Overview

What is chronic obstructive pulmonary disease (COPD)?

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 for you 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 to 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 emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 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 breathing tests, including 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. You will double your chances of quitting even if medicine is the only treatment you use to quit, but your odds get even better when you combine medicine and other quit strategies, such as counseling.¹ To learn more about how to quit, go to 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 shows 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 vaccine every year. You should also get a pneumococcal shot. 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 air that is cold and dry.
• 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 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.

What else should you think about?

Flare-ups: As COPD gets worse, you may have flare-ups when your symptoms quickly get worse and stay 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.

Depression and anxiety: Knowing that you have a disease that gets worse over time can be hard. It’s common to feel sad or hopeless sometimes. Having trouble breathing can also make you feel very anxious. If these feelings last, be sure to tell your doctor. Counseling, medicine, and support groups can help you cope.

End-of-life issues: 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.

Frequently Asked Questions

Learning about chronic obstructive pulmonary disease (COPD):	What is COPD? What causes COPD? Can I prevent it? What are the symptoms? What happens in COPD? What increases my risk? What is a COPD exacerbation? How common is COPD?
Being diagnosed:	Who can diagnose COPD? How is it diagnosed?
Getting treatment:	How is COPD treated? What medicines will I need to take? Will I need surgery? What is oxygen treatment? What is pulmonary rehabilitation?
Ongoing concerns:	What complications can develop? What is a pseudomonas infection? What should I do if my symptoms suddenly get worse?
Living with COPD:	What can I do at home to relieve symptoms? When should I call my doctor? How can I avoid triggers? What exercises can I do? How do I use breath training to breathe easier? How can I clear my lungs? How do I eat right? How can I avoid weight loss? How do I use a metered-dose inhaler? How do I use a dry powder inhaler? How do I use an incentive spirometer? How do I use oxygen at home?
End-of-life issues:	How can I prepare for end-of-life issues?

Cause

COPD is most often caused by smoking. Most people with COPD are long-term smokers, and research shows that smoking cigarettes increases the risk of getting COPD:²

• Out of every 100 long-term smokers, about 15 to 20 get COPD with symptoms. That means that about 80 to 85 out of 100 do not get COPD with symptoms.³
• Some studies show that up to half of long-term smokers older than age 60 get COPD.⁴
• Smoking both tobacco and marijuana increases the risk of COPD more than smoking either one.⁵

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 hard to breathe through the narrow airways, so you feel short of breath.

Long-term (chronic) mucus production and inflammation over many years may lead to permanent lung damage and may make it more likely that 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 trouble entering the air sacs. And carbon dioxide has a harder time getting out of the lungs.

See pictures 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.
• Preterm birth that leads to lung damage (neonatal chronic lung disease).
• Inherited factors (genes), including alpha-1 antitrypsin deficiency, a rare condition in which your body may not be able to make enough of a protein (alpha-1 antitrypsin) that helps protect the lungs from damage. People who have this disorder and who smoke generally start to have symptoms of emphysema in their 30s or 40s. Those who have this disorder but do not smoke generally start to have symptoms in their 80s.

Symptoms

When you have COPD:

• You have a cough that won't go away.
• You often cough up mucus.
• You are often short of breath, especially when you exercise.

COPD exacerbation

Many people with COPD have attacks called flare-ups or exacerbations (say “egg-ZASS-er-BAY-shuns”). This is when your usual symptoms quickly get worse and stay worse. A COPD flare-up can be dangerous, and you may have to go to the hospital.

Symptoms include:

• Coughing up more mucus than usual.
• A change in the color or thickness of that mucus.
• More shortness of breath than usual.

These attacks are most often caused by infections—such as acute bronchitis and pneumonia—and air pollution.

Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Try not to panic if you start to have one. Quick treatment at home may help you manage serious breathing problems.

The stages of COPD

The stages of COPD are often defined according to your symptoms plus a measure of how well your lungs work, called your “lung function.”

In the following symptoms lists, lung function FEV1 is a test result that shows how fast you can breathe air out of your lungs. FEV1 stands for forced expiratory volume in 1 second.

