COPD

What is COPD?

COPD is a group of progressive lung diseases that make it hard to breathe. Over time, airflow in and out of the lungs becomes limited due to airway damage and inflammation. In COPD:

• Airways and air sacs lose elasticity
• Walls between air sacs are destroyed
• Airway walls become thick and inflamed
• Excess mucus clogs the airways

Types of COPD

• Emphysema – damage to air sacs and their walls, reducing elasticity
• Chronic bronchitis – constant irritation and swelling of the airway linings, producing excess mucus

Most people have a combination of both.

Causes

• Long-term exposure to lung irritants, mainly cigarette smoke (most common cause in the U.S.)
• Other irritants: secondhand smoke, air pollution, workplace chemical fumes, or dust
• Rarely, a genetic condition called alpha-1 antitrypsin deficiency

Risk Factors

You are more likely to develop COPD if you:

• Smoke or used to smoke (about 75% of COPD patients)
• Have long-term exposure to lung irritants
• Are over age 40 when symptoms begin
• Have a family history of COPD
• Have asthma, which raises COPD risk

Symptoms

At first, symptoms may be mild, but they worsen over time. They can include:

• Chronic cough (with or without mucus)
• Wheezing or whistling sounds when breathing
• Shortness of breath, especially during activity
• Chest tightness
• Frequent respiratory infections (colds, flu)

In severe cases, COPD may cause:

• Weight loss
• Muscle weakness
• Swelling in the ankles, feet, or legs

Diagnosis

Providers may use:

• Medical and family history
• Lung function tests (spirometry)
• Chest X-ray or CT scan
• Blood tests

Treatments

There is no cure for COPD, but treatments can slow progression and improve quality of life.

Lifestyle changes

• Quit smoking (the most important step)
• Avoid secondhand smoke and irritants
• Exercise to strengthen breathing muscles
• Follow a nutrition plan tailored to your needs

Medicines

• Bronchodilators (inhalers) to relax airway muscles
• Inhaled steroids to reduce inflammation
• Vaccines (flu, pneumonia) to prevent complications
• Antibiotics for lung infections

Other therapies

• Oxygen therapy – for severe cases with low oxygen levels
• Pulmonary rehabilitation – includes exercise, nutrition counseling, and disease management support

Surgery (for severe COPD)

• Removal of damaged lung tissue or large air spaces (bullae)
• Lung transplant in advanced cases

When to Get Help

Seek emergency care if you have:

• Severe shortness of breath
• Trouble talking due to breathing difficulty
• Signs of infection (fever, worsening cough, or mucus changes)

Prevention

• Don’t smoke, and avoid secondhand smoke
• Reduce exposure to workplace chemicals, fumes, and dust
• Protect lungs from air pollution when possible

NIH: National Heart, Lung, and Blood Institute (NHLBI)

What is Emphysema?

Emphysema is a type of COPD (chronic obstructive pulmonary disease), a group of lung diseases that make it hard to breathe and worsen over time. The other main type of COPD is chronic bronchitis. Most people with COPD have both, but the severity of each can differ.

Emphysema damages the air sacs (alveoli) in your lungs. Normally, these sacs expand and contract to move oxygen into your body and carbon dioxide out. With emphysema, the walls between many air sacs are destroyed, leading to fewer, larger sacs that don’t work as well. This makes it harder for oxygen to reach your bloodstream and for carbon dioxide to leave your body.

Causes

• Long-term exposure to lung irritants, especially cigarette smoke (the main cause in the U.S.)
• Other tobacco smoke (cigar, pipe, etc.)
• Secondhand smoke, air pollution, workplace dust or chemical fumes
• Rarely, a genetic condition called alpha-1 antitrypsin deficiency

Risk Factors

You are more likely to develop emphysema if you:

• Smoke (current or past – about 75% of patients)
• Are exposed long-term to air pollution, secondhand smoke, or workplace irritants
• Are 40 years or older when symptoms begin
• Have a family history of COPD
• Have alpha-1 antitrypsin deficiency

Symptoms

Early emphysema may cause mild or no symptoms. As it worsens, symptoms can include:

• Frequent coughing or wheezing
• Mucus-producing cough
• Shortness of breath (especially during activity)
• Whistling or squeaky sounds while breathing
• Chest tightness

Severe emphysema may also cause:

• Frequent respiratory infections (colds, flu)
• Weight loss and muscle weakness
• Swelling in the ankles, feet, or legs

Diagnosis

Providers may use:

• Medical and family history
• Lung function tests (spirometry)
• Chest X-ray or CT scan
• Blood tests

Treatments

There is no cure for emphysema, but treatments can manage symptoms, slow disease progression, and improve quality of life.

