COPD

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. With COPD, the airways that lead to the lungs are narrowed, and the tiny air sacs in the lungs are damaged and lose their stretch. Over time, it may lead to severe shortness of breath and heart problems.

Education Topics

Activity

How do upper and lower body exercises help with COPD?

Upper body exercises like arm extensions, elbow circles, and elbow breathing increase strength in your arm and shoulder muscles. This gives support to your rib cage and can help improve breathing. Lower body exercises like knee extensions, leg lifts, and step-ups develop lower body muscles and will help you move around more easily.

Getting started with exercising for COPD

Exercises for COPD are simple to do and take little time.

If you become breathless while doing any of the exercises, rest in a position where your shoulders are supported, such as in a chair, and wait until you can breathe easily again.

  • Talk to your doctor.

    Your doctor may ask that you do specific exercises and will help you figure out how often and how long to do them. You may also get help with setting your long-term exercise program goals. It may take weeks before you are able to reach your goals. But how long it takes is not as important as doing the exercises consistently.

  • Start slowly and gradually.

    For each exercise, either time how long you can do it or count the number of times you can do it before you are mildly out of breath. Then rest and move on to the next exercise. Each week, increase the time you spend doing each exercise or how many times you do each one.

  • Pick activities that you enjoy.
  • Always have a warm-up and cool-down.

    This is a good time for stretches.

  • Pay attention to your breathing.

    Try to breathe slowly to save your breath. Breathe in through your nose, keeping your mouth closed. This warms and moisturizes the air you breathe. Breathe out through pursed lips.

How do you exercise for COPD?

To start an exercise program, talk with your doctor to set your long-term exercise goals. Start slowly and gradually with activities that you enjoy. Always have a warm-up and cool-down when you exercise, and pay attention to your breathing. You may do both aerobic exercise and upper and lower body exercises.

Cal's Story: Learning to exercise when you have COPD

Cal, 66
Find out how Cal was able to build up his strength.
"There was a time when I couldn't take 10 steps without running out of breath. Now I walk an hour around my neighborhood every day—without needing my oxygen. I feel better than I have in years."

"Why me?"

That's what Cal asked himself over and over after he was diagnosed with severe COPD 5 years ago.

"I spent the first 2 years moping around the house, feeling sorry for myself," he says. "I didn't go anywhere, I didn't do anything. I just sat in front of the TV and tried not to think about anything."

Then one day Sonny, his 5-year-old granddaughter, walked up to him as he sat in his easy chair. "She looked up at me-she's got these enormous brown eyes-and she said, 'Poppy, why won't you come outside and play with me?'

"Well, it about broke my heart. I decided that day to get out of that chair and get back into life. The trouble was, I couldn't take 10 steps without getting out of breath."

But he decided 10 steps was a good start. "I got on our old treadmill and walked for 1 minute that first day."

It was really hard for Cal. He had to stop twice, and he needed his oxygen while he was doing it. But he did it again the next day, and the next. Then he decided to see if he could add 1 minute of walking each week.

One minute gradually became 5 minutes. Then 5 minutes eventually turned into 15 minutes.

"That was 3 years ago," says Cal. "Now I walk an hour around my neighborhood every day. That's right, an hour! And I do it without my oxygen."

Cal thinks it helped a lot that he increased his walking time so gradually. It kept him from getting discouraged. "Now I feel better than I have in years. I'm really amazed."

And after school every day, Sonny and her little brother come over and play in the yard with their Poppy.

This story is based on information gathered from many people facing this health issue.

How does exercise help you feel better when you have COPD?

When you have COPD, activity and exercise can build muscle strength and endurance. This will help you be more active—you will be able to do more activities for longer amounts of time. It can also reduce shortness of breath.

Complications and Comorbidities

How do lung infections affect COPD?

Lung infections like pneumonia and acute bronchitis are common causes of COPD flare-ups. And people who have COPD are more likely to get these lung infections, especially if they smoke.

When you have COPD, it is important to know the symptoms of pneumonia and acute bronchitis and call your doctor if you have them. Symptoms include:

  • A cough that brings up more mucus than usual.
  • Fever.
  • Shortness of breath.

How do upper respiratory infections (URIs) affect COPD?

Colds, the flu, and other upper respiratory infections can make COPD symptoms worse. These symptoms include having too much mucus in your lungs, coughing, and being short of breath.

What kinds of health problems can COPD lead to?

COPD can lead to other health problems. Some of these include:

  • More frequent lung infections, such as pneumonia.
  • A higher risk of thin or brittle bones (osteoporosis) and broken bones, especially if you use oral corticosteroids often.
  • Problems with weight. Some people may need to lose weight, but others may need to gain weight.
  • Heart failure or an irregular heartbeat.
  • A collapsed lung (pneumothorax). COPD can damage the lung's structure and allow air to leak into the chest cavity.
  • Sleep problems because you aren't getting enough oxygen into your lungs.
  • Feelings of anxiety or depression.

What vaccines can help prevent lung infections when you have COPD?

When people with COPD get a cold or the flu, it often turns into something more serious, like pneumonia or acute bronchitis. These lung infections are common causes of COPD flare-ups. Vaccines can help prevent lung infections.

Flu vaccine

Get a flu shot each year, as soon as it's available. The flu vaccine can help prevent the flu from turning into a more serious infection. Also, getting regular flu vaccines may lower your chances of having COPD flare-ups.

Pneumococcal vaccine

People with COPD often get pneumonia. Getting the pneumococcal vaccine can help keep you from getting very ill with pneumonia.

People younger than 65 usually need only one shot. But doctors sometimes recommend a second shot for some people who got their first shot before they turned 65. Talk with your doctor about whether you need a second shot.

