Discuss all medical advice, diagnosis, and treatment with your healthcare provider.

The Basics

What is chronic obstructive pulmonary disease?

COPD (chronic obstructive pulmonary disease) is a disease of the airways and lungs that results in people having difficulty breathing air out (expiration); other symptoms include chronic coughing, difficulty walking due to shortness of breath, and frequent chest infections. In healthy people the airways are elastic and springy so that when a person breathes in air, the airways fill up like small balloons, and when a person breathes out, the balloons deflate. However, in a person suffering from COPD, the airways lose their shape, resembling floppy balloons, and less air is able to pass in and out.

In COPD, air flow is reduced during expiration because of inflammation (swelling and mucus buildup) in the lining of the air passages, or damage to some of the air passages, or a combination. In order for people to breathe easily, the airways and lungs need to be wide open. However, in patients with COPD the airways and lungs are partially or completely blocked.

Medications such as salbutamol, a bronchodilator, can open up these airways allowing air to flow more easily. These medications are used by people with asthma, however, there is a very important difference between COPD and asthma. In asthma, medications can help a blocked airway become fully unblocked, and this is called reversible airway obstruction, whereas in COPD, these medications can only partially unblock the airways. This is called airway obstruction that is not fully reversible. Even with medical testing, it is sometimes difficult to tell if someone has COPD or asthma. Furthermore, it is possible for someone to have both COPD and asthma.

To summarize, there are four problems affecting the airways in COPD, leading to airway obstruction that is not fully reversible whereby a person with this disease experiences shortness of breath and a limited ability to exercise. These problems include:

• The elastic fibers that allow the airways to expand and contract become less elastic, like old rubber bands
• The walls of many of the air passages are destroyed
• The walls of the airways swell and thicken
• Mucus builds up in the airways.

Symptoms

• Cough
• Sputum (mucus) production or a change in color of sputum can indicate a chest infection
• Shortness of breath, especially with exercise
• Wheezing (a whistling or squeaky sound when you breathe)
• Chest tightness

When a person with COPD is given the right treatment, she or he will experience none or fewer symptoms on a day -to-day basis. However, if a "flare up" occurs, not only may his or her symptoms become more severe, but they may experience new symptoms as well. A symptom "flare up," also called an exacerbation, is commonly triggered by chest infections or environmental factors like temperature changes and air pollutants. A flare up requires medical treatment to avoid significant deterioration in the ability to breathe.

(Diagram courtesy of National Heart, Lung, and Blood Institute)

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What causes chronic obstructive pulmonary disease?

In the United States, the leading cause of COPD is cigarette smoking by either smokers or former smokers; inhaled pipe and cigar smoke can also contribute to COPD.

In the United States, at least 400,000 people die each year as a result of diseases related to cigarette smoking. In COPD, most of the damage to the airways and lungs caused by cigarette smoking is not reversible. However, stopping smoking can definitely reduce further damage and reduce many symptoms of COPD such as chronic coughing and shortness of breath.

Other factors and conditions that contribute to the development of COPD are not fully understood, but they include asthma, exposure to air pollutants at home and in the workplace, and genetic factors.

Some evidence suggests that there is a genetic role in the development of COPD. In rare cases, COPD is caused by a gene-related disorder called alpha-1-antitrypsin (an-te-TRIP-sin) deficiency. Alpha-1-antitrypsin deficiency accounts for 2% to 3% of COPD cases in the United States. Alpha-1-antitrypsin is a protein in the blood that helps counteract destructive proteins, but when levels of alpha-1-antitrypsin are low, destructive proteins in the body thrive.

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Types of chronic obstructive pulmonary disease

With asthma, airway obstruction is reversible; however, with COPD, airway obstruction is not fully reversible or is irreversible. The leading characteristic of COPD is reversible airway obstruction, thus any condition or disease that causes this problem may be referred to as COPD.

Several common conditions can cause irreversible airway obstruction and therefore be considered a form of COPD. Although sometimes in COPD sufferers, these conditions occur together, rather than as a single condition.

• Chronic bronchitis
  Chronic bronchitis is a condition characterized by a chronic wet cough persisting for 3 months a year for 2 successive years. The cough is not caused by an infection, asthma, or medication, and there is no medical explanation for its cause.


• Emphysema
  Emphysema is a disease in which there is permanent damage to airways, which become floppy and enlarged. Emphysema is common in people who have severe forms of COPD.


• Asthma
  Asthma is a chronic condition of the airways caused by inflammation (swelling and mucus build-up) that blocks or obstructs the airways. Symptoms similar to COPD include trouble breathing, particularly when breathing out, except that in asthma the airway blockage or obstruction is reversible when treated. Sometimes people who are thought to have asthma fail to reverse their airway blockage after using medications (for example, bronchodilators), and are subsequently diagnosed as having COPD. Furthermore, long-term, poorly controlled asthma can eventually worsen leading to irreversible airway obstruction.

It is important to know which of the above conditions in the individual is causing COPD, because each can cause slightly different symptoms requiring different treatment. Most importantly in diagnosing COPD is determining an irreversible airway obstruction or blockage exists and its severity.

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Chronic obstructive pulmonary disease and women: the statistics

• Men have a greater chance than women of dying from COPD, but the margin is narrowing. Between 1980 and 2000, the COPD mortality rate grew much faster for women than for men. Among women, the rate rose from 20.1 deaths per 100,000 in 1980 to 56.7 deaths per 100,000 in 2000. Among men, the rate grew from 73 deaths per 100,000 in 1980 to 82.6 deaths per 100,000 in 2000.