Lifestyle changes

• Quit smoking (most important step)
• Avoid secondhand smoke and other lung irritants
• Follow a nutrition plan and exercise to strengthen breathing muscles

Medicines

• Bronchodilators (inhalers) to relax airway muscles
• Inhaled steroids to reduce inflammation (in more severe cases)
• Vaccines (flu, pneumonia) to prevent complications
• Antibiotics for infections

Other therapies

• Oxygen therapy – if blood oxygen levels are low
• Pulmonary rehabilitation – exercise, disease management training, nutrition counseling, and psychological support

Surgery (for severe emphysema)

• Remove damaged lung tissue
• Remove large air spaces (bullae) that interfere with breathing
• Lung transplant in very severe cases

When to Seek Help

• Emergency: Severe shortness of breath or inability to speak
• Call provider: Worsening symptoms or signs of infection (such as fever)

Prevention

• Don’t smoke
• Avoid secondhand smoke
• Limit exposure to air pollution, dust, and chemical fumes

NIH: National Heart, Lung, and Blood Institute (NHLBI)

What is Chronic Bronchitis?

Chronic bronchitis is a type of COPD (chronic obstructive pulmonary disease), a group of lung diseases that make it harder to breathe and worsen over time. The other main type of COPD is emphysema. Most people with COPD have both, but the severity of each can differ.

Chronic bronchitis is long-term inflammation and irritation of the bronchial tubes (the airways that carry air to and from your lungs). The irritation causes swelling and excessive mucus buildup, which blocks airflow. This makes it harder to move oxygen into the body and carbon dioxide out.

Causes

• Long-term exposure to lung irritants, especially cigarette smoke (the leading cause in the U.S.)
• Other tobacco smoke (pipe, cigar, etc.)
• Secondhand smoke, air pollution, workplace dust, and chemical fumes
• Rarely, a genetic condition called alpha-1 antitrypsin deficiency

Risk Factors

You are more likely to develop chronic bronchitis if you:

• Smoke (past or present – up to 75% of patients)
• Are exposed long-term to air pollution, secondhand smoke, or workplace irritants
• Are 40 years or older when symptoms begin
• Have a family history of COPD
• Have alpha-1 antitrypsin deficiency

Symptoms

Early symptoms may be mild but worsen over time. They include:

• Frequent or chronic cough (often with a lot of mucus)
• Wheezing
• Shortness of breath, especially during activity
• Whistling or squeaky breathing sounds
• Chest tightness

Severe cases may also cause:

• Frequent respiratory infections (colds, flu)
• Weight loss
• Muscle weakness
• Swelling in the ankles, feet, or legs

Diagnosis

Providers may use:

• Medical and family history
• Lung function tests (spirometry)
• Chest X-ray or CT scan
• Blood tests

Treatments

There is no cure for chronic bronchitis, but treatments can help manage symptoms and slow progression.

Lifestyle changes

• Quit smoking (most important step)
• Avoid secondhand smoke and other irritants
• Exercise to strengthen breathing muscles
• Follow a nutrition plan to support overall health

Medicines

• Bronchodilators (inhalers) to relax airway muscles
• Inhaled steroids to reduce inflammation (for more severe cases)
• Vaccines (flu, pneumonia) to prevent complications
• Antibiotics if infections occur

Other therapies

• Oxygen therapy – for severe cases with low oxygen levels
• Pulmonary rehabilitation – exercise training, nutrition counseling, disease management, and psychological support

Surgery (last resort)

• Lung transplant if symptoms remain severe despite other treatments

When to Seek Help

• Emergency: Severe shortness of breath or inability to talk
• Call provider: Worsening symptoms or infection signs (such as fever)

Prevention

• Don’t smoke
• Avoid secondhand smoke
• Limit exposure to air pollution, chemical fumes, and workplace dust

NIH: National Heart, Lung, and Blood Institute (NHLBI)

What is Pulmonary Rehabilitation?

Pulmonary rehabilitation (also called pulmonary rehab or PR) is a structured program designed for people with ongoing breathing problems. It helps improve lung function, physical ability, and quality of life. PR does not replace medical treatment—it works alongside it.

