COPD Drug Side Effects:


  • Irregular heart rhythms (arrhythmias), palpitations
  • Headache
  • Nervousness, anxiety, tremor
  • Throat irritation, pharyngitis
  • Rash, itching
  • High blood pressure


  • Dry mouth
  • Symptoms of an upper respiratory tract infection, sore throat, cough
  • Pain in the chest area, palpitations
  • Digestive distress, stomach pain, indigestion, constipation
  • Urinary tract infection, difficult urination
  • Headache, dizziness, depression, difficulty sleeping
  • Nose bleeds
  • Glaucoma

Reports from Readers:

Reading a long list of side effects is often counterproductive. That’s because our eyes and brain glaze over after three or four symptoms. To better understand how these drugs affect people, here are some anecdotes from visitors to this website:

Elizabeth in England had problems with Spiriva:

“I took Spiriva for less than two months. It helped my breathing, but by week 7 I was overheating at night. This wasn’t a hot flush or night sweat. It was incredibly severe. It also caused frequent urination and sleeplessness, aside from the dry mouth etc. I had to stop.”

Kerry in Australia reports:

“I have COPD from welding and smoking. I was ok till I took Spiriva for 12 months. Gave it up for 5 months. Then I had a lung infection. I got antibiotics and Spiriva again.

“All of a sudden Spiriva took my breath away. I ended in emergency on morphine for pain twice. I used Atrovent and Flutiform [formoterol plus fluticasone] effectively, virtually living on augmentin and doxycyclin. I ended up in hospital with pneumonia for 8 days. They game me iv antibiotics. I came out really good for 2 weeks then lost my breath again for the last month and can’t work it out.”

L.C.J. in Texas had some scary side effects:

“In four days of use for mild COPD, I experienced significant memory loss. Day two I developed spots about two inches in diameter across my abdomen. Day three the spots felt like wood splinters and were terribly painful. I took Spiriva day four and called my pulmonologist. He told me to stop taking it.

“I read the side effects, and discovered another side effect. High Blood Pressure and heart palpations, which was the reason my cardiologist sent me to the pulmonologist along with pulmonary leak and swollen heart (left side). No one seems to be able to get my problem under control. I’m afraid of stroke or heart attack.”

You can learn more about Spiriva side effects at this link:

Spiriva (Tiotropium) Side Effects & Memory Problems

Share your own experience with COPD medication below in the comment section.

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  1. Marietta H.
    rhode Island

    I just stopped taking sparivia couldn’t afford it but glad I did caz I think it was giving me stomach problems and weight problems I noticed I’m not as bloated I wonder if any one else had this problem and my breathing seems to be better

  2. Mary S.

    I just started last week on Incruse inhaler which is going along with my symbicort. I had a breathing test, which I have not had since 2006, which indicated COPD. I went on symbicort in 2006, and I have been on it ever since until now.

    The problems started because I saw a pulmonologist for a 3mm nodule in my right lung. I found him quick. He got me in right away, and then told me I need a complete lung scan, which I did. I forgot to mention that this all really began about a month ago with a calcium scoring test for my heart that was $49, and that’s when they found a few incidental things. One was the 3mm nodule.

    So getting back to what I wanted to say: this specialist, the 2nd time I saw him, put me on Incruse. I had a breathing test that put me at a moderate level of COPD so I’m taking this along with my symbicort which is the 80/450. But now I really have a hoarse voice. I had to clear my throat a little bit before but now it seems like I’m constantly clearing my throat because of the phlegm build-up. Is this normal when taking the Incruse??

  3. Walter


    My COPD herbal remedy is made of organic/natural roots and herbs only, no side effects, no diet involved when taking it and is on liquid form.

    You take after meal twice daily with tea spoon ..The major ingredient used for production are: lemon,yerba santa,Eucalyptus,garden angelica and ginseng roots…

    My herbal remedy will reverse your COPD within 5-6 weeks of usage 100%. The herbal remedy helps to relax the muscle around your  airways, so that shortness of breath will stop and you will be able to breath easily and terminate all your symptoms totally…You will experience total freedom from COPD the last week of usage.

