Chronic Obstructive Pulmonary Disease (COPD)

Overview

What is chronic obstructive pulmonary disease (COPD)?

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

COPD is often a mix of two diseases:

• Chronic bronchitis (say “bron-KY-tus”). 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 to breathe.
• Emphysema (say “em-fuh-ZEE-muh”). In a healthy person, the tiny air sacs in the lungs are like balloons. As you breathe in and out, they get bigger and smaller to move air through your lungs. But with emphysema, these air sacs are damaged and lose their stretch. Less air gets in and out of the lungs, which makes you feel short of breath.

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

What causes COPD?

COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibers in the lungs.

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

It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.

You may be more likely to get COPD if you had a lot of serious lung infections when you were a child. People who get COPD in their 30s or 40s may have a disorder that runs in families, called alpha1-antitrypsin deficiency. But this is rare.

What are the symptoms?

The main symptoms are:

• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.

As COPD gets worse, you may be short of breath even when you do simple things like get dressed or fix a meal. It gets harder to eat or exercise, and breathing takes much more energy. People often lose weight and get weaker.

At times, your symptoms may suddenly flare up and get much worse. This is called a COPD exacerbation (say “egg-ZASS-er-BAY-shun”). An exacerbation can range from mild to life-threatening. The longer you have COPD, the more severe these flare-ups will be.

How is COPD diagnosed?

To find out if you have COPD, a doctor will:

• 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 a simple breathing test called spirometry to find out how well your lungs work.
• Do chest X-rays and other tests to help rule out other problems that could be causing your symptoms.

If there is a chance you could have COPD, it is very important to find out as soon as you can. This gives you time to take steps to slow the damage to your lungs.

How is it treated?

The only way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.

It’s hard to quit smoking. Talk to your doctor about treatments that can help. Using medicines and support increases the chance that you will quit for good. To learn more about how to quit, go to http://www.smokefree.gov, or call 1-800-QUITNOW (1-800-784-8669).

Your doctor can prescribe treatments that may help you manage your symptoms and feel better.

• Medicines can help you breathe easier. Most of them are inhaled so they go straight to your lungs. If you get an inhaler, it is very important to use it just the way your doctor showed you.
• A lung (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.
• In time, you may need to use oxygen some or most of the time.

People who have COPD are more likely to get lung infections, so you will need to get a flu shot every year. You should also get the pneumonia vaccine. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably will not be as sick.

There are many things you can do at home to stay as healthy as you can.

• Avoid things that can irritate your lungs, such as smoke, pollution, and cold, dry air.
• Use an air conditioner or air filter in your home.
• Take rest breaks during the day.
• Get regular exercise to stay as strong as you can.
• Eat well so you can keep your strength up. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

What else should you think about?

As COPD gets worse, you may have flare-ups when your symptoms suddenly get much worse. It is important to know what to do if this happens. Your doctor can prescribe medicines to help. But if the attack is severe, you may need to go to the emergency room or call 911 .

Knowing you have a disease that gets worse over time can be hard. It’s common to feel sad or hopeless sometimes. If these feelings last, be sure to tell your doctor. Counseling and support groups can help you cope.

Be sure to talk to your doctor about what kinds of treatment you want if your breathing problems become life-threatening. You may want to write a living will. You can also choose a health care agent to make decisions in case you are not able to. It can be comforting to know that you will get the type of care you want.

Health Tools

Health tools help you make wise health decisions or take action to improve your health.

	Actionsets are designed to help people take an active role in managing a health condition.
	Avoiding triggers for COPD
	Avoiding weight loss when you have chronic obstructive pulmonary disease
	Breath training for COPD (chronic obstructive pulmonary disease)
	Clearing your lungs when you have COPD
	Eating well when you have chronic obstructive pulmonary disease
	Exercises for chronic obstructive pulmonary disease (COPD)
	Using a dry powder inhaler
	Using a metered-dose inhaler (MDI)
	Using oxygen at home

Frequently Asked Questions

Cause

Chronic obstructive pulmonary disease (COPD) is most often caused by smoking. Nearly everyone with COPD (80% to 90%) has been a long-term smoker, and research supports the fact that smoking cigarettes increases the risk of developing COPD.¹ At least 10% to 15% of long-term smokers develop COPD with symptoms; some studies indicate up to 50% of long-term smokers older than age 45 develop COPD.² This may be in part due to inherited factors (genes) and exposure factors that can affect your risk of developing COPD.¹

See a graph on how smoking affects the ability to breathe.

COPD is often a mix of two diseases, chronic bronchitis and emphysema. Both of these diseases are caused by smoking. Although you can have either chronic bronchitis or emphysema, people more often have a mixture of both diseases.