Most programs are done on an outpatient basis at a hospital or clinic, though some can be done at home. A team of health care providers works with you to reduce symptoms, improve exercise capacity, and make daily activities easier.

Who Needs Pulmonary Rehabilitation?

Your provider may recommend PR if you have a chronic lung disease or other condition that limits breathing. PR can help if you:

• Have COPD (chronic obstructive pulmonary disease) – including emphysema or chronic bronchitis
• Have an interstitial lung disease (e.g., sarcoidosis, pulmonary fibrosis)
• Have cystic fibrosis (CF), which causes thick mucus that clogs airways
• Are you preparing for or recovering from lung surgery
• Have a muscle-wasting disease that weakens breathing muscles (e.g., muscular dystrophy)

PR is most effective when started before the disease becomes severe, but people with advanced lung disease can still benefit.

What Does Pulmonary Rehabilitation Include?

At the start of PR, your care team may perform:

• Lung function tests
• Exercise assessments
• Blood tests
• A review of your medical history, diet, and emotional health

Based on this, they create a personalized plan that may include:

• Exercise training – endurance and strength-building exercises (walking, treadmill, cycling, weights) tailored to your ability
• Nutritional counseling – guidance to maintain a healthy weight, since both underweight and overweight can affect breathing
• Education – learning to manage symptoms, prevent infections, and use medicines correctly
• Energy-saving techniques – tips for daily activities (avoiding heavy lifting, bending, or stressful movements that strain breathing)
• Breathing strategies – such as pursed-lip breathing and diaphragmatic breathing to improve oxygen flow and reduce breathlessness
• Psychological support – counseling or support groups to manage stress, anxiety, or depression linked to chronic lung disease

Pulmonary rehabilitation helps you breathe easier, stay active, and live better despite chronic lung conditions.

NIH: National Heart, Lung, and Blood Institute (NHLBI)

What are the health effects of smoking?

Smoking is one of the leading causes of preventable disease and death. It harms nearly every organ in the body and is responsible for about 1 in 5 deaths in the U.S. Cigarette smoke contains thousands of harmful chemicals, many of which are toxic and cancer-causing.

Major health effects include:

• Cancers: Most common cause of lung cancer and oral cancer. Also linked to cancers of the larynx, throat, esophagus, stomach, pancreas, colon/rectum, bladder, kidney, liver, cervix, and can cause acute myeloid leukemia (AML).
• Lung diseases: Leading cause of COPD (chronic obstructive pulmonary disease). Can worsen asthma and increase risk of pneumonia.
• Cardiovascular diseases: Damages blood vessels, raises blood pressure, and increases risk of heart disease, blood clots, and stroke.
• Vision problems: Increases risk of cataracts and macular degeneration (AMD).
• Pregnancy complications: Raises the risk of miscarriage, preterm labor, low birth weight, and sudden infant death syndrome (SIDS).

Smoking also causes addiction to nicotine, making it very difficult to quit.

What are the risks of secondhand smoke?

Secondhand smoke exposes nonsmokers to many of the same toxins as smokers, leading to:

• Increased risk of lung cancer and heart disease in adults
• In children: higher risk of ear infections, bronchitis, pneumonia, severe asthma, and SIDS
• During pregnancy: higher risk of preterm birth and low birth weight

Are other forms of tobacco dangerous?

Yes—all tobacco products carry risks:

• Cigars and hookahs (water pipes): Contain harmful chemicals and nicotine. One large cigar can have as much tobacco as a pack of cigarettes.
• Smokeless tobacco (chewing tobacco, snuff): Increases risk of oral cancers, gum disease, oral lesions, and heart disease.
• E-cigarettes (vaping): Contain nicotine (highly addictive, harmful in pregnancy, dangerous for children and teens). E-cig aerosols expose users and bystanders to harmful chemicals. Long-term health effects are still being studied.

Why should I quit?

There is no safe level of tobacco use. Even one cigarette per day increases the risk of cancers and early death. The sooner you quit, the greater the benefits.

Immediate benefits of quitting include:

• Lower heart rate and blood pressure
• Decreased carbon monoxide levels in the blood (improves oxygen transport)
• Better circulation
• Less coughing and wheezing

Long-term benefits:

• Reduced risk of cancer, heart disease, stroke, and lung disease
• Longer life expectancy and improved quality of life

Quitting smoking is difficult but possible—with medical support, counseling, nicotine replacement therapies, and healthy lifestyle changes.