FEV1 can be measured by machines called spirometers (say “spy-RAW-muh-terz”). The test result is reported as a percentage of normal. In other words, an FEV1 of 100% means the lungs are working normally; 80% is less than normal; 30% is very much less than normal.

Here is how the stages of COPD are described by the Global Initiative for Chronic Obstructive Lung Disease, also known as GOLD:³

• Mild COPD (stage 1)
  • Usually, but not always, a chronic cough that often brings up mucus from the lungs
  • Lung function FEV1 of 80% of normal or higher
• Moderate COPD (stage 2)
  • Chronic cough with a lot of mucus
  • Shortness of breath, especially with exercise
  • An occasional COPD flare-up
  • Lung function FEV1 of 50% to 79%
• Severe COPD (stage 3)
  • Chronic cough with a lot of mucus
  • Shortness of breath
  • Fatigue and a reduced ability to exercise
  • Repeated and sometimes severe COPD flare-ups
  • Lung function FEV1 of 30% to 49%
• Very severe COPD (stage 4)
  • Chronic cough with a lot of mucus
  • Severe shortness of breath
  • Weight loss
  • Blue skin color, especially in the lips, fingers, and toes (called cyanosis)
  • Fluid buildup in the legs and feet (called edema)
  • Life-threatening COPD flare-ups
  • Lung function FEV1 of less than 30%, or of less than 50% along with chronic respiratory failure (a condition caused by carbon dioxide that stays in the lungs)

Conditions with similar symptoms

Conditions with symptoms similar to COPD include:

• Heart failure .
• Coronary artery disease .
• Asthma . Some people with COPD may have asthma too. But the two conditions differ in a number of ways, including how old you are when you get the disease and what triggers an attack.
• Cystic fibrosis .
• Pulmonary fibrosis .
• Bronchiectasis .

What Increases Your Risk

Things that increase your risk for COPD include those you can control, such as smoking, and others that you cannot control, such as a family history of COPD.

Risks you can control

Tobacco smoking is the most important risk factor for COPD. Compared to smoking, other risks are minor.

• About 15 to 20 out of 100 cigarette smokers get COPD with symptoms.³ Some studies show that up to half of long-term smokers older than age 60 get COPD.⁴
• Pipe and cigar smokers have less risk of getting COPD than cigarette smokers. But they still have more risk than nonsmokers.
• Smoking both tobacco and marijuana increases the risk of COPD more than smoking either one.⁵
• The risk for COPD increases with both the amount of tobacco you smoke each day and the number of years you have smoked.

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

For more information, see the topic Quitting Smoking.

Risks you can partly control

• Outside air pollution. Air pollution may make COPD worse. It may increase the risk of a flare-up, or COPD exacerbation, when your symptoms quickly get worse and stay worse. Try not to be outside when air pollution levels are high.
• Indoor air pollution. Have good ventilation in your home to avoid indoor air pollution.
• Secondhand smoke. It is not yet known whether secondhand smoke can lead to COPD. But a large study showed that children who were exposed to secondhand smoke were more likely to get emphysema than children who were not exposed.⁶ And people who are exposed to secondhand smoke for a long time are more likely to have breathing problems and respiratory diseases.
• Occupational hazards. If your work exposes you to chemical fumes or dust, use safety equipment to reduce the amount of fumes and dust you breathe.

Risks you can't control

• Family history of COPD. Some people may be more at risk than others for getting the disease, especially if they have low levels of the protein alpha-1 antitrypsin (alpha-1 antitrypsin deficiency), a disorder that runs in families.
• Preterm birth. Preterm babies usually need to have long-term oxygen therapy because their lungs are not fully developed. This therapy can cause lung damage (neonatal chronic lung disease) that can increase the risk for COPD later in life.
• Asthma . People with asthma or with airways that narrow in response to environmental triggers, such as pollen, rarely progress to COPD.

When to Call a Doctor

Call 911 or other emergency services now if:

• Breathing stops.
• Moderate to severe difficulty breathing occurs.
• Severe chest pain occurs, or chest pain is quickly getting worse.