Chronic bronchitis

Almost all people with chronic bronchitis are, or have been, tobacco smokers. Over time, tobacco smoke and other lung irritants can lead to inflammation in the airways of the lungs (bronchial tubes). As a result, the airways produce more mucus than they normally would. Inflammation and excess mucus cause coughing and narrow the airways. It is difficult to breathe through the narrow airways, making you feel short of breath.

Long-term (chronic) mucus production and inflammation over many years may lead to worsening and permanent lung damage and may make it more likely you will get lung infections.

Emphysema

In emphysema, tobacco smoke and other irritants can damage the elastic fibers in the lungs. These stretchy strands of tissue are needed for normal lung function. They allow the lung tissue to stretch when you breathe in and help pull the lungs back to their normal size and shape as you breathe out. When the elastic fibers are damaged:

• The tiny air sacs (alveoli) at the end of the bronchial tubes are damaged. These air sacs are where the blood exchanges carbon dioxide (a by-product of metabolism) for oxygen. When air sacs are damaged or destroyed, their walls break down and the sacs become larger. These large air sacs move less oxygen into the blood. After air sacs are destroyed, they cannot be replaced.
• The smaller airways in the lungs (bronchioles) tend to collapse when you breathe out, trapping air in the alveoli. As a result, oxygen-rich air has difficulty entering the air sacs and the bloodstream.

See an illustration of bronchitis and emphysema.

Other causes

Other possible causes of COPD include:

• Long-term exposure to lung irritants such as industrial dust and chemical fumes.
• Low birth weight and having repeated lung infections.
• Inherited factors (genes), including alpha1-antitrypsin deficiency, a rare condition in which your body may not be able to make a protein (alpha1-antitrypsin) that helps protect the lungs from damage. People with this disorder who smoke generally develop the symptoms of emphysema in their 30s or 40s. Those who have this disorder but do not smoke generally develop symptoms in their 80s.

COPD exacerbations

A COPD exacerbation is a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath). A COPD exacerbation can be mild to life-threatening, and you may have to go to the hospital. They are most commonly caused by infections and air pollution. Infections may be caused by viruses or bacteria. Infections may affect the airways in the lungs (bronchitis) or the lungs themselves (pneumonia).

Symptoms

People who have chronic obstructive pulmonary disease (COPD) usually have some symptoms of both chronic bronchitis and emphysema. Your symptoms will change depending on the severity of your COPD.

Key symptoms include:

• Long-term (chronic) cough.
• Chronic mucus (sputum) production when you cough.
• Repeated episodes of acute bronchitis.
• Shortness of breath that is persistent and gets worse, occurs during exercise, and gets worse during respiratory infections, such as colds.

You may have a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath), especially if your COPD is mainly chronic bronchitis. This is called a COPD exacerbation. A COPD exacerbation can be life-threatening, and you may have to go to the hospital.

A number of medical organizations have classified COPD according to symptoms and lung function. Lung function is based on spirometry tests that measure how much air you can breathe out compared to a person without COPD (the predicted value). The specific tests used evaluate how much air you can breathe out in one second (forced expiratory volume, or FEV1) and the amount of air you can breathe out after taking a deep breath (forced vital capacity, or FVC).

The guidelines are all similar. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses the following classifications:

At risk for COPD

You are at risk for COPD if you have risk factors, such as smoking, and you have long-term (chronic) cough and mucus production. People at risk for COPD have normal lung function, as measured by FEV1.

Mild COPD (stage 1)

Symptoms of mild COPD include a usually, but not always, chronic cough that often brings up mucus from the lungs.

People with mild COPD have impaired lung function, as measured by a FEV1 of 80% or more of predicted value. You may have no shortness of breath and may not know you have impaired lung function until a lung test is done.

Moderate COPD (stage 2)

In moderate COPD, you have some of the symptoms of stage 1, plus you may have:

• A chronic cough that is getting worse and that brings up a large amount of mucus from the lungs.
• Shortness of breath and fatigue with exercise and strenuous daily activities.
• An occasional COPD exacerbation, which is a rapid, sometimes sudden, worsening in your usual shortness of breath or in other symptoms.

People with moderate COPD have a FEV1 of 50% to 79% of predicted value. Early symptoms of COPD often are overlooked or considered part of getting older.

Severe COPD (stage 3)

In severe COPD, you have some of the symptoms of stages 1 and 2, plus you may have:

• Shortness of breath with even simple daily activities, such as getting dressed and eating.
• Weight loss.
• Repeated and sometimes severe COPD exacerbations that have an impact on your life.

People with severe COPD have greatly reduced lung function (a FEV1 of 30% to 49% of predicted value).

Very severe COPD (stage 4)

In very severe COPD, you have some of the symptoms of stages 1 through 3, plus you may have:

• Blue skin color (cyanosis), especially in the lips, fingers, and toes.
• Fluid buildup in the legs and feet (edema).
• Bloated abdomen.
• Confusion (because of too little oxygen and too much carbon dioxide in the blood).
• Life-threatening COPD exacerbations.