• More women than men were admitted to hospitals due to COPD in 2000, for which women were hospitalized 404,000 times whereas men were hospitalized 322,000 times.


• More women (59,936) than men (59,118) died from COPD in 2000.


• These high death rates among women is most likely due to women's increased rate of smoking since the 1940s, relative to men.


• The proportion of the US population between the ages of 25 and 54 with mild or moderate COPD has declined over the past 25 years, and it is hoped that the increases in deaths will abate.


• Female smokers as opposed to nonsmokers are nearly 13 times as likely to die from COPD. Male smokers as opposed to nonsmokers are nearly 12 times as likely to die from COPD.


• Females are more than twice as likely to be diagnosed with chronic bronchitis as males. In 2004, 2.8 million males compared to 6.3 million females were diagnosed with chronic bronchitis.

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How chronic obstructive pulmonary disease affects women differently

• General consensus was once that women were immune to lung diseases, but in fact, the opposite may be true. Recent studies have shown that women are actually more susceptible to COPD than men.


• Women's lungs and airways are generally smaller than men's. Therefore, when the airways narrow, the room for air to pass through them is even more restricted.


• Women have lower elastic recoil at any given lung volume, meaning the airways and air sacs are less able to regain their original form after a breath.


• Studies have also shown that women develop COPD at lower levels of smoking. In other words, a woman who smokes the same amount as a man is more likely to get COPD, and a woman who smokes less than a man is as likely as he is to get COPD.


• People who start smoking between the ages of 10 and 18 may never fully develop their lungs.

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Ask Your Healthcare Provider

Diagnosis and talking to your doctor

If you are experiencing symptoms of COPD, you should see your healthcare provider for a professional diagnosis. He or she will ask you to describe your symptoms and your risk factors, such as if you smoke cigarettes, how many a day, and for how long you have been smoking. He or she will examine your lungs and, if necessary, order some lab tests, X-rays, and a measurement of your lung function using a machine called a spirometer.

A spirometer is a special machine that measures how well you breathe air out. A spirometry reading indicating that a person cannot breathe air out normally and is not improving with medication such as a bronchodilater, is the single most important way to diagnose COPD.

When your healthcare professional administers a spirometry test you will be asked to do the following:

1. Place mouth on the spirometer mouthpiece, which is a long flexible tube attached to a recording device.
2. Take a deep inhalation.
3. Exhale as hard and fast as possible into the tube of the spirometer machine.

To summarize, the purposes of the spirometry test are

• To diagnose COPD. A person with COPD has trouble breathing air out and this will be detected by a spirometer.


• To assess the severity of a person's COPD. A person can have mild, moderate, or severe COPD depending on how difficult they find it to breath air out.


• To see how well medications like bronchodilaters can improve a person's breathing.


• To determine if a person's lung disease is worsening. Serial spirometry readings can determine a person's ability to breath air out.

Someone who has severe COPD compared to mild COPD will suffer many more symptoms, like shortness of breath and a reduced ability to exercise. Severity of a person's COPD is not only a measure of their symptoms but also a measure of the prognosis of their condition and of their quality of life.

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Treatment

There is no cure for COPD, but there are ways to prevent it, to slow down the deterioration of the lungs, and to ease the symptoms so that a person can have a better quality of life.

The goals of treatments for a patient with COPD are

• Preventing deterioration of the lungs


• Relieving symptoms


• Improving ability to exercise


• Preventing and treating exacerbations of COPD


• Preventing hospital admission


• Increasing longevity

Treatment for COPD depends on the individual's symptoms; some medications work in some people but not in others. It is recommmended that most people with COPD use a combination of the following treatments.

Main treatments for chronic obstructive pulmonary disease

1. Bronchodilators
   
   — Beta agonists short- and long-acting
   — Anticholinergics short- and long-acting
   — Theophylline
   
   

   Bronchodilaters relax the muscles around the airways to allow air to flow in and out of the lungs more easily.

2. Anti-inflammatories
   
   — Inhaled corticosteroids or "inhaled steroids"
   — Inhaled corticosteroids or "inhaled steroids"
   
   

   Anti-inflammatories reduce the swelling and mucus in the airways causing them to open up and become wider again. Inhaled steroids can take 4 to 6 weeks to have an effect, while oral steroids act more rapidly.

3. Treatments for exacerbations (antibiotics)
   
   

   Exacerbations are often caused by a chest infection, which is suspected if there is a change in sputum color and/or volume. Antibiotics are required to clear up bacterial infections.

4. Oxygen therapy (at home or in a hospital)
   
   

   People with severe cases of COPD get inadequate oxygen in their blood stream to sustain life, and consequently require supplemental oxygen at home and/or in a hospital.

The following sections will discuss prevention and treatment of COPD in more detail.

Prevention

One of the most important goals in the management of COPD is to prevent deterioration of the lungs—in other words, to maintain the best level of lung health possible. Preventative treatment in COPD also involves preventing exacerbations or "flare-ups."

The most important way to prevent deteriorations of the lungs in COPD is by quitting smoking and avoiding exposure to second-hand smoke. Avoiding smoking will also reduce the chances of developing COPD in the first place. Your healthcare provider can suggest to you ways to quit smoking, including nicotine replacement and other medications.