    Please you don’t have to worry is 100% cure, so you needs 2 bottles of my COPD  herbal formula for 6 weeks, that will cost you ($420.00 ). So  after payment  i will send the herbal remedy to your home address  through courier service, as soon as you receive it i will tell you how to use the herbal remedies.

    If you are ready to make the payment today, let me know, so that I will send you payments detail, we only accept western union and moneygram for now….

  4. solution health

    This year May I was told I had mild emphysema-COPD. I was shocked, I had only had minor breathing problems at times. However I had smoked for 17 years when I was very young and had quit over 38 years ago, when I developed asthma. I always heard your lungs were cleared 5 years after you quit smoking, but they don’t tell you the damage is already done!

    Mild is not mild, I am on oxygen all the time.my son purchased herbal remedy for emphysema from solution health herbal clinic ,which i used for 6 weeks and am totally Emphysema free ,all thanks to solution health herbal clinic, solution health herbal clinic also cure all type of disease in humans life..please Stop smoking! It will kill you. Contact solution health herbal clinic details E-mail: (solutionsherbalclinic@gmail.com)

  5. Karen

    Jan. 2014 I came down sick and was sleeping 18-20 hours a day. My GP could not find problem and sent me to a pulmonologist who sent me to the hospital for an out patient test. The test came back that I had a bacteria infection in my lungs, but he never treated me for it.

    By the time I received all copies of tests ordered and run, it was August 2014. I took all the paper work to another pulmonologist who said, “Well, right here is the problem, did this doctor treat you for this bacterial infection?” I said no, which he had not. I asked the new pulmonologist, can you treat me for this? He said no, it is too late, your lungs are already permanently damaged????


    Asthmatic for many years, smoked,now have COPD. On Symbicort inhaler and Incruse inhaler. Seems to be a good combo.

    Tried Spiriva. Not good at all. Made me breathless.

    Am trying to wean myself from these drugs, as I suspect they cause their own set of problems.

    Good luck to everyone out there.



    My twin sister was diagnosed with COPD few years ago. She was on a trial for some months. It turned out that the drug she was given was not a placebo, but the real thing, and it was working. Then they pulled the plug on it saying it was not viable! So they got her on another trial. That trial also was cancelled after a while. In 2017 I ordered COPD herbal remedy from an online source, and they shipped it to me. She only used the COPD herbal remedy for 5 weeks, and all her symptoms disappeared. She stopped wearing oxygen, and my family doctor confirmed her COPD-free now. Is almost 5 months, and no more COPD.

    • Karen

      I would like to know what herbal COPD Charlotte from Texas, twin sister used please. They just put me on Symbicort today. After researching it since I got home, I have decided to stop taking it.

  8. JAMES

    I smoked for approximately four years, from age 18 to age 22. I am now age 66 plus and was very recently diagnosed with emphysema. I had for some time now noticed having difficulty catching a deep breath. Never in my wildest dreams did it cross my mind that I may develop a serious lung disease. Last year december i purchased emphysema herbal remedy from Best Health Herbal Centre, my emphysema was totally reversed within five weeks of usage. Am so happy, now living a normal life. Please all smokers must note, I am only writing this to inform others that if you think you will escape the dangers of a serious lung disease please think about it again because it is not avoidable under any circumstances. It will catch up with you in time. Please victims like me should purchase emphysema herbal remedy asap from Best Health Herbal Centre..

    • Leila

      Can you tell me which herbs was taken. I take many herbs and have one for lung. I don’t know if I should take that all time or when I feel bad. I am using Breo and oxygen and hate it. Thanks in advance for name of herb.

  9. Joe
    Seattle, WA 98198

    I am 94 years old with both COPD & Asthma. My medications include Flovent HFA 220 mcg. and an Albuterol Emergency Inhaler which I have never needed but have in on hand. I also use a nebulizer when I feel the need arises using Ipratropium Bromide & Albuterol Sulfate. I try to avoid taking any medications unless absolutely necessary as I believe they can do more harm than good at times. I use the inhaler only when I start wheezing or find myself short of breath.

    Fortunately, I can go for days without taking any of the above but they are there when needed. I see no reason to take them on a daily basis unless absolutely necessary. My Dr. listens to my lungs monthly and is surprised how little I use the meds as his recommendation was that I use the inhalers daily and he was quite surprised when I told him how I use them. Not only that, they are very expensive so, I use them, not as the Dr. ordered, but as I feel the need.