Call your doctor immediately or go to the emergency room if you have been diagnosed with COPD and you:

• Cough up 0.5 cup (120 mL) or more of blood.
• Have shortness of breath or wheezing that is quickly getting worse.
• Start having new chest pain.
• Are coughing more deeply or more often, especially if you notice an increase in mucus (sputum) or a change in the color of the mucus you cough up.
• Have increased swelling in your legs or belly.
• Have a high fever [over 101°F (38.3°C)].
• Develop flu-like symptoms.

If your symptoms (cough, mucus, and/or shortness of breath) suddenly get worse and stay worse, you may be having a COPD flare-up, or exacerbation. Quick treatment for a flare-up may help keep you out of the hospital.

Call your doctor soon for an appointment if:

• Your medicine is not working as well as it had been.
• Your symptoms are slowly getting worse, and you have not seen a doctor recently.
• You have a cold and:
  • Your fever lasts longer than 2 to 3 days.
  • Breathlessness occurs or becomes noticeably worse.
  • Your cough gets worse or lasts longer than 7 to 10 days.
• You have not been diagnosed with COPD but are having symptoms. A history of smoking (even in the past) greatly increases the likelihood that symptoms are from COPD.
• You cough up any amount of blood.

Talk to your doctor

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

• Help to stop smoking. To review tips on how to stop smoking, see the topic Quitting Smoking.
• A yearly flu vaccine
• A pneumococcal shot. Usually, people need only one shot. But doctors recommend a second one for some people who got their first shot before they turned 65.
• An exercise program or pulmonary rehabilitation.
• Any updates of your medicines or treatment that you may need.

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, called a pulmonologist (say "pool-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 or corticosteroid therapy.
• You and your doctor are considering surgery, such as a lung transplant or lung volume reduction.

Exams and Tests

To diagnose COPD, your doctor will probably do the following tests:

• Medical history and physical exam . These will give your doctor important information about your health.
• Lung function tests . These measure the amount of air in your lungs and the speed at which air moves in and out. Spirometry is the most important of these tests.
• Chest X-ray . This helps rule out other conditions with similar symptoms, such as lung cancer.

Tests done as needed

• Arterial blood gas test . This test measures how much oxygen, carbon dioxide, and acid is in your blood. It helps your doctor decide whether you need oxygen treatment.
• Oximetry . This test measures the oxygen saturation in the blood. It can be useful in finding out whether oxygen treatment is needed, but it provides less information than the arterial blood gas test.
• 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.

Tests rarely done

• A test to measure levels of alpha-1 antitrypsin, or ATT. ATT is a protein your body makes that helps protect the lungs. People whose bodies don't make enough ATT are more likely to get emphysema.
• A CT scan. This gives doctors a detailed picture of the lungs.

Regular checkups

Because COPD is a disease that keeps getting worse, it is important to schedule regular checkups with your doctor. Checkups may include:

• Spirometry.
• Arterial blood gas test.
• X-rays or ECGs.

Tell your doctor about any changes in your symptoms and whether you have had any flare-ups. Your doctor may change your medicines based on your symptoms.

Early detection

The sooner COPD is diagnosed, the sooner you can take steps to slow down the disease and keep your quality of life for as long as possible. Screening tests help your doctor diagnose COPD early, before you have any symptoms.

Talk to your doctor about COPD screening if you:

• Are a smoker or ex-smoker.
• Have had serious asthma symptoms for a long time, which have not improved with treatment.
• Have a family history of emphysema.
• Have a job where you are exposed to a lot of chemicals or dust.

The U.S. Preventive Services Task Force (USPSTF) does not recommend COPD screening for adults who are not at high risk of developing COPD.⁷

Treatment Overview

Although COPD cannot be cured, it can be managed. The goals of treatment are to:

• Slow down the disease by avoiding tobacco smoke and air pollution.
• Limit your symptoms, such as shortness of breath.
• Increase your activity level.
• Improve your overall health.
• Prevent and treat flare-ups . A flare-up, or exacerbation, is when your symptoms quickly get worse and stay worse.

Many people are able to manage their COPD well enough to take part in their usual daily activities, hobbies, and family events.