Annual influenza vaccination as well as vaccination against pneumococcal infection (a type of pneumonia) for COPD patients, independent of their age, will prevent these lung infections and reduce the risk of COPD exacerbations. For pneumoccocal protection, after the initial vaccination, a further booster is required after 5 years.

Many who suffer from COPD are undernourished and generally less able to defend themselves against infection or cope with their underlying disease. Consulting a dietitian who can recommend food supplements and sample meal plans is helpful for many patients.

Common Treatments

Treatments available for COPD include medications that reduce symptoms as well as those that can reduce the risk of exacerbations.

Symptom relievers

Short-acting bronchodilaters are commonly prescribed for symptom relief and act quickly, usually within 15 minutes. Three types of short-acting bronchodilaters are beta agonists, anti-cholinergics, and theophyllins. Beta agonists and anticholinergics are most commonly prescribed.

These bronchodilaters are available in a puffer or in a liquid that is used in a nebulizer machine. Bronchodilators help because they relax the muscles around the airways and causing them to open up so air can pass in and out more easily. It is important to ensure that a puffer is used correctly to make sure the medication is inhaled adequately into the lungs.

Examples of short-acting bronchodilaters:

1. Beta agonists:
   Albuterol (Proventil® and Ventolin®)
   Pirbuterol (Maxair®)
   Metaproterenol (Alupent®)


2. Anti-cholinergics:
   Ipratropium (Atrovent®)


3. Theophyllins:
   Theophylline (eg, Theo-dur®, Slo-bid®, Uniphyl®, or Uni-Dur®)

Most people with COPD whether mild or severe, will need to take at least one of the above bronchodilaters for symptom relief in order to improve shortness of breath, wheeze, and exercise tolerance.

Long-acting symptom relievers and medications for reducing the risk of exacerbations

Therapies that reduce exacerbations as well as reducing symptoms include long-acting beta agonists, which take longer to start working than short-acting beta agonists but the therapeutic effect lasts for up to 12 hours. These medications include long-acting anticholingerics or inhaled/oral corticosteriods.

People with moderate or severe cases of COPD are more likely to be prescribed these medications to reduce exacerbations. Initially, a healthcare provider will prescribe these treatments as a trial to see if they are effective. If they are effective, it will be recommended to continue them long-term together with your symptom reliever medication.

When you have COPD, you will need to see your healthcare provider for regular checkups. She or he will discuss with you any problems with your medicines such as difficulty using the puffer and/or side effects. Your healthcare professional will also perform spirometry intermittently to monitor how your lung function is responding to the medications. Depending on your symptoms and lung function, your healthcare provider may adjust your medications (for example, by reducing the dose or replacing one medication with another).

Examples of long-acting beta agonists:
Salmeterol (Serevent®)
Formoterol (Foradi®, Performist®)
Arformoterol (Brovana®)

Example of long-acting anticholinergic:
Tiotropium (Spiriva®)

Examples of inhaled corticosteroids:
Beclomethasone (Vanceril®, Beclovent®)
Triamcinolone (Azmacort®)
Flunisolide (Aerobid®)
Fluticasone (Flovent®)
Budesonide (Pulmicort®)

There are puffers available that combine an inhaled corticosteroid with an inhaled long-acting beta agonist, which makes it much easier to remember to take both medications (for example, Advair®, a combination medication of Flovent® and Serevent® and Symbicolt®, a combination medication of Pulmicort® and Foradil®).

Other Treatments

In severe cases of COPD, oxygen therapy may be required to assist a person with breathing. Oxygen therapy can be used at home and is also available as a mobile form for use away from home.

Surgery, such as lung volume reduction surgery or even lung transplant surgery, is sometimes indicated for severe cases of COPD or in cases when other treatments are not effective. Lung reduction surgery involves removing diseased parts of the lungs. Surgery is not suitable for everyone with COPD; you should talk to your healthcare provider to learn more about whether it is an option for you.

Pulmonary rehabilitation programs are special tailored to the needs of the person with COPD to improve his or her ability to exercise and to help control day-to-day symptoms. Your healthcare provider will arrange an assessment to determine what kind of rehabilitation program is needed. Common activities associated with pulmonary rehabilitation include special exercises, education, and counseling, and advice about nutrition and prevention.

Purified alpha-1-antitrypsin (prepared from donated blood) is available for people who have alpha-1-antitrypsin deficiency as a cause of their COPD. This treatment is helpful in reducing the deterioration in the lungs. The treatment is not necessarily suitable for everyone with alpha-1-antitrypsin deficiency, so if you have questions about this you should talk to your healthcare provider.

Treatment of exacerbations of chronic obstructive pulmonary disease

When a person with COPD experiences a "flare up" or exacerbation, their symptoms worsen and they require extra and/or additional medication to control their condition. Extra medication may include an increased dosage of their bronchodilator and additional medication such as a course of antibiotics if a chest infection is present and/or a course of oral corticosteroids, for example, Deltasone® (prednisone) or Medrol® (methylprednisolone). Sometimes if treatment at home isn't effective, the sufferer may need to go to a hospital for an exacerbation, where he or she may be given intravenous antibiotics along with supplemental oxygen therapy.