    • Marsha

      How much did this herbal remedy cost? I can’t find this on their website. Thank you.

  10. Noreen

    I have been thinking that some beta blockers and other drugs may be causing breathing problems. The more medication, the more problems. FDA blocked terpinhydrate which was a great expectorant for COPD sufferers who are being suffocated to death. My mother passed as a result of COPD. Inhalers made it worse. I was prescribed inhalers but will not use them. I was exposed to silicone drywall dust in my office at the state of Colorado Drivers Services. Workers wore masks but office employees were unprotected. Lying, thieving government.

  11. maggie d
    san diego

    I finally went to a naturopathic physician due to numerous side effects from Spiriva, i.e.: increased palpitations, increased heart rate, CHF, atrial fibrillation, severe hoarseness, and nausea. After I stopped it, had vomiting & diarrhea for about 1 month. I have COPD and also had palpitations before starting Spiriva. It did help me to breathe better, but the side effects were severe, and when the Spiriva finally cleared my system, the side effects gradually diminished –

    Naturopathic doc put me on nebulized glutathione (amino acid) which opened up my airways so I could breathe. Since I cannot take any kind of inhaler, this has saved my life. Nebulized glutathione has been around for many years, but conventional medicine is not allowed to use it, from my understanding.

    Everyone on Spiriva who has cardiac problems needs to be monitored very closely or taken off completely. I eventually ended up in the hospital w/ high heart rate, atrial fibrillation

    I continue with my naturopathic doc and the glutathione, which I use 1 time a week (at first had to use 3 times a week), then was able to taper down –

    That’s only part of the story – hope it helps.

    • Tom

      Hi Maggie,
      I’m also in San Diego, would you please write me your Naturopathic doc’s contact info? Thanks very much!

  12. AGD

    My second concern is my grandson, who was born 3 months early but is now a pretty healthy 18 month-old toddler. Like most kids, once he entered daycare at a year of age, he started catching colds and has now had pneumonia as well. He now has a nebulizer to help him when he is wheezing so he can sleep better at night. All would seem well but after reading about cardiac and mental affects, I wonder about the use of a nebulizer with such a young child (they also apply baby Vicks rub and run a small vaporizer). Are there more natural approaches that could help him?

  13. AGD

    I have two concerns: First, my husband has had lung cancer treatments and surgery as well as a pulmonary embolism and a mysterious and unidentifiable (UCLA doctors’ best guess was some type of fungal) lung infection that required a year on a multiple drug regimen of 4 antibiotics and an anti fungal. He now has a tough time getting through any respiratory illness without resorting to antibiotics and lately, steroids (prednisone). He has used a nebulizer on and off for years with albuterol and ipratroprium; lately just uses the albuterol. He has a small QVAR inhaler that he sometimes uses instead. Physically, he is as well as can be expected.

    But at 74, his cognitive abilities have changed rather dramatically. I understand being somewhat forgetful due to age. However, he is not only incredibly forgetful but also needs longer and more detailed explanations. He seems in a bit of a fog at times as well. I wonder about the impact of the continued use of the nebulizer and inhaler – but honestly, listening to his struggles breathing before he got those made them seem a godsend. The drugs are the best solution his doctors offer. One doctor laughed at me for suggesting he attend a workshop for breathing techniques, saying his problem wasn’t bad enough to warrant it. Do people with COPD or damaged lungs or asthma have any other choices?

  14. Betty

    I’m 70 years old and have taken LABA’s since 1980. Doctor gave me Tiopropium (now known as Spiriva) in 1993. It took my breathing away and I had to sit down in the middle of the street in Napa, CA.

    • Marsha

      Please check out the effects of Anticholinergic products and LABA’s on COPD. The People’s Pharmacy has an excellent list of products containing these dangerous agents.