Initial treatment

At first, treatment for COPD helps you breathe better and slow the disease. Much of the treatment includes things you do for yourself:

• Quit smoking. This is so important. And it's never too late. No matter how long you have had COPD or how serious it is, quitting smoking will help slow down the disease and improve your quality of life. Today's medicines offer lots of help for people who want to quit. You will double your chances of quitting even if medicine is the only treatment you use to quit, but your odds get even better when you combine medicine and other quit strategies, such as counseling.¹

  For more information, see the topic Quitting Smoking.

• Stay active. If you stay active, you may have less shortness of breath, have a better attitude about your life and the disease, and be less likely to feel depressed or isolated from friends and family. Exercise improves shortness of breath and will help you be more active.

  COPD: Using Exercise to Feel Better

• Stay healthy. The flu, pneumonia, and other illnesses involving your lungs can make your COPD worse. Do your best to avoid them:
  • Wash your hands often.
  • Stay away from people who have a cold or the flu.
  • Talk with your doctor about getting a yearly flu vaccine and a pneumococcal shot. If you've already had one pneumococcal shot, ask your doctor if you should have a second shot. Sometimes a second shot is advised for people who got their first shot when they were younger than 65.
• Eat regularly and well. Muscle weakness and weight loss are common with severe COPD. And they make it harder for your body to fight the disease.

  COPD: Keeping Your Diet Healthy

  COPD: Avoiding Weight Loss

• Avoid triggers. Stay away from things that can trigger a flare-up, including indoor and outdoor air pollution, cold dry air, hot humid air, and high altitudes.

  COPD: Avoiding Your Triggers

• Learn how to breathe. Learn ways to breathe that improve airflow in and out of your lungs. Learn ways to clear your lungs to save energy and oxygen.

  COPD: Learning to Breathe Easier

  COPD: Clearing Your Lungs

  Breathing Exercises: How to Use a Manual Incentive Spirometer

• Rest often. Take rest breaks during household chores and other activities. Talk to an occupational or physical therapist about finding ways to do everyday activities with less effort.

Oxygen treatment

Oxygen treatment is mainly used to prevent right-sided heart failure or keep it from getting worse.

Oxygen Therapy: Using Oxygen at Home

Medicines

• Bronchodilators . These medicines open the bronchial tubes, which are your lungs' airways. This helps you breathe better. The medicines are either short-acting to help relieve your symptoms or long-acting to help prevent them.
• Anti-inflammatory medicines such as corticosteroids. These may be pills that you take or medicine that you inhale. Inhaled medicines are used with an inhaler, which delivers more medicine directly to the lungs. If you use an inhaler, make sure that you know how to use it properly.

  Breathing Problems: Using a Metered-Dose Inhaler

  Breathing Problems: Using a Dry Powder Inhaler

• Expectorants . These medicines may make it easier to cough up mucus, but they are no longer commonly used.

Education and support

Treatment should also include:

• Education. Educating yourself and your family about COPD and your treatment plan helps you and your family cope with your disease.
• Counseling and support groups. Shortness of breath may lower your activity level. That can make you feel sad and alone because you cannot enjoy activities with your family and friends. But you should be able to lead a full life, including being sexually active. Counseling and support groups can help both you and your family.
• Building a support network of family and friends. Learning that you have a disease that may shorten your life may cause depression or grief. Anxiety can make your symptoms worse and can cause flare-ups and make them last longer. Support from family and friends can lower your anxiety and stress.

One Woman's Story: Fran, 52 "Someone told me to go online and hook up with a support group. I did, and it literally changed my life."—Fran Read more about how Fran found support.

Ongoing treatment

COPD flare-ups

COPD flare-ups, or exacerbations, are when your symptoms—shortness of breath, cough, and mucus production—quickly get worse and stay worse.

Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Do not panic if you start to have one. Quick treatment at home may help you prevent serious breathing problems.

