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| Therapy | Mechanism of action | Drug name | Adverse effects | Note |
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| Inhaled short-acting β2-agonist (SABA) | Stimulates β2 adrenergic receptors, increasing cyclic AMP with functional antagonism to bronchoconstriction | Albuterol (salbutamol), levalbuterol | Sinus tachycardia, dose-dependent tremors, and hypokalemia, temporarily lower partial pressure of arterial oxygen | In most cases, used for mild diseases with low symptoms or more advanced diseases to relieve acute symptoms in addition to maintenance inhalers |
| Inhaled long-acting β2-agonist (LABA) | Salmeterol, formoterol, indacaterol, olodaterol, vilanterol | Headache, sinus tachycardia, dose-dependent tremor, and hypokalemia, temporarily lower partial pressure of arterial oxygen | Selected as maintenance therapy when short-acting bronchodilators do not give adequate relief of symptoms |
| Inhaled short-acting muscarinic antagonist (SAMA) | Blocks bronchoconstriction effects of acetylcholine on M3 muscarinic receptors expressed in airway smooth muscles | Ipratropium bromide, oxitropium bromide | Foul smell, dry mouth, urinary retention, impaired vision, progressive narrow-angle glaucoma, and cataracts | In most cases, used for mild diseases with low symptoms or more advanced diseases to relieve acute symptoms in addition to maintenance inhalers |
| Inhaled long-acting muscarinic antagonist (LAMA) | Tiotropium bromide, aclidinium bromide, glycopyrronium bromide, umeclidinium, glycopyrroate, revefenacin | Foul smell, dry mouth, urinary retention, impaired vision, progressive narrow-angle glaucoma, and cataracts | Selected as maintenance therapy when short-acting bronchodilators do not give adequate relief of symptoms, also in those who are at risk of exacerbations |
| Methylxanthine | Inhibition of cyclic nucleotide phosphodiesterases with competitive antagonism of adenosine receptors with bronchodilator and anti-inflammatory effects | Theophylline, doxofylline | Headache, restlessness, insomnia, nausea, vomiting, cardiac flutter, tachycardia, seizure, and status epilepticus with higher doses | Not suggested unless other long-acting bronchodilators are either intolerable or costly |
| Inhaled corticosteroids | Anti-inflammatory and suppression of IL-13-induced goblet cell metaplasia and reduce MUC5AC and ATP-stimulated mucus secretion | Fluticasone, budesonide, beclomethasone | Oral candidiasis, pneumonia, skin bruises, hoarse voice | Typically combined with a long-acting bronchodilator rather than administered alone in patients at risk for exacerbation |
| Phosphodiesterase-4 inhibitors | Selective inhibitors of PDE-4 inhibiting the breakdown of intracellular cyclic AMP with anti-inflammatory effects | Roflumilast | Diarrhea, weight loss, insomnia, and depressive moods | In patients with moderate to severe COPD, it is recommended as a maintenance therapy for the prevention of exacerbations |
| Macrolide antibiotics | Reduce airway mucus secretion with anti-inflammatory effects | Azithromycin | Nausea, diarrhea, abdominal pain | Recommended as a maintenance therapy for the prevention of exacerbations |
| Ambroxol | Expectorant with mucokinetic, antioxidant, and anti-inflammatory properties and can induce surfactant formation with inhibition of neuronal sodium channels | Ambroxol | Occasional GI side effects but are mild in nature | As an expectorant with antioxidative and anti-inflammatory properties, it enhances antibiotic levels in the lung tissue and mucus and minimizes exacerbation when given with antibiotics |
| Thiol derivatives | Mucolytic agents act by lowering S–S bonds with antioxidant, anti-inflammatory properties | N-acetylcysteine (NAC), erdosteine, carbocysteine | Nausea, vomiting, foul smell, dry mouth | As mucolytic agents with antioxidants, anti-inflammatory, and antibacterial properties, it reduces mucus viscosity by lowering S–S bonds in mucus proteins and acts as a source of replacement for intracellular glutathione level |
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