Chronic obstructive pulmonary disease (COPD) can cause breathing symptoms like shortness of breath, wheezing, coughing, and more. Often, COPD is confused for a sign of aging or asthma.
But COPD is something different—a chronic condition that can get worse over time. Quitting smoking is the only thing that can slow progression of COPD. Getting the right diagnosis means getting the right treatment.
It starts with a test of your breathing—called spirometry.
When you visit your doctor to discuss your breathing symptoms, you may be asked to take a lung function test called spirometry. Very simply, spirometry is a test that measures how much air you can breathe out.
Your results from this test will be compared to what's normal for a person of your age, size (height and weight), and sex. This way, your doctor can tell if you have COPD.
If your doctor doesn't perform this test, you may want to ask if you should have one. You can also ask if you should see a lung specialist (known as a pulmonologist).
Chronic obstructive pulmonary disease (COPD) can include chronic bronchitis and emphysema, 2 conditions that cause different symptoms. Because COPD is usually a progressive disease, more of your airways can become narrowed or blocked over time. Quitting smoking is the only thing that can slow the progression of COPD.
Some symptoms of COPD may include:
Shortness of breath
Wheezing
Chronic cough and mucus
A feeling of tightness in the chest
In the later stages of COPD, you may experience:
Decreased ability to perform your daily activities (walking, climbing stairs, household chores)
Shortness of breath during everyday activities, like carrying the laundry or even showering
Chronic cough (with mucus) most of the time
Complications, like respiratory infection, from common illnesses like the flu or a cold
Fatigue that may keep you from activities you enjoy
Diagnosing COPD
What are the signs of COPD?
Chronic obstructive pulmonary disease (COPD) can cause breathing symptoms like shortness of breath, wheezing, coughing, and more. Often, COPD is confused for a sign of aging or asthma.
But COPD is something different—a chronic condition that can get worse over time. Quitting smoking is the only thing that can slow progression of COPD. Getting the right diagnosis means getting the right treatment.
It starts with a test of your breathing—called spirometry.
When you visit your doctor to discuss your breathing symptoms, you may be asked to take a lung function test called spirometry. Very simply, spirometry is a test that measures how much air you can breathe out.
Your results from this test will be compared to what's normal for a person of your age, size (height and weight), and sex. This way, your doctor can tell if you have COPD.
If your doctor doesn't perform this test, you may want to ask if you should have one. You can also ask if you should see a lung specialist (known as a pulmonologist).
Chronic bronchitis
Chronic bronchitis can be a part of COPD
Chronic bronchitis is long-term inflammation of the lungs. Chronic bronchitis causes coughing (with phlegm or mucus) that you have every day. Chronic bronchitis is treatable.
With chronic bronchitis, inflammation can cause the muscles around your lungs to tighten up and narrow your airways. This can limit airflow in and out of your lungs, making it hard to breathe. You might believe you have a cold that won't go away. But it could be due to damaged airways that limit airflow in and out of your lungs. Unlike the bronchitis you may experience with a common cold or other virus, chronic bronchitis can come and go over months or years.
The airways in the lungs resemble the branches of a tree. Central airways are larger in size and branch out several times into smaller airways that reach across the width of the lung.
Chronic bronchitis can be associated with chronic obstructive pulmonary disease (COPD). While chronic bronchitis of the larger airways is often caused by respiratory infections, COPD is caused by inflammation in very small airways and can lead to airflow obstruction.
COPD progression may be affected by:
The severity of inflammation in the small airway walls
The extent of narrowing of airway space
The amount of mucus
Quitting smoking is the only thing that can slow the progression of COPD.
Emphysema
Emphysema can be a part of COPD.
Emphysema can be a part of chronic obstructive pulmonary disease (COPD). With emphysema, which affects the air sacs in your lungs (called alveoli), you may feel like you can’t take a deep breath.
When you have emphysema, inflammation in your airways causes the inner walls of these air sacs to weaken and eventually break down—creating one larger air space instead of many small ones. This reduces the surface area of the lungs and reduces the amount of oxygen that is able to reach your bloodstream. The damaged air sacs are also unable to squeeze out all of the air inside them when you exhale. This air becomes trapped in your lungs, leaving less room for fresh air. All of this can make you feel short of breath.
Inflammation causes the air sacs to become damaged and break down. This damage decreases the elasticity of the air sacs. Think of an old balloon that is no longer stretchy and loses its shape
Old air gets trapped inside the air sacs, so there is less room for new air to get in
From New England Journal of Medicine, Mitzner W, Emphysema—a disease of small airways or lung parenchyma? 365(17):1638. Copyright 2011 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.
As emphysema progresses into the later stages of the disease, patients are sometimes placed on oxygen therapy to help with their breathing.
COPD progression
How COPD may progress.
Chronic obstructive pulmonary disease (COPD) is usually progressive. That means symptoms can get worse over time. Quitting smoking is the only thing that can slow the progression of COPD. Appropriate treatments and lifestyle changes can help you breathe easier. Talk to your doctor now about managing COPD.