Pertussis vaccine

Pertussis (also called whooping cough) can increase the risk of having a COPD flare-up. So make sure you are current on your vaccinations.

Course

What happens when you have COPD?

COPD gradually gets worse over time. As it gets worse, you may be short of breath even when you do things like get dressed, fix a meal, or eat. People often feel weaker and limit activities. And some people may get lung infections and heart problems.

Shortness of breath gets worse as COPD gets worse.

  • Early in the disease, before you have a lot of lung damage, you may not have much trouble breathing, even when you are active.
  • Later in the disease, you may have already lost much of your lung function.
    • If you are active, you may be short of breath during activities that didn't used to cause this problem.
    • If you aren't very active, you may not notice how much shortness of breath you have until your COPD gets worse.
  • When you've had COPD for many years, you may be short of breath even when you are at rest. Even simple activities may cause very bad shortness of breath.

If you smoke, quitting can slow the rate at which breathing gets more difficult. You can't undo the damage to your lungs. But you may be able to postpone or avoid more serious problems with breathing.

Definition

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. With COPD, the airways that lead to the lungs are narrowed, and the tiny air sacs in the lungs are damaged and lose their stretch. Over time, it may lead to severe shortness of breath and heart problems.

COPD can't be cured, but medicines and lifestyle changes may help reduce symptoms.

The best way to slow COPD is to stop smoking.

Diagnostics

How is COPD diagnosed?

To find out if you have COPD, your doctor may:

  • Do a physical exam and listen to your lungs.
  • Ask you questions about your past health and whether you smoke or have been exposed to other things that can irritate your lungs.
  • Have you do breathing tests, including spirometry, to find out how well your lungs work. These tests measure the amount of air in your lungs and the speed at which air moves in and out.
  • Do a chest X-ray to look at your lungs.
  • Do a one-time test for Alpha-1 antitrypsin (AAT). AAT is a protein your body makes that helps protect the lungs. People who have a low AAT are more likely to get emphysema.
  • Do other tests to help rule out other problems that could be causing your symptoms, such as lung cancer.

Your doctor may order other tests, as needed. These may include:

Arterial blood gas test.
This test measures how much oxygen, carbon dioxide, and acid is in your blood.
Oximetry.
This test measures the oxygen saturation in your blood.
Electrocardiogram (ECG, EKG) or echocardiogram.
These tests may find certain heart problems that can cause shortness of breath.
Transfer factor for carbon monoxide.
This test looks at whether your lungs have been damaged, and if so, how much damage there is and how bad your COPD might be.
CT scan.
This gives doctors a detailed picture of the lungs.

Diet

How can you get enough to eat when you have COPD?

Getting enough nutrition gives your body energy. But that can be hard to do when you have little appetite or feel too tired. So choose foods that are easy to prepare. Try eating small, frequent meals to prevent getting too full. Before you eat, clear your lungs or use medicines that make breathing easier.

Avoiding weight loss when you have COPD

If you have COPD and are beginning to lose weight and muscle mass, you probably need to eat more protein and get more calories. This generally means eating more foods containing fat and protein. Talk with your doctor or a dietitian about what foods you need to gain or maintain your weight.

Here are some ways to get more calories and protein.

  • Eat high-calorie snacks.

    Snack foods that can help you add calories to your diet include:

    • Ice cream.
    • Pudding.
    • Cheese.
    • Granola bars.
    • Custard.
    • Avocado.
    • Eggs.
    • Crackers with peanut butter.
    • Cereal with half-and-half.
    • High-calorie drinks like whole milk, milkshakes, and nutritional supplements, such as nutrition shakes.
  • Add calories to a meal or snack.

    Making simple changes to the foods you already eat can help you add calories and protein to your diet.

    • Add an egg or egg yolk to meat loaf, macaroni and cheese, or similar foods. Be sure to cook the food after adding the egg.
    • Add powdered milk to creamed soups, scrambled eggs, pudding, potatoes, yogurt, and casseroles.
    • Add cheese to sandwiches, crackers, casseroles, soups, toast, and pasta.
    • Add extra vegetable oil or olive oil, mayonnaise, butter, or sour cream to sandwiches, bread, casseroles, soups, cooked cereals, pasta, potatoes, rice, or vegetables.
    • Grind up some nuts and sprinkle them on puddings, gravy, mashed potatoes, casseroles, salads, and yogurt.
  • Add protein to your diet.

    Milk, milk products, and meats are high in protein. Try to eat more of these foods, or:

    • Add skim milk powder to milk, cold cereals, scrambled eggs, soups, and ground meat.
    • Add cheese or peanut butter to snacks.
    • Choose desserts that use eggs, such as sponge cake, egg custard, and rice pudding.
    • Use nutritional supplements high in protein, such as nutrition shakes.

How do you avoid losing weight when you have COPD?

To avoid losing weight and muscle mass when you have COPD, you generally need to eat more foods that have fat and protein. Talk with your doctor or a dietitian about what foods you need to gain or maintain your weight.

Getting the nutrition you need when you have COPD

The following tips can make eating easier and help you get the nutrition you need. But if you have other diet limitations, talk with your doctor or a registered dietitian before making changes in what you eat.