People with very severe COPD have a FEV1 of less than 30% of predicted value or 30% to 49% of predicted value plus chronic respiratory failure (carbon dioxide remains in the lungs).

Conditions with similar symptoms include heart failure and coronary artery disease.

Asthma is another lung condition that may have symptoms similar to COPD, and some people with COPD may have asthma. The two conditions differ in a number of ways, including the age at which the conditions develop and what triggers a reaction.

What Increases Your Risk

Risk factors for chronic obstructive pulmonary disease (COPD) include those you can control, such as smoking, and others that you cannot control, such as inherited factors (genes).

Risk factors you can control

Tobacco smoking is the most important risk factor for COPD. In comparison, other risk factors are minor.

• At least 10% to 15% of all cigarette smokers develop COPD with symptoms; some studies indicate up to 50% of long-term smokers older than age 45 develop COPD.^{3, 2} Inherited factors (genes) and exposure factors probably determine which smokers develop COPD.
• Pipe and cigar smokers have less risk of developing COPD than cigarette smokers but still have greater risk than nonsmokers.
• The risk of developing COPD increases with both the amount of tobacco you smoke per day and the number of years you have smoked.

It is not yet known whether secondhand smoke can lead to COPD. However, people who are exposed to secondhand smoke for a long time are more likely to have breathing problems and respiratory diseases.

See a graph on how smoking affects the ability to breathe.

Risk factors you can partially control include:

• Outside air pollution. Air pollution may make COPD worse if you already have it and may increase the risk of a COPD exacerbation—a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath). Try not to be outside when air pollution levels are high.
• Indoor air pollution. Have adequate ventilation in your home to avoid indoor air pollution.
• Occupational hazards. If your work exposes you to chemical fumes or dust, use safety equipment to reduce the amount of these irritants you breathe. Coal miners may be at risk for black lung disease.
• Frequent, severe respiratory infections. Repeated lung infections, especially in childhood, may make you more likely to develop COPD later in life.

Risk factors you cannot control include:

• Family history of COPD. Some people may be more at risk than others for developing the disease, especially if they have low levels of the protein alpha1-antitrypsin (alpha1-antitrypsin deficiency).
• Low birth weight. People born at a low birth weight are more likely than those of normal birth weight to have smaller lungs and therefore to have reduced lung function.
• Asthma. People with asthma or with airways that narrow in response to environmental triggers, such as pollen, are more likely to develop COPD.

When to Call a Doctor

Call your health professional immediately if you have been diagnosed with chronic obstructive pulmonary disease (COPD) and you:

• Have shortness of breath or wheezing that is rapidly getting worse.
• Are coughing more deeply or more frequently, especially if you notice an increase in mucus (sputum) or a change in the color of the mucus you cough up.
• Cough up blood.
• Have increased swelling in your legs or abdomen.
• Have a high fever [over 100° (37.78°)].
• Feel severe chest pain.
• Develop flu-like symptoms.
• Notice that your medication is not working as well as it had been.
• Your symptoms are gradually getting worse and you have not seen a health professional recently.

If you have a rapid, sometimes sudden, and prolonged worsening of symptoms (cough, amount of mucus, and/or shortness of breath), you may be having a COPD exacerbation. Quick treatment for a COPD exacerbation may prevent serious breathing problems that might require hospitalization.

Call your health professional for an appointment if you have not been diagnosed with COPD but are experiencing relevant symptoms. A history of smoking (even in the past) greatly increases the likelihood that symptoms are due to COPD.

If you have been diagnosed with COPD, talk with your health professional at your next regular appointment about:

• Getting a yearly influenza (flu) shot.
• Getting a pneumococcal vaccine. Usually, people need only one dose of this vaccine. But doctors sometimes recommend a second dose for some people, especially if they have a long-term disease.
• Participating in an exercise program or pulmonary rehabilitation.
• Updating your medications or treatment routine.
• Getting help to stop smoking. To review tips on how to stop smoking, see the topic Quitting Tobacco Use.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. If you have the symptoms of COPD but have not been diagnosed, see your health professional.

If you have been diagnosed with COPD, you and your health professional will determine how often to have checkups. An older adult who has a history of lung or heart disease should call his or her health professional if shortness of breath becomes worse or if it occurs with fever, discolored mucus, or chest pain.

If you have COPD and a cold, you can treat the cold at home with cough suppressants, aspirin or acetaminophen (Tylenol), lots of fluids, and rest. But you should call your health professional if a fever lasts longer than 2 to 3 days, breathlessness occurs or becomes noticeably worse, or a cough gets worse or lasts for longer than 7 to 10 days.