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Frequently asked questions

What is the difference between chronic obstructive pulmonary disease and asthma?
COPD and asthma are both chronic diseases that affect the airways. COPD is usually caused by long-term smoking, however, asthma is usually triggered by an allergic response in the airways to various substances. COPD usually starts later in life, whereas asthma can start early or late in life. The main difference between COPD and asthma involves the obstruction to airflow in the airways. In both diseases, the obstruction is related to airway inflammation and mucus. However, in asthma the obstruction is reversible with medications whereas in COPD, the obstruction is only partially reversible at best. A spirometry reading can help distinguish whether your symptoms are caused by COPD or asthma.

My inhaler is not relieving my breathlessness. Is there anything else I can do?
Your healthcare professional should be able to adjust your treatment to determine a better combination of medicines that will work for you. If the change has been sudden, you should seek emergency medical care because your condition may be worsening.

Should I expect any side effects from my treatment?
Bronchodilators and inhaled corticosteroids can have side effects. If you experience any side effects from your medication, you should report this to your doctor. Some inhaled corticosteroids may cause mild hoarseness. For this reason, it is important to gargle with water after using an inhaled corticosteroid. Anticholinergic therapies can cause dry mouth, and some beta-2 agonists (a type of bronchodilator) can cause a fine tremor.

I have been told I have to use my bronchodilator every day whether I feel chest tightness or not. Is it right to continue with treatment when I'm not having any symptoms?
You should always take your medicines as instructed by your healthcare professional. If you have been told to take your bronchodilator every day, it is because you need ongoing treatment. Your bronchodilator will prevent your airways from tightening, and if you stop taking it, you could be putting yourself at risk of worsening symptoms, for example, worsening shortness of breath.

How will I know if I am having an exacerbation of chronic obstructive pulmonary disease?
When your COPD is under control, you should not be experiencing unexpected symptoms. From day to day, you should feel more or less the same. When you are having an exacerbation, the symptoms will worsen, and this may occur rapidly. You may experience worsening of

• Breathlessness
• Wheezing
• Chest tightness
• Confusion
• Coughing, and mucus when you cough
• A change in the color or volume of your mucus
• Fever
• Excessive sleepiness. This is a sign of a potentially fatal carbon dioxide intoxication, which occurs if you are not able to exhale adequately.
• Blue lips or fingernails

Be aware that these exacerbations can be life-threatening, and you will need to seek immediate medical care.

If you have been diagnosed with COPD and you find yourself experiencing confusion or excessive sleepiness, you need to seek emergency care immediately. These are signs that the levels of carbon dioxide in the blood are dangerously high. If left unattended, this could be fatal. Have an emergency contact—a friend, relative, or neighbor—who can be with you immediately and can stay with you until you receive the medical attention you need.

In the days prior to an exacerbation, you will probably feel unusually fatigued and unable to exercise normally. Be cognizant of this.

Will I have to change my diet, or are there any special foods that can help?
Because your body is particularly vulnerable when you are sick, you should do everything you can to maintain good health. This includes eating sensible, healthful foods. You may find that you have difficulty breathing after a heavy meal so it may be better for you to eat smaller portions more often throughout the day. If you are losing weight, try vitamin-fortified, high-protein drinks. You may need to consult a dietitian to get advice on nutritional supplements and to devise a meal plan that is right for you.

How often should I see my healthcare professional?
You should see your healthcare professional at least every 6 months. You should also see him or her immediately if you feel a worsening of any of your symptoms or if you find your medicine is not working effectively. How often you see your healthcare professional depends on your symptoms, your medications, and your confidence in taking care of yourself.

Are there any over-the-counter medicines that I should avoid?
Avoid taking cough medicines on a regular basis because the coughing process protects the lungs, and these medicines often contain codeine. Also avoid taking any painkillers that contain codeine, which can reduce your ability to breathe deeply and properly.

If I get breathless when I'm exercising, is it okay to continue?
Pushing yourself occasionally during exercise is just as important in COPD patients as it is in anyone else. Although it may seem challenging, the long-term benefits of exercise will help your COPD and you will find you experience less shortness of breath from exercise.

When exercising, you should feel challenged but not totally out of breath. As long as you are not experiencing breathing difficulties, it is okay to continue. The best guide on exercise is to stop if your pulse increases to more than 20 beats per minute higher than it is at rest.

To take your pulse, place your first and second fingers on the inside of your wrist:

• Count the number of beats in 15 seconds
• Multiply that number by 4
• This is your heart rate in beats per minute

Ask your healthcare professional about entering a pulmonary rehabilitation program. In this program you will be given advice on exercise for improving your COPD fitness.

How do I cough the right way?
Inhale deeply, and hold your breath for 2 seconds. While keeping your mouth slightly open, cough twice. The first cough will loosen the mucus, the second will move it up the throat.

I've been told I should check my mucus when I cough. How do I do this?
You should spit the mucus into a piece of tissue. Healthy mucus should be transparent, perhaps with a slightly creamy tinge. If it is yellow, green, or red, this could be a sign of infection, and you should see your healthcare provider.

How will my chronic obstructive pulmonary disease change over time?
COPD is a progressive disease, which means the condition of the lungs worsens over time. This results in an increase in symptoms over time. Sometimes symptoms worsen quite suddenly. This is what is called an exacerbation. There are a lot of things you can do to reduce the risks of an exacerbation; these include avoiding pollution, making sure the air quality in your house is good, and avoiding things that might irritate your lungs such as chemicals or tobacco smoke. Some of the treatments that are prescribed by your healthcare professional may also reduce your chances of having an exacerbation, as well as reducing your symptoms on a day-to-day basis.