  • Make eating easier.
    • Choose foods that are easy to prepare.
    • Eat in a relaxed setting.
    • Eat with friends and family.
    • If you eat a main meal, try to eat it early. This way, you will have energy throughout more of the day.
    • Try to include a favorite food in your meals.
  • Avoid shortness of breath while eating.
    • Rest before eating if eating makes you short of breath or tired.
    • Use your bronchodilator about an hour before you eat. Then clear your lungs. This can help you breathe better during your meal.
    • Eat while sitting up. This helps remove pressure on your lungs.
    • If you use oxygen, use it while eating. Eating and digestion require energy, which causes your body to use more oxygen.
    • Try eating smaller, frequent meals so the stomach is never too full. A full stomach can push on the muscle that helps you breathe (your diaphragm) and make it harder to breathe.
    • Drink your beverage at the end of the meal. Drinking before or during the meal can fill you up more quickly.
    • If you notice that you have belly bloating that makes it hard to breathe, limit the amount of foods you eat that cause gas. These foods include onions, broccoli, cauliflower, cabbage, and beans.
    • Avoid foods that are hard to chew. Eat and chew slowly so you are less likely to become short of breath. Try putting your spoon or fork down between bites to slow your eating speed.
    • If you have trouble breathing while eating solid food, try a liquid meal replacement, such as Ensure, Boost, or instant breakfast drinks.
  • Eat healthy foods.
    • Try to eat a variety of foods, including fruits and vegetables, dairy products, grains, and proteins.

Getting Support

Fran's Story: Finding support when you have COPD

Fran
Read more about how Fran draws strength from others who understand her experience.
"Someone told me to go online and connect with a support group. I did, and it literally changed my life."

"I was so scared when the doctor told me I had emphysema. I was afraid to go anywhere or do anything.

"Someone told me to go online and connect with a support group. I did, and it literally changed my life. I was pretty shy at first, and all I did was read what everyone else was writing. Then one day I was having trouble with the company that supplies my oxygen. I went online and asked for advice. I got it. I was able to clear up the problem the very next day thanks to a woman who'd had the same thing happen to her.

"The next advice I took was to talk to my doctor about my depression. I wish I had done it sooner. He put me on antidepressants and had me see a counselor. I'd never been to a counselor before and didn't really believe in that kind of thing. But this counselor really did help me deal with my fears. I feel so much better about things now. I look forward to every day.

"Now there's no stopping me. I go online every day and 'chat' with people. They cheer me up when I'm feeling blue. They answer questions. They give me tips. They've become true friends. I still have bad days. But no matter how bad my day has been, I usually feel much better after checking in with my online friends.

"And the best part is that now I'm one of the ones giving tips and trying to cheer people up. It's amazing how good it feels to help someone else like that. It really makes your day."

This story is based on information gathered from many people facing this health issue.

Living With

Conserving energy when eating

Conserving, or saving, your energy means finding ways to do daily activities with as little effort as possible. With some planning and a few tips, you can get tasks done more easily and enjoy your daily routine.

Here are some ways you can conserve your energy when eating.

  • Try eating small, frequent meals instead of three larger meals so your stomach is never too full. A full stomach can push on the muscle that helps you breathe (your diaphragm) and make it harder to breathe.
  • If you get too tired to eat much, try to eat higher-calorie but healthy foods. Have a yogurt-and-fruit smoothie for breakfast. Put avocado on a sandwich. Or add cheese or peanut butter to snacks.
  • If you don't feel very hungry, try to eat first and drink water or other fluids after meals. This will help you keep from losing weight. Sip small amounts of fluids if you need to drink while you eat.

Conserving energy when bathing and dressing

Even simple activities can be exhausting when you have COPD, heart failure, or another long-term (chronic) condition. You may feel at times as though you've lost your ability to live your life.

Conserving, or saving, your energy means finding ways to do daily activities with as little effort as possible. With some planning and a few tips, you can get tasks done more easily and enjoy your daily routine.

Here are some ways you can conserve your energy when bathing and dressing.

  • Sit on a shower chair or stool while you bathe. Also sit down while you shave or put on makeup.
  • Sit down (on a high stool) as often as you can when you get dressed.
  • Wear tops and sweaters that have zippers or buttons so you don't have to pull them over your head.

Conserving energy when moving around and doing activities

Sometimes even simple activities like walking across your living room can be exhausting when you have COPD, heart failure, or another long-term (chronic) condition. You may feel at times as though you've lost your ability to live your life.

Conserving, or saving, your energy means finding ways to do daily activities with as little effort as possible. With some planning and a few tips, you can get tasks done more easily and enjoy your daily routine.

Here are some ways you can conserve your energy when moving through your day.

  • Move slowly when you walk or do an activity such as housework.
  • Sit down (on a high stool) as often as you can when you get dressed, do chores, or cook.
  • Use a raised toilet seat.
  • Use a cart with wheels to roll items, such as laundry, from one room to another.
  • Push or slide boxes or other large items instead of lifting them.
  • Limit the trips you take up stairs.
    • Use a downstairs room for your bedroom so you won't have to take the stairs as often.
    • If you can afford it, think about getting an electric lift to take you up the stairs.

Conserving energy by planning daily activities

Cooking dinner, putting away laundry, or even just walking across your living room can be exhausting when you have COPD, heart failure, or another long-term (chronic) condition. You may feel at times as though you've lost your ability to live your life.

Conserving, or saving, your energy means finding ways to do daily activities with as little effort as possible. With some planning and a few tips, you can get tasks done more easily and enjoy your daily routine.

Here are some ways you can conserve your energy when doing daily tasks.

  • Make a list of what you have to do every day, and group the tasks.

    Group the tasks by location so that you do all the chores you have in one part of your house at around the same time.

  • Go out for errands or do chores at the time of day when you have the most energy.
  • Leave plenty of time to do tasks or get to events.

    Adding extra time will keep you from feeling rushed and breathless.

  • Include rest periods in your day.
  • Ask for help from family or friends for chores that are too tiring to do by yourself.

Having sex when you have COPD

For many people, having chronic obstructive pulmonary disease (COPD) can get in the way of sex. Being out of breath makes things difficult. Just thinking about it might make you want to avoid sex. But it doesn't have to be like that.

Here are some ideas for making the most of your intimate time with your partner.

  • Think about what could help you be more comfortable.