A flare-up can be life-threatening, and you may need to go to your doctor’s office or to a hospital. Treatment for flare-ups includes:

• Medicines to help you breathe.
  • Anticholinergics (ipratropium, tiotropium)
  • Oral corticosteroids (prednisone, methylprednisolone)
  • Beta2-agonists (albuterol, metaproterenol)
• Machines to help you breathe. The use of a machine to help with breathing is called mechanical ventilation. Ventilation is used only if medicine is not helping you and your breathing is getting very difficult.
  • Noninvasive positive pressure ventilation (NPPV) forces air into your lungs through a face mask.
  • With invasive ventilation, a breathing tube is inserted into your windpipe, and a machine forces air into your lungs.
• Oxygen to help you breathe. Oxygen treatment involves getting extra oxygen through a face mask or through a small tube that fits just inside your nose. This can be done in the hospital or at home. For more information, see:

  Oxygen Therapy: Using Oxygen at Home

• Antibiotics. These medicines are used when a bacterial lung infection is considered likely. People with COPD have a higher risk of pneumonia and frequent lung infections. These infections often lead to COPD exacerbations, or flare-ups, so it's important to try to avoid them.

Other ongoing treatment

Treatment for depression . COPD can affect more than your lungs. It can cause stress, anxiety, and depression. These things take energy and can make your COPD symptoms worse. But anxiety and depression can be treated with counseling and medicine. If you feel very sad or anxious, call your doctor.

One Woman's Story: Fran, 52 "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 feel so much better about things now. I look forward to every day."—Fran Read more about how Fran dealt with depression.

Treatment for muscle weakness and weight loss . Many people with severe COPD have trouble keeping their weight up and their bodies strong. This can be treated by paying attention to eating regularly and well.

COPD: Keeping Your Diet Healthy

COPD: Avoiding Weight Loss

Pulmonary rehabilitation . Your doctor may also suggest a rehab program that is just for people with lung problems. It includes activities such as exercise and breath training.

Treatment if the condition gets worse

As COPD gets worse, you may have more shortness of breath and more flare-ups. It will become harder to do your daily activities. A pulmonary rehabilitation program, which includes activities such as exercise and breath training, can help make it possible for you to do your daily activities.

Other treatment includes:

• Medicines such as methylxanthines or oral corticosteroids.
• Oxygen treatment, which increases the amount of oxygen in the blood and lungs. This may improve shortness of breath and help people with severe COPD live longer.

  Oxygen Therapy: Using Oxygen at Home

• Surgery, which is not common. There are several types of surgery for severe COPD:
  • Lung volume reduction surgery removes part of one or both lungs, making room for the remaining lungs to work better.
  • Lung transplant replaces a diseased lung with a living lung from a person who has recently died.
  • Bullectomy 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.

Heart failure that affects the right side of the heart, called cor pulmonale, often occurs in people with COPD. Treatment may include oxygen and diuretic medicine.

What to think about

Treatment for COPD is getting better all the time. But COPD is a disease that keeps getting worse and can be fatal. You and your doctor should discuss what types of treatment you want if sudden, life-threatening breathing problems occur.

This discussion may include writing an advance directive. This is a document that your doctor and family can use if you become unable to tell them what your wishes are. For more information, see the topics:

• Writing an Advance Directive.
• Care at the End of Life.

Prevention

Preventing COPD

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. For most people who quit, loss of lung function is slowed to the same rate as a nonsmoker's.

Today's medicines offer lots of help for people who want to quit. You will double your chances of quitting even if medicine is the only treatment you use to quit. And your odds get even better when you combine medicine and other quit strategies, such as counseling.¹ For more information, see the topic Quitting Smoking.

Stopping smoking is especially important if you have low levels of the protein alpha-1 antitrypsin. People who have this may lower their risk for severe COPD if they get timely shots of alpha-1 antitrypsin that has been obtained from human plasma.

Avoid bad air: 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.

Preventing other problems

Flu vaccines: If you have COPD, you need to get a flu vaccine every year. When people with COPD get the flu, it often turns into something more serious, like pneumonia. A flu vaccine can help prevent this from happening.

Also, getting regular flu vaccines may lower your chances of having COPD flare-ups.⁸

Pneumococcal shot: People with COPD often get pneumonia. Getting a shot can help keep you from getting very ill with pneumonia. Usually, people 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.

Ongoing Concerns

COPD gradually gets worse over time.

Shortness of breath gets worse as COPD gets worse.