In COPD, the lungs tend to deteriorate over time, especially if you smoke and do not quit. When lung disease is severe, people often are limited in their everyday functioning and can become housebound and reliant on oxygen therapy. Heart failure is also a complication of long-term COPD.

What forms of exercise are okay?
Walking, dancing, and stretching exercises are all good forms of exercise. Just make sure that the places where you will be exercising have good air quality. Avoid smoky bars for dancing and polluted areas for running or walking. Ask your healthcare professional for more information on exercising with COPD.

Do I need to have any tests before I start an exercise program?
You should consult your healthcare professional before beginning a new exercise regimen. He or she will conduct tests to see what kind of exercise is best for you. One type of test involves using a specially adapted exercise bicycle that is equipped to take measurements of how much oxygen is used and how much carbon dioxide is emitted, as well as taking other measurements such as heart rate.

I've been told I'm at high risk of a genetic form of chronic obstructive pulmonary disease. What does this mean?
Most cases of COPD result from the damage caused by smoking or environmental pollution. However, there is a rare genetic disorder called alpha-1 antitrypsin deficiency. Alpha-1 antitrypsin is a small protein found in the body that stops enzymes such as trypsin from doing damage to the body. If you are short of alpha-1 antitrypsin, the trypsin in your body will do damage to your lungs over time, and this damage can result in COPD.

Is there anything I can do to reduce my chances of getting chronic obstructive pulmonary disease?
If you are a smoker, the best thing you can do is stop smoking. If you are not a smoker or have already given up, try to avoid smoky places where you may be exposed to tobacco smoke, which can damage your lungs.

Do children get chronic obstructive pulmonary disease?
Rarely. COPD in children is only associated with alpha-1 antitrypsin deficiency (see above).

Empower Yourself

Dealing with chronic obstructive pulmonary disease

There is no known cure for COPD, but there are ways that you can improve your illness and slow the deterioration of the lungs. By taking an active approach to manage your illness, you can continue to live a normal life with limited symptoms.

• Reading this information resource shows that you are taking the first step in managing your illness. Read everything you can about lung disease and stay up-to-date on new medical breakthroughs.
• Work closely with your healthcare provider so that you can do everything possible to reduce symptoms.
• Join a support group. Chronic illnesses can lead to other problems like depression and anxiety. By talking about your illness with other COPD patients, as well as with professionals, you will be able to cope better.
• Create and maintain an exercise regimen that challenges you without exhausting you and discuss your regimen with your healthcare provider to make sure your goals are reasonable. It is important to stay active. Do not use COPD as a reason to avoid physical activity. Keeping your body healthy will help keep your lungs healthy.

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Glossary of chronic obstructive pulmonary disease Terms

Acapella: see mucus clearing device

Acute: occurring suddenly

Advance directives: legal documents including the Living Will and Durable Power of Attorney for Health Care. A Living Will states what type of treatment you wish to receive in the event that you become physically or mentally unable to communicate your wishes. A Durable Power of Attorney for Health Care authorizes another person to make medical decisions for you when you yourself are unable to do so. See also Living Will and Durable Power of Attorney for Health Care.

Airway obstruction: blockage or space limitation of airflow in the passages of the lungs

Allergen: a substance (such as a food or pollen) that your body perceives as dangerous and can cause an allergic reaction

Allergy: abnormal reaction to a stimulus called an allergen. An allergy can cause an abnormal response in the airways to inhaled stimuli such as pollen or to certain foods that may cause unusual airway reactions and lead to bronchospasm. A bronchospasm is a narrowing of the airways that causes difficulty breathing.

Alpha1-antitrypsin (AAT):) (also called alpha antiproteinase or AAP); a protective material produced in the liver and transported to the lungs to help combat inflammation; deficiency states occur as the result of hereditary defects

Alveoli: thin-walled, small sacs located at the ends of the smallest airways in the lungs where the exchange of oxygen and carbon dioxide takes place

Antibiotic: medication used to treat infection caused by bacteria. Antibiotics do not protect against viruses and do not prevent the common cold.

Anticholinergics: (also called cholinergic blockers or "maintenance" bronchodilators); this type of medicine helps open (dilate) the bronchial tubes (airways) so that more air can move easily into and out of the lungs; anticholinergics also help clear mucus from the airways—as the airways open, the mucus can be coughed out more easily; anticholinergics work differently and more slowly than fast-acting bronchodilators

Antihistamine: medication that prevents symptoms of congestion, watery eyes, sneezing, itchy and runny nose by blocking histamine receptors

Anti-inflammatory: medication, such as prednisone, aspirin or steroids, that reduces inflammation and swelling

Apnea: absence of breathing for more than 10 seconds. See also sleep apnea

Arterial blood gas test: a blood test that measures oxygen and carbon dioxide in the blood

Asthma: chronic airway disease characterized by reversible airway obstruction

Atelectasis: partial or complete collapse of the lung, usually due to a blockage of the air passages with fluid, mucus or infection; symptoms include dry cough, chest pain, and mild shortness of breath

Asthma, chronic: a disease of the air passages that carry air in and out of the lungs; asthma causes the airways to narrow, the lining of the airways to swell, and the cells that line the airways to produce more mucus; these changes make breathing difficult and cause a feeling of not getting enough air; common symptoms include shortness of breath, wheezing, and excess mucus production; in asthma, the air flow limitation is usually reversible by taking medication such as bronchoinhalers that can loosen the muscles around the airways