  15. Willa

    My understanding is that meds for COPD only help symptoms, not treat the disease, which is irreversable. I got off everything anticipating inclusion in a clinical trial & did fine. I didn’t make the cut due to another med I take.Those inhalers(I’m on Medicare & have fallen in the “donut hole” every year) are quite expensive & when I began again on my routine 2 meds, my pulmonologist told me which one was the better of the two so I could buy it. Actually, it’s not working too well at all and virtually ALL the others gave me terrible sore throats, no matter how well or often I gargled & rinsed. I’m doing Silver Sneakers exercise & “pursed-lip”breathing & dread starting over with deductables, etc. Staying healthy with diet, supplements, exercise, & good hygeine I learned by working 30 yrs. in a hospital. WASH YOUR HANDS & keep them away from eyes & nose.Otherwise, I hope for another clinical trial-where the folks running the study pay for your meds-and keep filling-out every customer survey I can in hopes of winning some money.

  16. Gigi Mac
    Boise, ID

    Thank you for this post. It’s always good to hear from other sufferers. Sometimes we do my make the connection between what’s going on and the possibility of it being a side effect. The other reason this is so helpful is because many physicians don’t know the side effects and these forums help to identify them. Additionally, sharing here could save someone’s life. I was nearly dead after using duo-nebs as they made it impossible to expectorate mucous at all! Tweaking meds to get my heart rate down hispitalist switched me from duo-nebs to xonponex. Instant and sustained improvement! Went from 16 liters and a walker to .5 liters and kayaking, snow tubing, etc!

  17. Berdie

    What can you take besides Spiriva? I also use Budesonide in my nebulizee, is this safer? If it is I am going to quit Spiriva. Would like to know safer drugs for Asthma.

  18. Jane

    I wish more would add opinions of their COPD drugs. I quit the Spiriva/Advair because it made me so hoarse it took great effort to talk. Decided I’d rather talk than breathe. Now I’m on Stiolto and not only does it not work well at all, but it doesn’t have a ‘real’ counter on it so you don’t know if you’re getting medicine with the first couple or last few doses. I have an upcoming appt so hopefully my doc will take me OFF this no-good drug.

    My allergist is a more knowledgable doc than my pulmonary doc and he says they’re coming out with a new 3-in-1 inhaler in Jan 2018 so I’ll ask about that. He firmly believes I have an asthma element to my COPD.

    Come on, folks…give us your opinions! :)

  19. Dee

    What are alternatives to Spirivea besides low dose zpack?

  20. LS

    A year ago, I was diagnosed with Emphysema after receiving a pneumonia vaccination. I have never smoked, my home has always been a non-smoking zone, I do not go places where the smoking is allowed, and I have never worked in a factory or hazardous environment. Current treatments for it seem to have their own set of challenges. Does anyone know of a more natural treatment that is effective?

    • maggie d

      Go to a naturopathic md for exam – ask for nebulized glutathione – in my opinion? Saved my life. I can breathe and have nothing good to say about Spiriva –

    • Buddy's Mom

      Regarding your emphysema: Have you had the genetic test to determine if you are an Alpha1? Your emphysema could be due to that. See a pulmonary doctor for the test…just a finger stick. Results will come back in about 2 weeks.

  21. Carey

    When my mom was put on Albuterol, it put her into atrial fibrillation, which she battled from then on. She was born with a heart murmur, which I guess made her more susceptible. A family friend with COPD lived several years longer than my mom did, despite being 15 years older, because she did not have this added issue with her heart.

  22. Terry

    This is horrible, you give all the negative reasons for not wanting to take these drugs and all the horrible side affects without any advice for what to do about this! No suggestions at all really? I have been reading your column for years now and love it. It is so helpful, but not in this case! My father has Alzheimer’s (early stages) and emphysema. He has been prescribed ipratropium bromide and albuterol and recently we have been concerned that he is not getting any of the medication in his system. Now after reading this, I am concerned about his blood pressure, he sometimes has a very red face for no apparent reason, so far his blood pressure is normal, but I now am very concerned but have no idea what to do! He has begun wheezing more than before also.

    • Joe Graedon


      Please note that the articles we cited refer to the first month of treatment. In other words, the cardiovascular risks are associated with the early treatment phase with LABAs or LAMAs. Once a person with COPD gets past the first month or so, the risk appears to disappear.

      We cannot make recommendations for treatment. That is up to the physician who is treating the patient. Each case is different. There are a number of treatments for COPD that a vigilant pulmonologist can utilize to assist the patient with breathing problems. And once the early phase of treatment with LABAs and/or LAMAs is over the risk of CVD (cardiovascular disease) appears to disappear.

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