Who to See

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

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

You may need to see a specialist in lung disease (pulmonologist) if:

• Your diagnosis of COPD is uncertain or difficult to make because you have diseases with similar symptoms.
• You have unusual symptoms or signs that are not usually seen in people with COPD.
• You appear to have COPD but do not have a history of smoking cigarettes.
• You are younger than 50 and/or have no history or a short history of cigarette smoking.
• You have to go to the hospital repeatedly because of a sudden increase in shortness of breath (COPD exacerbation).
• You require long-term oxygen or corticosteroid therapy.
• You and your health professional are considering surgical treatment, such as lung transplantation or lung volume reduction surgery.

Exams and Tests

Chronic obstructive pulmonary disease (COPD) can usually be diagnosed using a medical history and lung function tests, such as spirometry. Your doctor will also conduct a physical examination and take a chest X-ray to rule out other conditions with similar symptoms, such as asthma. Some tests are done to rule out other diseases or conditions that may make COPD worse and its treatment more difficult.

Early detection of COPD is very important. The sooner you quit smoking and avoid other environmental factors that contribute to COPD, the better your chance of slowing damage to your airways and lungs.

Routine tests

• A history and physical exam provide important information needed to diagnose COPD and monitor its treatment.
• Lung function tests measure the amount of air in your lungs and the speed at which air moves in and out of the lungs and airways. They provide the essential information needed to diagnose, grade, treat, and monitor COPD. Spirometry is the most important of these tests.
• A chest X-ray helps ensure that there are no heart or lung problems (such as cancer) causing your symptoms.
• A complete blood count (CBC) can reveal information about how well oxygen is getting into the blood and about any possible infection.

Tests done as needed

• Arterial blood gases test measures the amount of oxygen, carbon dioxide, and acid in the blood. It is used in making the decision about using oxygen therapy.
• Oximetry measures the oxygen saturation in the blood. It can be useful in determining whether oxygen therapy is needed but provides less information than an arterial blood gases test.
• Electrocardiogram (ECG, EKG) or echocardiogram may diagnose certain heart problems that can cause shortness of breath.
• A sputum exam looks at coughed-up mucus (sputum) and is often used to determine whether you have a lung infection and can help to diagnose other diseases, such as asthma.
• Transfer factor for carbon monoxide (sometimes called a DLCO determination, or a lung-diffusing capacity for carbon monoxide) is a test to help determine whether your lungs have been damaged, and if so, the extent of the damage; the test is also used to assess the severity of your COPD.
• A bronchodilator response test helps to determine whether you need medications that open or relax the airways of the lungs and relieve shortness of breath (bronchodilators).

Tests rarely done

• A test to measure levels of alpha1-antitrypsin (AAT). AAT is a protein that helps protect the lungs from the damage caused by inflammation that can lead to emphysema and COPD.
• A computed tomography (CT) scan provides a detailed image of the lungs. It may be used to get a detailed look at lung damage caused by emphysema. It also may be used to diagnose other problems in the lungs, such as blood clots or possible tumors.

Regular checkups

Because COPD is a progressive disease, it is important to schedule regular checkups with your health professional. Spirometry may be done at the checkup, and the results of this test may indicate you need an arterial blood gas test. If your checkup suggests complications, then X-rays or ECGs may be done. Your health professional also will ask about medications and whether you experience sudden or prolonged changes in your symptoms (COPD exacerbations) and possibly make changes in the medications you are using.

Early Detection

Screening is often recommended for adults who are at increased risk of developing COPD. These people include:

• Smokers and ex-smokers.
• People with long-term (chronic) asthma.
• People with a strong family history of emphysema.
• People with significant on-the-job exposure to lung irritants, such as chemicals.

Screening is often done using spirometry, which can detect obstructive airway disease in its early stages.

Screening of the general population is not recommended for detecting levels of alpha1-antitrypsin.⁴

Treatment Overview

Although chronic obstructive pulmonary disease (COPD) cannot be cured, it can be managed. Treatment for COPD focuses on:

• Slowing the progression of the disease by avoiding tobacco smoke and other environmental factors, such as air pollution.
• Reducing and controlling symptoms, such as shortness of breath.
• Increasing your activity level.
• Improving your overall health.
• Preventing and treating a COPD exacerbation—a rapid and sudden increase in your cough, amount of mucus, and/or shortness of breath—and other complications.

Following your treatment plan may reduce symptoms enough to allow you to participate in hobbies, daily activities, and family events.

Because people are diagnosed at different stages of COPD, your initial treatment will depend on the severity of your COPD and your associated symptoms.