Bacteria: infectious organisms (germs) that may cause conditions such as bronchitis or pneumonia

BIPAP (bi-level positive airway pressure) machine: a breathing machine that uses two pressure levels (inspiratory and expiratory) to provide breathing assistance; this machine is often used for patients with sleep apnea or respiratory failure

Black pigment: the material that gives damaged human lungs a black and sooty appearance

Breath sounds: sounds heard through a stethoscope; the intensity of the sound of air moving in and out of the lungs may indicate the amount of obstruction

Breathing rate: the number of breaths per minute

Bronchial tubes: branches of the airways (air passages) in the lungs

Bronchioles: the smallest branches of the airways in the lungs. They connect to the alveoli (air sacs)

Bronchitis, chronic: irritation and inflammation of the lining of the bronchial tubes; the irritation causes coughing and excess amounts of mucus in the airways which can lead to difficulty breathing; bronchitis is considered chronic when the person has a productive cough (coughs up mucus) and shortness of breath that lasts at least 3 months each year for at least 2 years in a row

Bronchodilator: medication used in asthma or COPD to relax the muscles around the airways that tighten; bronchodilators also can help clear mucus from the lungs

Bronchodilators, fast-acting: (also called "rescue" or "quick relief" medications); these medications quickly relax and widen the muscles around the airways, eases breathing, and reduces shortness of breath

Bronchodilators, long-acting: also called ("maintenance" medications); these medications prevent airway spasms throughout the day and night; they take effect more slowly than fast-acting bronchodilators, but work for a longer period of time

Bronchospasm: the sudden tightening of muscle bands surrounding the airways, causing the airways to become narrower; bronchospasm may result in wheezing, shortness of breath, and chest pains

Bronchus: an airway that transports air in and out of the lungs

Capillary: the smallest diameter of blood vessel, responsible for connecting the arteries and veins of the circulatory system

Carcinogen: cancer-causing substance

Chronic: continuing over a long period of time; long-term

Cilia: hair-like structures that line the airways in the lungs and help to clear the airways

CPAP (continuous positive airway pressure) machine: a breathing machine that provides pressure to keep the upper airways open during breathing; this machine is often used for patients with obstructive sleep apnea

Clinical trials: research programs conducted with patients to evaluate a new medical treatment, drug, or device; the purpose of clinical trials is to find new and improved methods of treating different diseases and special conditions

Closed mouth technique: a method for inhaling medicine from a metered dose inhaler; the open mouth technique is the preferred method (see open mouth technique)

Contraindication: any condition that indicates that a particular course of treatment (or exercise) would be inadvisable or cause harm

Controlled coughing: a technique in which the cough comes from deep within the lungs and has just enough force to loosen and carry mucus through the airways without causing them to narrow and collapse; controlled coughing saves energy and oxygen

COPD (chronic obstructive pulmonary disease): COPD is a general term for several lung diseases, including chronic bronchitis, emphysema, and chronic asthma

Cor pulmonale: enlargement of the right side of the heart because of disease in the lungs (for example, COPD); cor pulmonale weakens the heart and causes increased shortness of breath and swelling in the feet and legs; patients who have chronic COPD with low oxygen levels may develop this condition

CPR (cardiopulmonary resuscitation): a first-aid method to restore breathing and heart action through mouth-to-mouth breathing and chest compression

Decongestant: medication that shrinks swollen nasal tissues to relieve symptoms of nasal swelling, congestion, and mucus secretion

Diaphragm: most efficient breathing muscle, located at the base of the lungs

Diaphragmatic breathing: method of breathing that helps you use the diaphragm correctly so you exert less effort and energy to breathe

Diffusion capacity: a measurement of how much oxygen is carried from your lungs into your bloodstream

Dry powder inhaler (DPI): a device for inhaling respiratory medications that come in powder form

Durable Power of Attorney for Health Care: a legal document that authorizes another person to make healthcare decisions for you if you became physically or mentally incapacitated

Dyspnea: shortness of breath

Emphysema: the destruction, or breakdown, of the alveoli walls located at the end of the bronchial tubes, the damaged alveoli are not able to exchange oxygen and carbon dioxide between the lungs and the blood, the bronchioles lose their elasticity and collapse during exhalation, trapping air in the lungs, keeping fresh air and oxygen from entering the lungs

Exacerbation of COPD: a COPD flare-up or worsening of symptoms in COPD; this can be the result of a chest infection or exposure to environmental pollutants

Expectorant: medication that helps to thin mucus in the airways so it can be coughed out more easily

Exhalation: breathing air out of the lungs; expiration

Flutter valve: see mucus clearing device

Hereditary defect: a genetic problem or abnormality

High-efficiency particulate air filter (HEPA): a filter that removes particles in the air by forcing it through screens containing microscopic pores

High blood pressure: a condition (that usually has no symptoms) involving higher than normal pressure of the blood against the walls of the blood vessels; high blood pressure increases the risk of developing heart disease and stroke

Histamine: a naturally-occurring substance that is released by the immune system after being exposed to an allergen; when you inhale an allergen, mast cells located in the nose and sinus membranes release histamine; histamine then attaches to receptors on nearby blood vessels, causing them to enlarge (dilate); histamine also binds to other receptors located in nasal tissues causing redness, swelling, itching, and changes in the secretions

Holding chamber: see spacer

Home care company: organization that provides many aspects of COPD care in the home, including the use and care of respiratory equipment, teaching, monitoring, and review of environment and treatment