    Share your thoughts with your partner, and come up with solutions together.

  • Be well rested before having sex.
  • Choose the time of day when you have more energy and when breathing is easiest.

    You might want to avoid times when you've just eaten or had alcohol or when it's hot or humid.

  • Clear your lungs beforehand.

    Use your bronchodilator medicine before you have sex. This can improve your shortness of breath.

  • Take your time, take it easy, and enjoy one another.
  • Try a side-by-side position. It can be less tiring.
  • Let your partner know when you need them to take the more active role.
  • Stop and rest if you have trouble breathing.
  • Talk with your doctor if you or your partner is worried about having sex.

    Your doctor can give you support and advice.

Conserving energy when reaching for and grabbing items in your home

Sometimes simple activities like putting away laundry or cleaning the house can be exhausting when you have COPD, heart failure, or another long-term (chronic) condition. You may feel at times as though you've lost your ability to live your life.

Conserving, or saving, your energy means finding ways to do daily activities with as little effort as possible. With some planning and a few tips, you can get tasks done more easily and enjoy your daily routine.

Here are some ways you can conserve your energy when you need to reach or grab something.

  • Put things you use the most on shelves that are at the level of your waist or shoulder.

    Bending down and reaching up can make you tired quickly if you have trouble breathing.

  • Use long-handled grabbers or other tools to reach items on a high shelf or to pick up things off the floor.
  • Use long-handled dusters when you clean the house.

Medication Therapy

How are medicines used to treat COPD?

Most people with COPD find that medicines make breathing easier. Medicines are used to:

  • Reduce shortness of breath.
  • Control coughing and wheezing.
  • Prevent COPD flare-ups or keep the flare-ups you do have from being deadly. (Flare-ups are also called exacerbations.)

Medicine choices for COPD include bronchodilators and other types of medicines. Most COPD medicines are used with devices called inhalers or nebulizers. It's important to learn how to use each device correctly. Many people don't use them correctly, so they don't get the full benefit from the medicine.

Bronchodilators

There are different types of medicines used to open or relax your airways and help your shortness of breath. They include:

Short-acting bronchodilators.

Short-acting bronchodilators ease your symptoms. They are considered a good first choice for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). They include:

  • Anticholinergics. An example is ipratropium.
  • Beta2-agonists. Examples are albuterol or levalbuterol.
  • A combination of the two, such as a combination of albuterol and ipratropium.
Long-acting bronchodilators.

Long-acting bronchodilators help prevent breathing problems. They help people whose symptoms do not go away (persistent symptoms). They include:

  • Anticholinergics. Examples are aclidinium, tiotropium, or umeclidinium.
  • Beta2-agonists. Examples are formoterol or salmeterol.
  • A combination of the two, or a combination of a beta2-agonist and a corticosteroid medicine.
  • A combination of an anticholinergic, a beta2-agonist, and a corticosteroid medicine.

Other medicines

These include:

Phosphodiesterase-4 (PDE4) inhibitor.

The only PDE4 inhibitor available is roflumilast. This medicine is taken every day to help prevent COPD flare-ups.

Corticosteroids.

Corticosteroids (such as prednisone) may be used in pill form to treat a COPD flare-up or in an inhaled form to prevent flare-ups. They are often used if you also have asthma.

Alpha-1 antitrypsin.

People who have an alpha-1 antitrypsin deficiency may lower their risk for severe COPD if they get regular infusions of alpha-1 antitrypsin.

Other medicines.

These include methylxanthines, chronic antibiotics and others, which often are used for severe cases of COPD.

Overview

Chronic obstructive pulmonary disease (COPD): Overview

Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. With COPD, the airways that lead to the lungs are narrowed, and the tiny air sacs in the lungs are damaged and lose their stretch. People with COPD have decreased airflow in and out of the lungs, which makes it hard to breathe. The airways also can get clogged with thick mucus. Cigarette smoking is a major cause of COPD.

Although there is no cure for COPD, you can slow its progress. Following your treatment plan and taking care of yourself can help you feel better and live longer.

Physical Therapy and Rehab Treatment

What can you expect during pulmonary rehab for COPD?

An ongoing pulmonary rehabilitation (rehab) program can help you function better over the long term. Each program should set short-term and long-term goals to help you keep track of changes and successes. This makes sure that the program continues to meet your needs.

How well does pulmonary rehab for COPD work?

Pulmonary rehabilitation (rehab):

  • Improves shortness of breath and fatigue.
  • Gives you more control over your condition.
  • Improves quality of life more than other types of treatment (like medicine) do.
  • Modestly improves how much you can exercise.

To work well, a rehab program should last at least 6 weeks. The longer the program is, the better it works.

What are the risks of pulmonary rehab for COPD?

There is little or no risk to these programs if they are well supervised.

Why is pulmonary rehab for COPD done?

Pulmonary rehabilitation (rehab) is recommended for people who have lung problems such as COPD. It helps most people who have COPD. It especially helps if you were recently in the emergency room or hospital for a flare-up (exacerbation).

Pulmonary rehabilitation (rehab) for COPD: Overview

Pulmonary rehabilitation for COPD combines different treatments to:

  • Help you lead a more active life.
  • Help reduce your symptoms.
  • Improve your quality of life.
  • Encourage your active participation in your treatment.
  • Help keep you out of the doctor's office and out of the hospital.

Pulmonary rehabilitation—"rehab" for short— will not reverse the damage to your lungs from COPD. But it will help you do your daily tasks, such as dressing, grocery shopping, and walking, more easily.

There are many different kinds of pulmonary rehab programs. Some are done in the hospital. Some are done at home.

Health professionals who may be involved with these programs include:

  • Doctors.
  • Nurses.
  • Dietitians.
  • Physical therapists.
  • Occupational therapists.
  • Respiratory therapists.