Several factors may contribute to COPD progression:
Smoking
Age: The breathing trouble you experience with COPD is more than just age-related. But COPD can progress as time goes on and you get older
Exposure to toxic substances
This is how emphysema associated with COPD may progress in the lungs.
From New England Journal of Medicine, Mitzner W, Emphysema—a disease of small airways or lung parenchyma? 365(17):1638. Copyright 2011 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.
No treatment can stop the progression of COPD, but quitting smoking can slow it down, and maintenance treatments can help you breathe easier.
Quitting smoking is the only proven way to slow COPD progression.
Quitting smoking helps stop the harmful damage caused by cigarette smoking. Stopping smoking also slows down the rate at which chronic obstructive pulmonary disease (COPD) gets worse. As hard as it can be, millions of people have managed to quit smoking—and you can too.
Start with your doctor.
Talk about it.Your doctor can help explain the benefits of quitting smoking and can help provide valuable advice as you start trying to quit
Consider smoking cessation products. Your doctor can tell you more about the prescription and over-the-counter products available to help you quit. Ask your doctor if any of these products might be right for you:
The nicotine patch: Gives you a steady level of nicotine
Nicotine gum: Lets you take it when you feel the need
Nicotine inhalers: Mimic the motions of cigarette smoking
Prescription treatments: Options are available that can help reduce cravings or limit the side effects of quitting
Keep these things in mind:
Know why you want to quit. Maybe you watched a friend suffer with lung disease. Or maybe you want to make sure you can play with your grandkids. Having a reason that inspires you can raise your chance of success
Know and avoid your smoking triggers. If you smoke while you watch the news, go for a walk instead. Change your routine. Dump habits like taking smoke breaks with coworkers
Get support from others who understand. Ask about support groups for people trying to quit. You can talk or just listen
Keep trying. If your first attempt at quitting doesn’t work, don’t worry. Just try again
Try programs to help you quit smoking.
The American Lung Association, the American Cancer Society, and the American Heart Association all sponsor smoking cessation programs.
It’s never too late to quit smoking. Before starting any smoking cessation program, talk to your doctor. He or she can tell you what program might be right for you, and how well it can work.
Lifestyle changes.
Lifestyle choices can play a role in treating your chronic obstructive pulmonary disease (COPD). Talk to your doctor about changes that could help you breathe easier.
Make smart choices.
If you smoke, try to quit. This can actually help slow the progression of COPD
Try to avoid respiratory infections—talk to your doctor about the flu shot and pneumonia vaccine, and avoid contact with people who are sick when possible
Ask your doctor about pulmonary rehabilitation
Try to avoid exposure to COPD triggers, including irritants like polluted air or toxins
Call your doctor at the first sign of an illness or increase in symptoms. It’s good to keep your doctor informed of any changes you experience so he or she can change your treatment, if needed
Pulmonary rehabilitation and breathing exercise
Improve your breathing.
Talk to your doctor about participating in a pulmonary rehab program. It could help you breathe easier.
Pulmonary rehabilitation.
Pulmonary rehabilitation programs vary, but a supervised pulmonary rehabilitation program may include exercise training, education, and behavioral changes.
Your pulmonary rehabilitation program will tailor your training and therapy to your abilities and goals. Once you complete the program, keep exercising and applying what you have learned to maintain any breathing improvement you may have achieved.
Pursed-lip breathing.
Pursed-lip breathing is a simple breathing exercise that can help improve your breathing. It is not a substitute for treatment or formal pulmonary rehabilitation. Before starting this or any exercise, ask your doctor if it is right for you.
Sit upright, and relax your neck and shoulder muscles.
Close your mouth, and breathe in slowly through your nose for a count of two: 1... 2. Just a normal breath will do.
Now, pucker or purse your lips as if you were going to whistle, and blow slowly and gently through your pursed lips while counting to four: 1... 2... 3... 4.
Repeat for a minute or two, or as long as you feel comfortable.
Avoiding COPD triggers.
In addition to considering your treatment options, try to identify your personal chronic obstructive pulmonary disease (COPD) triggers, so you can avoid as many of them as possible. Talk to your doctor about identifying and reducing your triggers.
The first and most common trigger is cigarette smoke. Smoking causes most cases of COPD in the United States (although nonsmokers can get COPD, too). If you smoke, it is important to quit. Quitting smoking can help slow the progression of COPD. If you’ve already quit, you’ve taken a great step.
Among the major triggers:
Dangerous gases (including carbon monoxide and radon)
Air pollution: indoor and outdoor air pollution can trigger COPD. Avoid traffic jams, smoke, and strong chemical fumes, and limit the time you spend outside if there is an air pollution alert
Respiratory infections
Make smart choices.
If you smoke, try to quit
Try to avoid exposure to irritants like polluted air or toxins
Try to avoid respiratory infections—talk to your doctor about the flu shot and pneumonia vaccine, and avoid contact with people who are sick when possible
Once you have chronic obstructive pulmonary disease (COPD), you’ll always have it. But that doesn’t mean you’re powerless to manage your COPD. You have options that can help you breathe easier. Be sure to discuss all of your options with your doctor.