Initial treatment

Initial treatment for chronic obstructive pulmonary disease (COPD) helps you breathe better and slow the disease. It includes:

• Quitting smoking. This is the most important step you can take to prevent or slow damage to your lungs—it is never too late to stop smoking. No matter how long you have had COPD or how serious it is, quitting smoking will help slow the progression of the disease and improve your quality of life. Nicotine replacement therapy, use of the medication bupropion (Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting.⁵ For more information, see the topic Quitting Tobacco Use.
• Doing all you can to make breathing easier.
  • Avoid conditions that may irritate your lungs, such as indoor and outdoor air pollution, smog, cold dry air, hot humid air, or high altitudes.

    Avoiding triggers for COPD

  • Take rest breaks. Schedule rest breaks when doing household chores and other activities. An occupational or physical therapist can help you find ways to do everyday activities with less effort.
  • Learn breath training techniques to improve airflow in and out of your lungs.

    Breath training for COPD

  • Learn ways to clear your lungs that can help you save energy and oxygen.

    Clearing your lungs when you have COPD

• Staying as active as possible and getting regular exercise. Exercise improves shortness of breath and will help you be more active. If you stay active, you may develop fewer complications, have a better attitude about your life and the disease, and be less likely to feel depressed or isolated from friends and family. For more information on exercising with COPD, see:

  Exercises for chronic obstructive pulmonary disease.

• Assessing the need for oxygen treatment, which is mainly used to prevent or slow the worsening of right-sided heart failure and to prevent premature death. For more information, see:

  Using oxygen at home.

• Avoiding respiratory illnesses, such as the flu (influenza) and pneumonia. Avoiding these illnesses can help prevent COPD getting worse. Talk with your health professional about getting a yearly flu shot and the pneumococcal vaccine (which can help protect against complications of pneumonia). Usually, people need only one dose of the pneumococcal vaccine. But doctors sometimes recommend a second dose for some people, especially if they have a long-term disease. Talk with your doctor about whether you need a second dose.
• Eating regularly and well. Problems with muscle weakness and weight loss are frequent with COPD. For more information, see:

  Eating well when you have COPD.

  Avoiding weight loss when you have COPD.

Medications can help relieve shortness of breath and prevent a rapid, sometimes sudden, and prolonged worsening cough, amount of mucus, and/or shortness of breath (COPD exacerbation). Medications include:

• Bronchodilators. Bronchodilators open the airways of the lung (bronchial tubes) so you can breathe more easily. Bronchodilators are either short-acting to relieve symptoms or long-acting to help prevent breathing problems. The two main types of bronchodilators are:
  • Anticholinergics (such as ipratropium and tiotropium).
  • Beta2-agonists (such as albuterol and metaproterenol).
• Anti-inflammatory medications such as corticosteroids may be taken orally, such as prednisone, or inhaled, such as beclomethasone dipropionate or fluticasone propionate. Inhaled medications are used with an inhaler, which delivers more medication directly to the lungs. If you use a metered-dose inhaler (MDI), be certain you know how to use it properly. For more information, see:

  Using a metered-dose inhaler.

  Using a dry powder inhaler.

• Mucolytics, such as acetylcysteine (Mucomyst or Mucosil-10) or iodinated glycerol (Organidin, Iophen), which thin the mucus in the bronchial tubes and lungs, possibly making it easier to cough up mucus. They are no longer commonly used.
• Expectorants, such as guaifenesin (Fenesin, Humibid L.A.), which also may make it easier to cough up mucus. They are no longer commonly used.

Treating more than the disease and its symptoms is vital to success. Treatment should also include:

• Education. Educating yourself and your family about COPD and your treatment plan helps you and your family cope with your lung disease.
• Counseling and support groups. Shortness of breath may reduce your activity level and make you feel socially isolated because you cannot enjoy activities with your family and friends. You should be able to lead a full life and be sexually active. Counseling and support groups can help you and your family learn to live with COPD.
• Building a support network of family and friends. Learning that you have a disease that may shorten your life may trigger depression or grief. Anxiety can make respiratory symptoms worse and can trigger or prolong exacerbations. Support from family and friends can reduce anxiety and stress and make it easier to live with COPD.

Ongoing treatment

As chronic obstructive pulmonary disease (COPD) progresses, it is important to recognize and treat complications, especially a COPD exacerbation. COPD exacerbations are a sudden and prolonged increase in symptoms—shortness of breath, cough, and mucus (sputum) production. A COPD exacerbation can be life-threatening, and you may need to go to your health professional’s office or to a hospital. Treatment includes:

• Anticholinergics (ipratropium, tiotropium), oral corticosteroids (prednisone, budesonide), and beta2-agonists (albuterol, metaproterenol), which make it easier to breathe.
• Mechanical ventilation, which is a machine that helps you breathe. Ventilation is used only if medication is not helping you.
• Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of some people who have severe COPD. For more information, see:

  Using oxygen at home.