Supervision and structure

Pulmonary rehab is usually supervised and structured. This means that it will include evaluation of your symptoms and treatment, short-term and long-term goals, education, support, and supervised therapy programs.

Evaluation and goals

Your rehab team will look at your symptoms and current treatment to make sure that you can get the most out of the program. They also will identify other concerns, such as heart problems, that might affect how well you can exercise and can do your daily tasks.

Then you and your team will set short-term and long-term goals to meet your specific needs. For instance:

  • Some people might want to be able to dress themselves every day.
  • Others might want to be able to walk 30 minutes every day.

Education

Understanding COPD—how it progresses and is best treated—makes it easier to live with and manage the disease. Rehab programs generally include education for both you and your family about:

  • How the program affects your COPD symptoms.
  • The importance of the program to your overall health.
  • How regular participation can help you meet your goals.

Support

Support and encouragement from friends, family, and your health team are crucial in helping you stay with your rehab plan.

  • Your doctor may recommend counseling for you and your family.
  • Support groups are available in many cities. These groups can help you and your family cope with COPD and the problems it can cause.
  • One of the greatest benefits of a rehab program is the chance to meet other people with COPD who are doing a lot to breathe better and live longer. You can exchange information about living with COPD with people who have had a lot of success.

Supervised therapy programs

Therapy programs are the heart of pulmonary rehab. They are created just for you, depending on your needs and goals. Programs cover many areas, such as:

Help to quit smoking.

If you still smoke, stopping is the most important therapy program. Quitting smoking can slow damage to your lungs. Your rehab team can help you find the right program for quitting, whether it involves medicine, counseling, and/or support groups.

Exercise.

Exercise training for COPD often includes aerobic exercise, such as walking or using a stationary bike, and muscle-strengthening exercises for your arms and legs.

  • Regular exercise can improve how active you can be. And it can reduce your shortness of breath.
  • If you stay active, you may have fewer problems from COPD, have a better attitude about your life and the disease, and be less likely to be depressed.

Always talk to your doctor before starting an exercise program. People with COPD may also have heart problems that limit their exercise choices. You may need medical supervision when you start the program.

Breath training.

Breath training can help you take deeper breaths and reduce shortness of breath. You must practice breath training regularly for it to work.

Three basic breath-training methods are diaphragmatic breathing, pursed-lip breathing, and breathing while bending forward. They can be used to help you get through periods when you feel more short of breath.

  • Diaphragmatic breathing helps your lungs expand so that they take in more air. (Your diaphragm is a muscle that helps draw air into your lungs as you breathe.) Many, but not all, people with COPD find this breathing method helpful.
    • Lie on your back, or prop yourself up on several pillows.
    • With one hand on your belly and the other on your chest, breathe in, pushing your belly out as far as you can. You should be able to feel the hand on your belly moving out, while the hand on your chest should not move.
    • When you breathe out, you should be able to feel the hand on your belly moving in.
    • After you can do this kind of breathing well lying down, you can learn to do it sitting or standing.
    • Practice this breathing for 20 minutes, 2 or 3 times a day.
  • Pursed-lip breathing may help you breathe more air out so that your next breath can be deeper. Pursed-lip breathing reduces shortness of breath and improves your ability to exercise.
    • Breathe in through your nose and out through your mouth while almost closing your lips.
    • Breathe in for about 2 seconds, and breathe out for 4 to 6 seconds.
  • Breathing while bending forward at the waist may make it easier for you to breathe. Bending forward while breathing may reduce shortness of breath in those with severe COPD, both at rest and during exercise. This may be because bending forward allows the diaphragm to move more easily.
Learning to eat well.

Eating well is important to keep up your strength and health. Problems with muscle weakness and weight loss happen often in severe COPD. If you lose too much weight, you can get even more short of breath and become even less active. Over time, you could become so weak that you need to depend on others for daily living.

Prevention

How can you help prevent COPD?

The best way to keep COPD from starting is to not smoke.

And if you smoke, the best way to prevent COPD from getting worse is to quit smoking. There are clear benefits to quitting, even after years of smoking. When you stop smoking, you slow down the damage to your lungs.

Providers

Who can diagnose and treat COPD?

Health professionals who can diagnose COPD and provide a basic treatment plan include:

  • Family medicine physicians.
  • Internists.
  • Nurse practitioners.
  • Physician assistants.

You may need to see a specialist in lung disease, called a pulmonologist (say "pull-muh-NAWL-uh-jist"), if:

  • Your diagnosis of COPD is uncertain or hard to make because you have diseases with similar symptoms.
  • You have unusual symptoms that are not usually seen in people with COPD.
  • You are younger than 50 and/or have no history or a short history of cigarette smoking.
  • You have to go to the hospital often because of sudden increases in shortness of breath.
  • You need long-term oxygen therapy.
  • You and your doctor are considering surgery, such as a lung transplant or lung volume reduction.

Risk Factors

What puts you at risk for COPD?

Tobacco smoking is the most important risk factor for COPD. Having asthma can also increase your risk for COPD. Other things that put you at risk include breathing in chemical fumes, industrial dust, or air pollution over a long period of time.

Self-assessment

How do you measure lung function for COPD?

Lung function means how well your lungs work. When you have COPD, your lungs can't move as much air in and out as they should. And the more serious your COPD is, the less air your lungs are able to move.

Spirometry tests are used to measure lung function. They measure how much air you breathe out when you take long, deep breaths and push the air out of your lungs. For people with COPD, the test measures how well the lungs do two important jobs:

  • How much air you can push out in 1 second. This is called forced expiratory volume in 1 second, or FEV1.
  • How much air you can push out after you take a deep breath, with no time limit. This is called forced vital capacity, or FVC.