Lifestyle changes beyond prescription treatment:
Make lifestyle changes. Lifestyle changes can help manage your COPD. These include quitting smoking (if you smoke), eating a healthy diet, and exercising. Talk to your doctor before starting any exercise program
Consider pursed-lip breathing and pulmonary rehabilitation.
Maintenance medicines (long-acting and short-acting medicines) are taken as little as once a day or up to 4 times a day and work to keep airways open for up to 24 hours
Some maintenance medicines include combination therapy, which has multiple medicines in one dose
Your doctor might also prescribe a “rescue” inhaler to help you breathe better when you experience sudden or worsening symptoms while on maintenance therapy
Talk with your doctor to see what types of COPD medications may be right for you.
Treatment types
There are 2 main types of prescription COPD treatments.
Prescription medicine can open your airways so you can breathe easier. Long-acting “maintenance” medicines help keep airways open, so you can maintain better breathing. “Rescue” inhalers can be used as needed to help you when your airways become narrowed, even while on maintenance treatment. Talk to your doctor about how both kinds of treatment work.
Daily maintenance medicines:
Taken once, twice, or up to 4 times a day to help keep your airways open for up to 24 hours
Some are available in steroid-free options, while some contain steroids
There are both long-acting and short-acting maintenance medicines
There are also combination therapies that have multiple medicines in one dose, such as a dual bronchodilator; talk with your doctor about whether this type of therapy is right for you
Rescue medicines:
The effects of one dose usually only last 4 to 6 hours
May be prescribed for use as needed when your airways are suddenly restricted
Your doctor can recommend 1 or more of these medicines to you, based on your level of symptoms. If your symptoms worsen or become more frequent, talk to your doctor about other treatment options.
There are also different types of inhaler devices available. Some inhalers use chemical propellants to deliver powdered medicine. Other inhalers use a spring action to deliver medicine in a slow-moving mist. Your doctor or pharmacist can help you learn how to use these inhalers and answer any questions you may have.
Keep taking your maintenance treatment, even when you’re breathing easier.
Some people stop taking their daily management medicine because they don't think it's working. Just remember: You should take prescribed maintenance medicines every day to keep your airways open so you can breathe easier. Maintenance medicines can help your lungs feel less constricted, allowing you to use rescue inhalers less often. However you are treating COPD, it’s important to take your medicines as directed by your doctor.
Goals of treatment
You can’t get rid of COPD, but you can get a handle on it.
The good thing about chronic obstructive pulmonary disease (COPD) is that it’s treatable. Learn about some options for managing COPD and discuss them with your doctor—so you can pursue the goal of breathing more easily.
Take action to breathe easier.
If you smoke, try to quit. Quitting smoking is the only thing that can help slow the progression of COPD
Pinpoint your COPD triggers
Talk to your doctor about pneumonia and flu vaccines
Talk to your doctor about maintenance treatment
Prescription medicine may help you breathe easier.
Long-term maintenance medicines are usually used to open your airways and help you breathe easier when taken every day. Rescue medicines may be prescribed for use when you feel sudden and uncontrolled symptoms while taking maintenance medication. Your doctor may prescribe both treatments to help you breathe easier.
Daily maintenance medicines are long-acting breathing medicines used for ongoing treatment of COPD
They're inhaled every day to help keep your airways open
Unlike rescue medications, maintenance medications are not used to treat worsening symptoms
Stick with it, even when your breathing improves.
To keep your airways open and your lungs less constricted, take your long-term maintenance medication every day. Long-term daily maintenance works best if you take it every day as prescribed by your doctor, even if you feel well. Taking daily maintenance therapy keeps your airways open so you can breathe easier.
What to expect from long-term treatment.
Daily maintenance medicines are taken every day to help you breathe easier and manage your symptoms. Talk to your doctor about the tips below and other ways to help you stick with maintenance treatment, so you can keep breathing easier:
Make it part of your routine. Take your medicine at the same time each day—such as when you wake up, at a mealtime, or before bed
Ask a family member to remind you to take your medicine (or set an alarm)
Keep your medicine in a place where you'll remember it
Ask your pharmacist if they have a refill reminder program
Mark your refill dates on a calendar. Choose a date 1 week before your current refill runs out
If your doctor has not already prescribed a rescue inhaler, ask about adding this type of treatment to help you when breathing problems are more severe and require immediate relief.
Know what to expect with maintenance treatment.
Even if you don’t feel it working, taking your maintenance medication every day can help keep your airways open and your lungs feeling less constricted
Maintenance medicines shouldn’t be used in an emergency
Taking maintenance medicines every day may allow you to use rescue inhalers less often
Continue to take maintenance treatments every day—even when you are breathing better—to keep your airways open
Take note and talk to your doctor.
Pay attention to your symptoms: note increases in shortness of breath or intense coughing
Tell your doctor if you’re unable to perform your normal daily activities or if you are using your rescue inhaler more often than normal
If you experience a severe COPD flare-up—extreme shortness of breath or increased coughing—seek immediate medical help
Set goals for yourself. Take note of the little everyday activities you can do that you weren’t able to do before
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