Humidification: the act of moisturizing the air with molecules of water

Hyperventilation: excessive rate and depth of breathing

Hypoxia: insufficient oxygen in the tissues, even though blood flow is adequate

Immune system: the body's defense system that protects us against infections and foreign substances

IAQ: indoor air quality

Incentive spirometer: a device that encourages deep inspiration to expand the lungs and improve cough effectiveness

Indication: the reason to use a treatment for a specific disease, symptom, or condition

Inflammation: a response in the body that may include swelling and redness

Influenza: a type of viral infection that can cause bronchitis and pneumonia

Inhaler: see metered dose inhaler (MDI)

Inspiration: breathing air into the lungs; inhalation

Intubation: placing a tube in the trachea (wind pipe) to enable artificial breathing; can be a lifesaving procedure

Irritant: substance that is not an allergen (see allergen) but can cause a reaction in the airways or damage the lungs

Leukotriene modifier: medication that blocks chemicals called leukotrienes in the airways; leukotrienes occur naturally in the body and cause tightening of airway muscles and production of excess mucus and fluid; leukotriene modifiers work by blocking leukotrienes and decreasing these reactions; these medications are also helpful in improving airflow and reducing some COPD symptoms

Lung volume reduction surgery: surgery in which damaged areas of the lungs are removed so the remaining portion of the lungs can function better; lung volume reduction surgery is performed only in the presence of certain types of COPD and after careful testing and evaluation

Lung transplantation: a surgical procedure in which a donor's healthy lung replaces the recipient's unhealthy lung; lung transplant as a treatment option for COPD is reserved for carefully selected patients

Maximal oxygen uptake: a person's highest rate of oxygen consumption; this measurement is usually expressed in milliliters of oxygen per kilogram of body weight per minute

Medical history: a list of a person's previous illnesses, present conditions, symptoms, medications, and health risk factors

Medical referral: a healthcare professional's recommendation that a patient see a qualified medical professional, often a specialist, to review the patient's health status and determine whether medical treatment is needed or a particular course of exercise and/or diet change is safe

Metabolism: the body's use of oxygen and food to produce energy

Metered dose inhaler (MDI): small, aerosol canister placed in a plastic container that releases a mist of medication that can be breathed into the airways; many COPD medications are taken using an MDI

Mucolytic agent: medication that thins mucus secretions

Mucus: a material produced by glands in the airways, nose, sinuses, and elsewhere in the body; mucus cleans and protects certain parts of the body such as the lungs

Mucus clearing device: a device used to loosen mucus in the airways so it can be coughed up more easily

Nasal cannula: a light-weight tube with two hollow prongs that fit just inside the nose; nasal cannulas are used to deliver oxygen

Nasal spray: medication used to prevent nasal allergy symptoms; available by prescription or over-the-counter in decongestant, corticosteroid, or salt-water solution form

Nebulizer: a machine that changes liquid medicine into fine droplets (in aerosol or mist form) that are inhaled through a mouthpiece or mask; nebulizers can be used to deliver bronchodilator (airway-opening) medications such as albuterol and ipratropium; a nebulizer may be used instead of a metered dose inhaler (MDI); it is powered by a compressed air machine and plugs into an electrical outlet

Open mouth technique: effective method for inhaling medicine from a metered dose inhaler; see closed mouth technique

Orthopnea: difficulty breathing related to body position, especially shortness of breath while lying on one's back; this is often treated by propping the person's head on two or more pillows

Oxygen: the essential element in the respiration process to sustain life; this colorless, odorless gas makes up about 21% of the air; oxygen may be prescribed if your lungs are not getting enough oxygen to your blood; breathing prescribed oxygen increases the amount of oxygen in your blood, reduces the extra work of the heart, and decreases shortness of breath

Oxygen, compressed: a form of prescribed oxygen that is stored in a tank as a gas; a flow meter and a regulator are attached to the tank to adjust the oxygen flow; the compressed oxygen system is generally prescribed when oxygen is not needed all the time, but only when walking or performing physical activity

Oxygen, liquid: at very cold temperatures, oxygen changes from a gas to a liquid; when liquid oxygen is warmed, it becomes a gas so that it can be used to help a person breathe; a liquid oxygen system includes a large stationary unit that stays in the home; a small, portable canister (weighing from 5 to 13 pounds) can be filled from the stationary unit for trips outside the home

Oxygen concentrator: an electric oxygen delivery system about the size of a large suitcase; the concentrator extracts some of the air from the room and separates the oxygen from other gases in the air; oxygen is then delivered through a nasal cannula; an oxygen concentrator may be recommended if oxygen is needed all the time or while sleeping

PEP valve: see mucus clearing device

Peak expiratory flow rate: a test used to measure how fast air can be exhaled from the lungs

Personal best peak expiratory flow (PEF): the highest peak flow number a person can achieve over a 2- to 3-week period when symptoms are under good control; the personal best PEF is the number to which all other peak flow readings will be compared

Pharynx: the back of the throat through which air passes when you inhale

Pneumonia: an infection of localized areas of the lungs; pneumonia often accompanies bronchitis

Pneumococcal infection: an infection caused by a bacteria called pneumococcus

Pollen: a fine, powdery substance released by plants and trees

Positive expiratory therapy valve: see mucus clearing device

Postural drainage: positioning oneself to allow gravity to help drain mucus or phlegm from the lungs