Why do you need to monitor your COPD symptoms?

At times, your symptoms may suddenly get much worse. These attacks are called COPD flare-ups, or exacerbations. They may be life-threatening. So it's important to keep track of your symptoms and know what to do if they get worse. Quick treatment at home may help prevent serious breathing problems.

Self-care Treatment

How can you care for yourself with breathing exercises?

  • Practice pursed-lip breathing and diaphragmatic breathing daily. Try to do them 3 or 4 times a day for 20 minutes each time.
  • Pursed-lip breathing helps you breathe more air out so that your next breath can be deeper. Pursed-lip breathing can relieve shortness of breath and help you be able to move around. Think of it as "smell the flowers (inhale) and blow out the candle (exhale)."
    • Breathe in through your nose for about 2 seconds.
    • Breathe out through your mouth while almost closing your lips for 4 to 6 seconds. Note that exhaling is longer than inhaling.
  • Diaphragmatic breathing, or belly breathing, helps your lungs expand so that they take in more air. It also helps strengthen your diaphragm. Your diaphragm is a large muscle that separates your lungs from your belly. It helps draw air into your lungs as you breathe.
    • Lie on your back, or prop yourself up on several pillows. You can also sit in a chair.
    • Put one hand on your belly and the other on your chest. Breathe in through your nose. Let your breath push your belly out as far as possible. You should feel the hand on your belly move out, while the hand on your chest does not move.
    • Breathe out through pursed lips. You should feel the hand on your belly move in.
    • When you can do this type of breathing well while lying down or leaning on pillows, learn to do it while sitting or standing.

Breathing while bending forward at the waist may make breathing easier. It can reduce shortness of breath. It helps the diaphragm move more easily. Make sure to hold on to something sturdy like a countertop or chair if you're standing.

How does clearing your lungs help you breathe?

When you have too much mucus in your lungs, learning to clear your lungs may help you save energy and improve your breathing. It may also help prevent lung infections.

Here are three ways to clear your lungs:

  • Postural drainage
  • Chest and back percussion
  • Controlled coughing

What are ways to clear your lungs?

Learning to clear your lungs may help you save energy and oxygen. It may also help prevent lung infections. Three things you can do to help clear your lungs are postural drainage, chest percussion, and controlled coughing.

What are ways to breathe easier when you have COPD?

It's important to avoid shortness of breath when you have COPD. Breath training can help you take deeper breaths so you can breathe easier and feel better. Breath training methods include pursed-lip breathing and breathing with your diaphragm.

Self-care Treatment Options

How can you care for yourself when you have COPD?

You can't undo the damage to your lungs from COPD. But you can take steps to prevent more damage and to feel better.

Quit smoking

This is the most important thing you can do to slow down the disease and improve your quality of life.

You may think that nothing can help you quit. But there are several treatments shown to be very good at helping people stop smoking. Talk to your doctor if you need help quitting.

Avoid things that can irritate your lungs

These things include smoke and air pollution.

Find ways to make breathing easier

Here are some ways you can make breathing easier.

  • Conserve your energy. You may get more tasks done and feel better if you learn to save energy while doing chores and other activities. For instance, take rest breaks and sit down whenever you can while you fold laundry, cook, and do other household tasks. An occupational or physical therapist can help you find ways to do everyday activities with less effort.
  • Learn breath-training methods—such as breathing through pursed lips—to improve airflow in and out of your lungs. Learn ways to clear your lungs that can help you save energy and oxygen.
  • Discuss pulmonary rehabilitation with your doctor.
  • Take the medicines prescribed by your doctor. If you use inhalers, be sure you know how to use each of them properly.

Stay as active as you can

Try to do activities and exercises that build muscle strength and help your heart. If you get out of breath, wait until your breathing is back to normal before you keep going.

Eat well

Getting enough to eat will help you keep up your strength. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

Avoid colds and other infections

Get a flu vaccine every year. And ask your doctor about getting the pneumococcal and whooping cough (pertussis) shots. Wash your hands often to prevent infections.

Seek education and support

Treating more than the disease and its symptoms is very important. Here are some things that can help you cope and live better with COPD.

  • Educate yourself and your family about COPD and your treatment program. This helps you and your family cope with your lung disease.
  • Counseling and support groups can help you learn to live with COPD. You may feel socially isolated because you can't enjoy activities with your family and friends the way you used to. But many people with COPD can lead a full life.
  • Ask for help from family, friends, and health professionals. Learning that you have a disease that may shorten or change your life may lead to depression or anxiety. These can make your COPD symptoms worse. But support can make it easier.
  • Try to follow your treatment plan. It may make you feel better and less likely to become depressed. A self-reward system—such as a movie night after staying on your medicine and exercise schedule for a week—can help keep you motivated.

What are ways to breathe easier when you have COPD?

It's important to avoid shortness of breath when you have COPD. Breath training can help you take deeper breaths so you can breathe easier and feel better.

Breath training methods include:

Pursed-lip breathing.
This helps you breathe more air out so that your next breath can be deeper.
Breathing with your diaphragm.
This helps your lungs expand so that they take in more air.

Use these methods when you are more short of breath than normal. Practice them often so you can do them well.

Preventing problems from COPD

There are many things you can do to prevent problems from COPD and stay as healthy as you can.

  • Don't smoke.

    The best way to keep COPD from starting or from getting worse is to not smoke.

    There are clear benefits to quitting, even after years of smoking. When you stop smoking, you slow down the damage to your lungs.

    Not smoking is especially important if you have low levels of the protein alpha-1 antitrypsin.

  • Avoid bad air.

    Other airway irritants, such as air pollution, chemical fumes, and dust, also can make COPD worse.

  • Get your flu, pneumococcal, and whooping cough (pertussis) vaccinations.