• Antibiotics, which are used when a bacterial lung infection is considered likely. People with COPD have an increased risk of pneumonia and frequent respiratory infections. Although most infections are caused by a virus, some are caused by bacteria. Most studies support the use of antibiotics. But some experts believe that since most exacerbations are caused by viruses, antibiotics should not be used unless there is a confirmed bacterial infection.

Other complications you may have include depression, which is treated through counseling and medication, and problems with muscle weakness and weight loss, which can be treated by improving your diet. For more information, see:

Eating well when you have COPD.

Avoiding weight loss when you have COPD.

Your health professional may also suggest a pulmonary rehabilitation program, which is a supervised program that includes activities such as exercise and breath training.

Breath training for COPD

Treatment if the condition gets worse

As chronic obstructive pulmonary disease (COPD) gets worse, you may experience increased shortness of breath and more COPD exacerbations, and it will become more and more difficult to perform daily activities. A pulmonary rehabilitation program, which includes activities such as exercise and breath training, can help make it possible for you to perform daily activities.

Other treatment includes:

• Using medications such as methylxanthines or oral corticosteroids.
• Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of people who have severe COPD and low oxygen levels. For more information, see:

  Using oxygen at home.

• Lung volume reduction surgery, which removes a portion of one or both lungs, making room for the remaining lung tissue to work more efficiently. This procedure is not appropriate for most people.
• A lung transplant, which is surgery to replace a diseased lung with a living lung from a person who has recently died. Lung transplants are not common.
• A bullectomy, which removes bullae from the lungs in those who mainly have emphysema. Bullae are formed when the tiny air sacs in the lungs break into larger air spaces. They sometimes can become so large that they interfere with breathing. However, they are rarely treated surgically.

Heart failure that affects the right side of the heart (cor pulmonale) frequently occurs in people with COPD. Depending on its severity, oxygen and diuretic medication may be needed.

Treatment for COPD is increasingly successful at prolonging life. However, COPD is a progressive and possibly fatal disease. You and your health professional should discuss what types of medical treatment you want to receive if sudden, life-threatening breathing problems develop, such as whether you want to receive mechanical ventilation. This discussion may include the possibility of your creating an advance directive to state your wishes if you become unable to communicate them. For more information, see the topics Writing an Advance Directive and Care at the End of Life.

What to Think About

Sticking with your treatment plan will make you feel better and make you less likely to become depressed. A self-reward system, such as a night out to eat after sticking to your medication and exercise schedule for a week, can help keep you motivated.

Prevention

The best way to prevent the development and worsening of chronic obstructive pulmonary disease (COPD) is to not smoke. Other airway irritants (such as air pollution, chemical fumes, and dust) also can make COPD worse, but they are far less important than smoking in causing the disease. Stopping smoking is especially important if you have low levels of the protein alpha1-antitrypsin. People who have a low level of this protein may reduce their risk of developing severe COPD if they receive timely injections of man-made alpha1-antitrypsin in the blood.

Local cancer and lung societies have information and programs on how to quit smoking. Your health professional also may be able to recommend a program to help you quit smoking. For more information on how to quit, see the topic Quitting Tobacco Use.

Vaccinations

A yearly flu shot (influenza vaccine) is recommended for all people with COPD. It is important to prevent the flu because people with lung problems often develop complications of the flu, such as pneumonia. A review of studies has found that the inactivated flu shot may reduce the risk of a sudden increase in shortness of breath (COPD exacerbation).⁶

Pneumococcal vaccine helps protect against severe infections caused by many types of pneumococcal bacteria, a common cause of pneumonia in people with COPD. Usually, people need only one dose of the pneumococcal vaccine. But doctors sometimes recommend a second dose for some people, especially if they have a long-term disease. Talk with your doctor about whether you need a second dose.

Ongoing Concerns

Chronic obstructive pulmonary disease (COPD) gradually gets worse over time. Your symptoms depend on when COPD was diagnosed, how far along it is, and your lifestyle.

• If you are diagnosed early, before a lot of lung damage has taken place, you may have very mild symptoms, even when you are active.
• If you are diagnosed later, you may have already lost much of your lung function.
  • If you have an inactive lifestyle, you may not notice that shortness of breath is interfering with your daily activities until you have lost a greater percent of your lung function.
  • If you have an active lifestyle, you may notice shortness of breath during more strenuous activities.
  • You may have difficulty breathing while performing simple household tasks.
• If you have had COPD for many years, you may be short of breath even when resting. If this is the case, even simple activities cause severe shortness of breath.

If you continue smoking after being diagnosed with COPD, the disease will progress faster, resulting in more severe symptoms and a greater risk of developing complications.

• You may become short of breath when doing light activities.
• You may feel short of breath, even while resting.
• Your lung function will decrease faster than that of a nonsmoker of the same age.

See a graph on how smoking affects the ability to breathe.