• If you are diagnosed early, before you have a lot of lung damage, 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 are active, you may be short of breath during more strenuous activities.
  • If you are not very active, you may not notice how much shortness of breath you have until your COPD gets worse.
• If you have had COPD for many years, you may be short of breath even when resting. Even simple activities may cause very bad shortness of breath.

It's very important to stop smoking

If you keep smoking after being diagnosed with COPD, the disease will get worse faster, your symptoms will be worse, and you will have a greater risk of having other serious health problems.

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 you 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

Other health problems from COPD may include:

• COPD flare-ups , also called exacerbations, which are sudden increases in coughing, shortness of breath, and/or the amount or color of mucus you cough up.
• More frequent lung infections, such as pneumonia.
• An increased risk of thinning bones (osteoporosis), especially if you use oral corticosteroids.
• Depression or anxiety. COPD may limit your ability to work and may reduce your independence, sexual activity, social activities, and self-esteem. This often causes depression. Having trouble breathing can make you feel very anxious.
• Problems with weight. If chronic bronchitis is the main part of your COPD, you may need to lose weight. If emphysema is your main problem, 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.

Care at the end of life

Treatment for COPD is getting better and better at helping people live longer. But COPD is a disease that keeps getting worse, and it can be fatal.

It's important to talk with your doctor about these issues:

• What is your idea of the "ideal death"? Do you want to be kept alive at all costs? Do you want a calm, peaceful death?
• If you have sudden, life-threatening breathing problems, do you want mechanical ventilation, which means being connected to a machine that breathes for you?
• What other kinds of medical treatment do you want, or not want, when you are near the end of life?
• Do you want an advance directive, which is a legal document that tells your doctor what treatment you want or don't want if you become unable to communicate?

For more information, see the topics:

• Care at the End of Life.
• Writing an Advance Directive.

Living With COPD

COPD can be managed, although it cannot be cured at this time. When you manage COPD, you:

• Quit smoking.
• Take steps to improve your ability to breathe.
• Eat well and stay active.
• Learn all you can about COPD.
• Get support from your family and friends.

Quit smoking

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.

There are clear benefits to quitting, even after years of smoking. When you stop smoking, you slow down the damage to your lungs. For most people who quit, loss of lung function is slowed to the same rate as a nonsmoker's.

Although lung damage that already has occurred does not reverse, quitting smoking can slow down how quickly your COPD symptoms get worse.

One Man's Story: Ned, 56 "I tried to quit cold turkey, but after just a few days I could tell that wasn't going to work. I realized that I needed to try something else. So I tried the patch, and that made a big difference. I can feel a difference in my breathing. And I feel hopeful that quitting will give me a few more years on my feet."—Ned Read more about how Ned quit smoking.

You may think that nothing can help you quit, but today there are several treatments shown to be very good at helping people stop smoking. They include:

• Nicotine replacement therapy.
• The medicines bupropion (Zyban or Wellbutrin) and varenicline (Chantix).
• Support groups.

You will double your chances of quitting even if medicine is the only treatment you use to quit, but your odds get even better when you combine medicine and other quit strategies, such as counseling.¹

For more information, see the topic Quitting Smoking.

Avoid shortness of breath

Do 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.

  COPD: Avoiding Your Triggers

• Take rest breaks. Schedule short rest breaks during household chores and other activities. An occupational or physical therapist can help you find ways to do everyday activities with less effort.
• Stay as active as possible, and get regular exercise. Try to do activities and exercises that build muscle strength and help your cardiovascular system.

  COPD: Using Exercise to Feel Better

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

  COPD: Learning to Breathe Easier

  Breathing Exercises: How to Use a Manual Incentive Spirometer

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

  COPD: Clearing Your Lungs

• Discuss pulmonary rehabilitation with your doctor.
• Take the medicines prescribed by your doctor. If you use a metered-dose inhaler (MDI), be sure you know how to use it properly.

  Breathing Problems: Using a Metered-Dose Inhaler

One Man's Story: Cal, 66 "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."—Cal Find out how Cal was able to build up his strength.