    If you have COPD, you need to get a flu vaccine every year. You also need to stay current with the pneumococcal and whooping cough (pertussis) vaccines. These infections can often be serious in people with COPD. They can also increase the risk of a COPD flare-up. Vaccines can help prevent this from happening.

How can you keep COPD from getting worse?

Not smoking is the best way to keep COPD from getting worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. Also, be sure to get your flu, pneumococcal, and whooping cough (pertussis) vaccines. And avoid air pollution, fumes, and dust as much as you can.

Signs and Symptoms

What are the symptoms of COPD?

When you have COPD, you have a cough that won't go away, and you're often short of breath. You may also cough up mucus. At times, your symptoms may suddenly flare up and get much worse.

Social and Emotional Aspects

Sarah's Story: Dealing with the emotions from COPD

Sarah, 67
Read more about how Sarah deals with her emotions.
"Not being the person I used to be—it makes me really sad sometimes. There are lots of days I don't want to even get up, but then I think about taking my walk or seeing my friends, and I want get out there. COPD may slow me down, but it isn't going to stop me."

More good days. It's possible to have them, even with COPD, says Sarah, who found out 3 years ago that she had the disease.

COPD sneaked up on Sarah. She began coughing more often, and the coughing lasted longer. Every day it got a little bit harder to breathe. One day she found she couldn't walk up the basement stairs without having to stop and catch her breath. And then she began coughing and couldn't stop.

"It was scary," she says. "I'd try to take a breath, but I'd cough instead. I was coughing up all this liquid—it felt like I was drowning. I just sat on the step and hung onto that railing until it stopped. It seemed like a really long time."

After that, Sarah knew she had to quit smoking.

"My husband had been telling me for years to quit, but I just couldn't," says Sarah, 67. "But when my doctor told me I had COPD, I knew I really had to do it. My mom had COPD but never quit smoking, and her last years were really hard."

It took a year, a few tries, the help of a quit-smoking group at a local hospital, and medicines before Sarah was able to quit for good. But it turns out that, for Sarah, quitting smoking isn't the toughest part about having COPD.

"Not being the person I used to be—it makes me really sad sometimes," Sarah says. "When I was in my 20s and 30s, I worked full-time and chased four kids around the house. Some days now I can't even get dressed without taking a break. And I need to take this oxygen tank with me every time I leave the house."

Feeling depressed and angry makes it hard to make it through the day, Sarah says. But going to a COPD support group every week at her local hospital helps a lot.

"I fit in there. I'm not the only one with a hose up my nose," she says. "I can talk about how mad I am that I have this disease. And it helps me to hear how other people are dealing with it."

The group helps Sarah stay on track with her pulmonary rehab program, medicines, and diet. She and a friend walk in the mall every morning. Sarah says that those walks make her feel strong. These days she's breathing a little easier too.

"Every time I have a good day, it makes me want to keep trying. There are lots of days I don't want to even get up," she says. "But then I think about taking my walk or seeing my friends, and I want to get out there. COPD may slow me down, but it isn't going to stop me."

This story is based on information gathered from many people facing this health issue.

Surgical Treatment

How is surgery used to treat COPD?

Lung surgery is rarely used to treat COPD. Surgery is never the first treatment choice and is only considered for people who have severe COPD that has not improved with other treatment.

Surgery choices include:

Lung volume reduction surgery.

This removes part of one or both lungs. It makes room for the rest of the lung to work better. It is used only for some types of severe emphysema.

Lung transplant.

This surgery replaces a sick lung with a healthy lung from a person who has just died.

Bullectomy.

This removes the part of the lung that has been damaged by the formation of large, air-filled sacs called bullae. This surgery is rarely done.

Other procedures:

Bronchoscopic interventions.

These non-surgical techniques collapse (or close off) diseased parts of the lungs to help the remaining parts work better.

Treatment

What is mechanical ventilation?

Mechanical ventilation means that a machine is used to help you breathe. This treatment can help people with serious breathing problems. It may be used in people who have asthma, cystic fibrosis, or chronic obstructive pulmonary disease (COPD).

Most of the time it's used only until you can breathe better on your own. But sometimes it's used for a longer time at home or in a care center. This is called chronic or long-term mechanical ventilation.

What is pulmonary rehabilitation (rehab) for COPD?

Pulmonary rehab combines different treatments to help you reduce your symptoms and stay as active and healthy as possible. You'll work with a care team that includes doctors, nurses, dietitians, and therapists. You'll learn techniques to help you breathe better. Your team will help you be active, eat well, and quit smoking if needed. You can learn easier ways to do daily tasks such as dressing, grocery shopping, and walking.

Exercise training may include activities such as walking or using a stationary bike. It may also include muscle-strengthening exercises for your arms and legs. Your care team will help you create an exercise program that's a good fit for you.

Problems with muscle weakness and weight loss happen often in severe COPD. So eating well is important. It helps you keep up your strength and health. And it helps you stay at a healthy weight.

What is pulmonary rehabilitation (rehab) for COPD?

Pulmonary rehab combines different treatments to help you reduce your symptoms and stay as active and healthy as possible. You'll work with a care team that includes doctors, nurses, dietitians, and therapists. You'll learn techniques to help you breathe better. Your team will help you be active, eat well, and quit smoking if needed.

What are the types of mechanical ventilation?

There are two types of mechanical ventilation: noninvasive and invasive.

Noninvasive

A mask that is the right size for you is placed on your face. It may cover just your nose. Or it may cover your nose and mouth. A machine then helps you breathe. This helps decrease the work of breathing and gives you more oxygen.

This treatment may be used if it's hard for you to breathe but you can still breathe on your own.