The lung damage that causes symptoms of COPD does not heal and cannot be repaired. But if you have mild to moderate COPD and stop smoking, you can slow the rate at which breathing becomes more difficult. You will never be able to breathe as well as you would have if you had never smoked, but you may be able to postpone or avoid more serious problems with breathing.

Complications

Complications of COPD may include:

• A sudden and prolonged worsening of coughing, shortness of breath, and/or mucus production (COPD exacerbation).
• More frequent lung infections, such as pneumonia.
• An increased risk of thinning of the bones (osteoporosis), especially if you use oral corticosteroids.
• Depression. COPD may limit your ability to work and reduce your independence, sexual activity, social activities, and self-esteem. This often results in depression.
• Problems with weight. If chronic bronchitis is the main component of your COPD, you may need to lose weight. If emphysema is your main component, you may need to gain weight and muscle mass.
• Heart failure affecting the right side of the heart (cor pulmonale).
• A collapsed lung (pneumothorax). COPD can damage the lung's structure and allow air to leak into the chest cavity.
• Sleep problems because you are not getting enough oxygen into your lungs.

Treatment for COPD is increasingly successful at prolonging life. However, COPD is a progressive and potentially fatal disease. You and your health professional should discuss what types of medical treatment you want to receive if sudden, life-threatening breathing problems develop, such as whether you want to receive mechanical ventilation. This discussion may include the possibility of your creating an advance directive to state your wishes if you become unable to communicate them. For more information, see the topics Writing an Advance Directive and Care at the End of Life.

Living With COPD

Chronic obstructive pulmonary disease (COPD) can be managed, although it cannot be cured at this time. Management includes quitting smoking if you smoke, taking steps to avoid shortness of breath, and staying active and eating well. Also, learning about COPD and support from your family and friends will help you cope with COPD.

Quitting smoking is the most important step you can take to prevent or slow damage to your lungs—it is never too late to stop smoking. No matter how long you have had COPD or how serious it is, quitting smoking will help slow the disease and improve your quality of life. Nicotine replacement therapy, use of the medication bupropion (Zyban or Wellbutrin), and supportive therapy significantly increase long-term success in quitting.⁵ For more information, see the topic Quitting Tobacco Use.

Avoid shortness of breath

Do all you can to make breathing easier. This includes:

Avoiding conditions that may irritate your lungs, such as indoor and outdoor air pollution, smog, cold dry air, hot humid air, or high altitudes.

Avoiding triggers for COPD

Taking rest breaks. Schedule short rest breaks when doing household chores and other activities. An occupational or physical therapist can help you find ways to do everyday activities with less effort.

Staying as active as possible and getting regular exercise. Try to do activities and exercises that build muscle strength and help your cardiovascular system. For more information, see:

Exercises for chronic obstructive pulmonary disease.

Learning breath training techniques to improve airflow in and out of your lungs.

Breath training for COPD

Learning ways to clear your lungs that can help you save energy and oxygen.

Clearing your lungs when you have COPD

Discussing pulmonary rehabilitation with your health professional.

Taking the medications prescribed by your health professional. If you use a metered-dose inhaler (MDI), be certain you know how to use it properly. For more information, see:

Using a metered-dose inhaler correctly.

Eat well

Good nutrition is important to maintain your strength and health. Problems with muscle weakness and weight loss are common in people with COPD. People with COPD who are very underweight, especially those with emphysema, are at higher risk of death than are people with COPD who have a normal weight.⁷ For more information, see:

Eating well when you have COPD.

Avoiding weight loss when you have COPD.

Seek education and support

Treating more than the disease and its symptoms is vital to success. You also need:

• Education. Educating yourself and your family about COPD and your treatment program helps you and your family cope with your lung disease.
• Counseling and support. Shortness of breath may reduce your activity level and make you feel socially isolated because you cannot enjoy activities with your family and friends. You should be able to lead a full life and be sexually active. Counseling and support groups can help you learn to live with COPD.
• A support network of family, friends, and health professionals. Learning that you have a disease that may shorten your life may trigger depression or grieving. Anxiety can make respiratory symptoms worse and can trigger or prolong exacerbations. Support from family and friends can reduce anxiety and stress and make it easier to live with COPD.
• To stick with your treatment plan. Following a treatment plan will make you feel better and less likely to become depressed. A self-reward system, such as a night out to eat after sticking to your medication and exercise schedule for a week, can help keep you motivated.

Palliative care

If your disease gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term disease, make future plans around your medical care, or help your family better understand your disease and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

Treatment for COPD is increasingly successful at prolonging life. However, COPD is a progressive and potentially fatal disease. Many important end-of-life decisions can be made while you are active and able to communicate your wishes. For more information, see the topics Care at the End of Life and Writing an Advance Directive.