Eat well

Good nutrition is important to keep up your strength and health. Problems with muscle weakness and weight loss are common in people with severe COPD. People with COPD who are very underweight, especially those with emphysema, are at higher risk of early death than are people with COPD who have a normal weight.³

COPD: Keeping Your Diet Healthy

COPD: Avoiding Weight Loss

Seek education and support

Treating more than the disease and its symptoms is very important. 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 can trigger depression or grieving. Anxiety can make your symptoms worse and can trigger flare-ups or make them last longer. Support from family and friends can reduce anxiety and stress and make it easier to live with COPD.
• 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 staying on your medicine and exercise schedule for a week, can help keep you motivated.

One Woman's Story: Sarah, 67 “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.”—Sarah Read more about how Sarah deals with her emotions.

Palliative care

If your disease gets worse, you may want to think about palliative care. Palliative (say "PAL-ee-uh-tiv") 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 from treating your illness.

Palliative care may help you to:

• Focus on improving your quality of life—not just in your body but also in your mind and spirit.
• Manage symptoms or side effects from treatment.
• Cope with your feelings about living with a long-term disease.
• Make future plans around your medical care.

Palliative care may also 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

Doctors are getting better and better at helping people with COPD live longer. But it is a disease that gets worse and can be fatal. Many important end-of-life decisions can be made while you are still able to communicate your wishes. For more information, see the topics:

• Care at the End of Life.
• Writing an Advance Directive.

Medications

Medicine for COPD is used to:

• Reduce shortness of breath.
• Control coughing and wheezing.
• Prevent COPD flare-ups, also called exacerbations, or keep the flare-ups you do have from being life-threatening.

Most people with COPD find that medicines make breathing easier.

Some COPD medicines are used with devices called inhalers or nebulizers. Most doctors recommend using spacers with inhalers. It's important to learn how to use these devices correctly. Many people don't, so they don't get the full benefit from the medicine.

Breathing Problems: Using a Metered-Dose Inhaler with or without a spacer

Breathing Problems: Using a Dry Powder Inhaler

Medication choices

• Bronchodilators are used to open or relax your airways and help your shortness of breath.
  • 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 (such as ipratropium).
    • Beta2-agonists (such as albuterol and levalbuterol).
    • A combination of the two (such as a combination of albuterol and ipratropium).
  • Long-acting bronchodilators help prevent breathing problems. They help people whose symptoms do not go away (persistent symptoms). They include:
    • Anticholinergics (such as tiotropium).
    • Beta2-agonists (such as salmeterol, formoterol, and arformoterol).
• 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.
• Other medicines include:
  • Expectorants, such as guaifenesin (Mucinex), which may make it easier to cough up mucus. Doctors generally don't recommend using them.
  • Methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects, so they are not usually recommended.

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 that the medicine will not help. Try the medicine for a while before you decide whether it is working.
• Metered-dose inhalers (MDIs) and nebulizers work equally well. MDIs are easier to carry. Nebulizers usually need to be plugged in.
• Many people don't use their inhalers right, so they don't get the right amount of medicine. Ask your doctor or nurse to show you what to do. Read the instructions on the package carefully.

  Breathing Problems: Using a Metered-Dose Inhaler with or without a spacer

  Breathing Problems: Using a Dry Powder Inhaler

Surgery

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

Lung volume reduction surgery	Removes part of one or both lungs, making room for the rest of the lung to work better. It is used only for severe emphysema.3
Lung transplant	Replaces a sick lung with a healthy lung from a person who has just died.
Bullectomy	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 Treatment

Other treatment for COPD includes:

• Pulmonary rehabilitation . This treatment involves a team of health professionals who treat many problems of COPD. It generally combines exercise, breathing therapy, emotional support, advice for eating well, and education. This treatment is required for people who are having lung volume reduction surgery or a lung transplant.
• Oxygen treatment . This treatment involves breathing extra oxygen through a face mask or through a tube inserted just inside your nose. It may ease shortness of breath. And it can help people with very bad COPD and low oxygen levels live longer. For more information, see:

  Oxygen Therapy: Using Oxygen at Home

• Ventilation devices . These are machines that help you breathe better or breathe for you. They are used most often in the hospital during COPD flare-ups.
• Alpha-1 antitrypsin injections (such as Aralast, Prolastin, or Zemaira). These medicines can help people who have alpha-1 antitrypsin deficiency.