Invasive

A breathing tube is placed in your mouth. The tube goes into your windpipe. A machine then helps you breathe. In severe cases, the machine may breathe for you while your lung function improves. You'll get medicines to help keep you as comfortable as possible. The breathing tube is removed when you feel better and can breathe on your own.

You may get this type of ventilation if:

  • You have severe trouble breathing or you can’t breathe on your own.
  • You are confused or can’t think clearly.
  • You have other health problems that make it more likely that noninvasive ventilation won’t work.
  • You had noninvasive ventilation, but it didn't help your breathing.

What do the results of a lung function test for COPD mean?

Your FEV1 and FVC numbers are lower than normal when you have COPD, and they get lower as the disease gets worse. These numbers are usually stated in the form of a percentage.

Picture a glass of water. If the glass is full to the brim, it is 100% full. If it is only half full, it is 50% full. And 33% means it is only one-third full, and so on. Likewise, if your FEV1 is 50%, your lungs are able to handle only half as much air as they should. If your FEV1 is 33%, your lungs are able to handle even less—only a third as much. The lower your FEV1 percentage, the less air your lungs are able to handle.

Here are the FEV1 numbers for the various grades of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The symptoms you have may vary from the symptoms listed below.

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COPD: Grade, FEV1, and symptoms

Grade

FEV1 and symptoms

Mild COPD (grade 1)

80% or higher. People at this stage may not have shortness of breath and may not know that their lungs aren't as healthy as they should be.

Moderate COPD (grade 2)

50% to 79%. People at this stage may think that their symptoms are just part of getting older.

Severe COPD (grade 3)

30% to 49%. At this level, the lungs are not working well at all.

Very severe COPD (grade 4)

Less than 30%. People at this stage get out of breath with just a little activity. When symptoms get worse, they can be life-threatening.

If you don't understand your lung function numbers, ask your doctor to explain them for you. To help make the best treatment plan for you, your doctor will look at your FEV1, your symptoms, your chance of having COPD flare-ups, and any other health problems you may have.

What is lung volume reduction surgery for COPD?

In lung volume reduction surgery (LVRS), a large area of damaged lung is removed to allow the remaining lung tissue to expand when you breathe in. This surgery is done only for people with severe chronic obstructive pulmonary disease (COPD) or with certain types of emphysema.

The National Emphysema Treatment Trial has examined the results of LVRS. The results of this study report that people not considered good candidates for this surgery include people who have:

  • Severely impaired lung function as measured by breathing tests or a uniform pattern of emphysema throughout the lungs.
  • Largely non-upper lung emphysema and who are able to exercise for a longer time than other people with COPD.
  • Certain other serious medical problems.

For other people LVRS, compared to medical treatment, may provide an increased ability to exercise and may result in fewer symptoms. LVRS also can reduce the number of COPD exacerbations for some people. But it does not improve the survival rate compared to medical treatment, except for people who have emphysema mainly in the upper portion of the lungs and who are not able to exercise well even after pulmonary rehabilitation.

Although selecting candidates for LVRS is subjective, criteria identifying good candidates for LVRS include people:

  • Who have severe emphysema that does not respond to medical therapy.
  • Who are younger than 75 to 80 years old.
  • Who have not smoked for at least 4 months.
  • Who have reasonable expectations of surgery results.
  • Who have areas of the lung that can be targeted.
  • Who have severe difficulty breathing, as determined by breathing tests.

Decision to have the surgery

The decision to have this surgery is not an easy one. Not all patients who have emphysema or COPD will benefit from this surgery. Detailed testing is needed to find out if a person is likely to be helped by LVRS. Talk with your doctor about all of the treatment options available for COPD.

Treatment Options

How is COPD treated?

COPD may be treated with medicines and oxygen, along with self-care.

Medicines

Medicines used to treat COPD include:

Bronchodilators.
There are different types of medicines used to open or relax your airways. They can help you breathe easier.
  • Short-acting bronchodilators ease your symptoms. They are considered a good first choice for treating stable COPD in a person whose symptoms come and go.
  • Long-acting bronchodilators help prevent breathing problems. They help people whose symptoms do not go away.
Phosphodiesterase-4 (PDE4) inhibitors.
These are taken every day to help prevent COPD flare-ups.
Corticosteroids.
These reduce airway inflammation. They help prevent and treat COPD flare-ups.
Other medicines.
These include methylxanthines, antibiotics, and others.

Oxygen therapy

Oxygen therapy boosts the amount of oxygen in your blood and helps you breathe easier. It can help people with very bad COPD and low oxygen levels live longer.

Self-care

There are things you can do for yourself to help manage your COPD. These include:

  • Not smoking.
  • Eating well.
  • Staying active.
  • Learning breathing methods to help you become less short of breath.
  • Avoiding colds, infections, and other things that may trigger your symptoms.
  • Staying current on vaccines.

A pulmonary rehab program can help you learn to manage your disease. A team of health professionals can provide counseling and teach you how to breathe easier, exercise, and eat well.

What Causes It

What causes COPD?

COPD is almost always caused by smoking. In some cases, COPD may be caused by a rare gene change that affects the body's ability to protect the lungs from damage.

What It Is

What is chronic obstructive pulmonary disease (COPD)?

COPD is a lung disease that makes it hard to breathe. COPD stands for chronic obstructive pulmonary disease. It is caused by damage to the lungs over many years, usually from smoking.

Other things that may put you at risk for COPD include breathing chemical fumes, dust, or air pollution over a long period of time. Secondhand smoke is also bad.

Chronic bronchitis and emphysema are two lung problems that are types of COPD. In chronic bronchitis, the airways that carry air to the lungs (bronchial tubes) get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard for you to breathe. It can also make you cough. In emphysema, the air sacs in your lungs are damaged and lose their stretch. Less air gets in and out of your lungs, which makes you feel short of breath.

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