Medications

Medication for chronic obstructive pulmonary disease (COPD) is used to reduce shortness of breath, control any coughing and wheezing, and to prevent and reduce a rapid, sometimes sudden, and prolonged worsening of cough, amount of mucus, and/or shortness of breath (COPD exacerbation). Most people with COPD find that medications make breathing easier.

Bronchodilators and inhaled corticosteroids are often used with a metered-dose inhaler (MDI), a dry powder inhaler (DPI), or through a mouthpiece or mask (nebulizer). Most health professionals recommend that everyone using an MDI also use a spacer, which efficiently delivers medication to the lungs and makes it easier to control the dose. Use of a spacer is especially important when using an inhaler containing a corticosteroid medication. Do not use a spacer with a dry powder inhaler (DPI).

Many people use an MDI incorrectly and do not get the full benefit from the medication. For more information, see:

Using a metered-dose inhaler correctly.

For information on how to use a dry powder inhaler, see:

Using a dry powder inhaler.

Medication Choices

Bronchodilators are used to open or relax the airways of the lung (bronchial tubes) and relieve shortness of breath. Bronchodilators are either short-acting to relieve symptoms or long-acting to help prevent breathing problems.

• Short-acting bronchodilators are considered a first-line therapy for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). Short-acting bronchodilators include:
  • Anticholinergics (such as ipratropium).
  • Beta2-agonists (such as albuterol and metaproterenol).
• Long-acting bronchodilators are effective and convenient for treating COPD in a person whose symptoms do not go away (persistent symptoms). Long-acting bronchodilators include:
  • Anticholinergics (such as tiotropium).
  • Beta2-agonists (such as salmeterol and fluticasone).

Oral corticosteroids (prednisone) may be used for a COPD exacerbation (in pill form) or to prevent COPD exacerbations (in inhaled form). They are often used if you also have asthma.

Other medications, which are not commonly used, include:

• Mucolytics, such as acetylcysteine (Mucomyst or Mucosil-10) or iodinated glycerol (Organidin, Iophen), which thin the mucus in the bronchial tubes and lungs, possibly making it easier to cough up mucus. They are no longer commonly used.
• Expectorants, such as guaifenesin (Fenesin, Humibid L.A.), which also may make it easier to cough up mucus. They are no longer commonly used.
• Methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects.

Other medications used for COPD include leukotrienes, cromolyn, and nedocromil. However, they are not very effective and are rarely used.

What to Think About

The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This does not always mean the medication will not help. It is usually best to try the medicine for a period of time before you decide whether it is working.

Combining beta2-agonists with anticholinergics or corticosteroids provides better results than using these medications alone.^{8, 9} It may also reduce the risk of side effects compared to increasing the dose of one medication.¹⁰

Metered dose inhalers (MDIs) and nebulizers deliver medication equally well. You can carry an MDI more easily than a nebulizer. Nebulizers usually need to be plugged in.

It is important to keep track of your inhaler doses and discard the inhaler when you have used the number of doses indicated on the package labeling. This not only prevents you from having an empty inhaler when you need medication but also prevents you from inhaling only propellant after the medication has run out.

Surgery

Lung surgery is rarely used to treat chronic obstructive pulmonary disease (COPD). Surgery is never the first treatment option and is only considered for people who have severe COPD that has not improved with other treatment.

Surgery Choices

• Lung volume reduction surgery removes a portion of one or both lungs, making room for the remaining lung tissue to work more efficiently. It is used only in selected people with severe emphysema.¹⁰
• A lung transplant is surgery to replace a diseased lung with a living lung from a person who has recently died.
• A bullectomy removes the part of the lung that has been damaged by the formation of large, air-filled sacs called bullae. This procedure is rarely done.

Other Treatment

Other treatment for chronic obstructive pulmonary disease (COPD) includes:

• Pulmonary rehabilitation, which employs a team of health professionals that monitors and treats the medical, physical, and emotional aspects of COPD. It generally combines exercise, breathing therapy, emotional support, nutritional guidance, and education. Pulmonary rehabilitation is required for those undergoing lung volume reduction surgery or a lung transplant.
• Oxygen treatment, which increases the amount of oxygen in the blood and lungs, may improve shortness of breath, and prolongs survival of people who have severe COPD and low oxygen levels. For more information, see:

  Using oxygen at home.

• Ventilation devices, which are used to aid breathing. They are used most often in the hospital during a sudden and severe increase in shortness of breath (COPD exacerbation).
• Alpha1-antitrypsin injections (such as Aralast, Prolastin, or Zemaira), which may be helpful for people who have alpha1-antitrypsin deficiency.

Other Places To Get Help

Online Resource

Organizations

Related Information

• Acute Bronchitis
• Asthma in Teens and Adults
• Care at the End of Life
• Choosing a Health Care Agent
• Grief and Grieving
• Hospice Care
• Pneumonia
• Quitting Tobacco Use
• Writing an Advance Directive