Productive cough: a "wet" cough that may involve coughing up mucus

Puffer: another term for inhaler or metered dose inhaler

Pulmonary function tests (PFTS): a series of tests that measure how well air is moving in and out of the lungs and how well oxygen is being carried to the blood stream

Pulmonary hypertension: a rare lung disorder in which the arteries in the lungs have become narrowed, making it difficult for blood to flow through the vessels

Pulmonologist: a doctor who specializes in caring for people with lung diseases and breathing problems

Pulse oximetry: a noninvasive test in which a device that clips on the finger measures the oxygen level in the blood

Pursed lip breathing: a method of breathing through pursed lips (as if blowing on a whistle) to improve breathing patterns

Relapse: the return of signs and symptoms of an illness after a period of improvement

Residual volume: the volume of air remaining in the lungs, measured after a maximum expiration

Respiration: the process of breathing allowing the exchange of gases in the blood (oxygen and carbon dioxide); see inhalation and exhalation

Respiratory failure: the sudden inability of the lungs to provide normal oxygen delivery or normal carbon dioxide removal

Respiratory therapist: a healthcare professional who specializes in assessment, treatment, and education for people with lung diseases

Respiratory therapy department: a hospital department that provides therapies and treatments to patients who have cardiopulmonary problems

Pulmonary rehabilitation: a program that can help a patient learn how to breathe easier and improve his or her quality of life; including treatment, exercise training, education, and counseling

Sleep apnea: a sleep disorder in which a person's breathing stops in intervals from 10 seconds to a minute or longer; when an apneic event occurs, air exchange may be impaired

Spacer: a tube-like device (also called a holding chamber) used with a metered dose inhaler; the spacer makes it easier to coordinate pressing on the inhaler and breathing in the medicine

Spirometry: a machine that measures lung function

Sputum: mucus or phlegm

Steroid: medication that reduces swelling and inflammation; comes in pill, injectable, and inhaled forms

Thorax: the muscular and bony structure of the chest

Tidal volume: the quantity of air inhaled and exhaled in one respiratory cycle during regular breathing

Total lung capacity test: a test that measures the amount of air in the lungs after a person has breathed in as much as possible

Trachea: the main airway (windpipe) supplying air to both lungs

Tracheostomy: a surgical opening made in the main airway, the trachea, when necessary to allow breathing

Vaccine: a medication, usually injected, that may stimulate the immune response to protect a person from an infection

Ventilator: the proper term for a breathing machine used to treat respiratory failure and help support breathing

Virus: a group of highly contagious infectious agents that cause a variety of colds and chest infections; viruses are not affected by antibiotics, however, the influenza vaccine is effective against the influenza virus

Vital capacity: maximal breathing capacity; the amount of air that can be expired after a maximum inspiration

Wheezing: the high-pitched whistling sound of air entering or leaving narrowed airways

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COPD Resources and Tools

Government Agencies

*Accepts Spanish calls

*National Women's Health Information Center, OWH, HHS
8270 Willow Oaks Corporate Drive
Fairfax, VA 22031
Phone: (800) 994-9662
TDD: (888) 220-5446
Fax: (703) 663-6942
http://www.4women.gov

NIEHS
National Institute of Environmental Health Sciences
Office of Communications
PO Box 12233
Research Triangle Park, N.C. 27709
Phone: (919) 541-3345
http://www.niehs.nih.gov

Office on Women's Health, HHS
200 Independence Avenue, SW, Room 712E
Washington, DC 20201
Phone: (202) 690-7650
Fax: (202) 205-2631
http://www.womenshealth.gov/owh

*National Center for Complementary and Alternative Medicine, NIH, HHS
PO Box 7923
Gaithersburg, MD 20898
Phone: (888) 644-6226
TTY: (866) 464-3615
Fax: (866) 464-3616
http://nccam.nih.gov

*National Heart, Lung, and Blood Institute, NIH, HHS
PO Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
Fax: (301) 496-1072
http://www.nia.nih.gov

*National Institute of Child Health and Human Development, NIH, HHS
Information Resource Center
PO Box 3006
Rockville, MD 20847
Phone: (800) 370-2943
TTY: (888) 320-6942
FaxX: (301) 984-1473
http://www.nichd.nih.gov

Office of Research on Women's Health, NIH, HHS
Building 1, Room 201
Bethesda, MD 20892-0161
Phone: (301) 402-1770
Fax: (301) 402-1798
http://orwh.od.nih.gov/index.html

Office of Women's Health, CDC, HHS
Parklawn Building, Room 1561
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 827-0350
Fax: (301) 827-0926
http://www.fda.gov/womens/default.htm



Private Organizations

American Lung Association
The American Lung Association
61 Broadway, 6th Floor
New York, NY 10006
Phone: 800.LUNG.USA
www.lungusa.org



Newsletters, Magazines, Reports

Healthy Women Today
The National Women's Health Information Center
www.womenshealth.gov/newsletter

COPD International
This is an online forum where you can correspond with others who are going through the same thing.
www.copd-international.com

Global Initiative for COPD
This online initiative brings people from all over the world together to raise awareness of COPD in our communities.
http://goldcopd.com



Tools

COPD Fact Sheet
This comprehensive guide is from the National Heart, Lung, and Blood Institute (in PDF format).
http://www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf

Self Assessment
If you think you might be suffering from COPD, take this easy self-diagnosis to bring to your doctor.
http://www.duoneb.com/patient/doihavecopd.asp

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