This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on February 4, 2020.

Dear COPD Coach,
I was recently diagnosed as having COPD. The doctor who diagnosed me said that my condition is still not very severe, but could get worse if I were to start having exacerbations. I understood him to mean that an exacerbation means time that I would end up in the hospital because of not being able to breathe. What exactly is an exacerbation and how do you avoid having one?

—Newly Diagnosed

Dear Newly Diagnosed,

An exacerbation is when there is an increase in the severity of the symptoms of a chronic disease.

The main symptoms of a COPD exacerbation are an increase in breathlessness which can also be accompanied by these additional symptoms: increased wheezing, a tightness in your chest or soreness when breathing, increased mucous production with a change in its color (usually a darker yellow or green) or thickness, and a fever. Oftentimes, severe exacerbations may result in pneumonia. Each time a person with COPD gets an exacerbation, lung damage can occur, and it is quite possible that some or all of the damage can be permanent. Repeated exacerbations can accelerate the progression of COPD. The two most common causes for a COPD exacerbation are viral or bacterial lung infections or exposure to pollutants.

Treatments for an exacerbation might include supplemental oxygen, antibiotics, corticosteroids, bronchodilators or in the case of a major exacerbation, ventilation either by a mask or a tube inserted into the windpipe. Exacerbations are the most common cause for a person with COPD to be admitted to a hospital.

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Dear COPD Coach,

Why do I feel so short of breath after eating? More than a few times after eating out, I was so short of breath I could barely walk to my car. I love good food, but I am beginning to feel that it isn’t worth the pain of not being able to breathe.

-Breathless

Dear Breathless,

Feeling bloated or out of breath after a large meal is not uncommon with people who have COPD. There are actually a couple reasons why this occurs. When we eat a large meal, we require more energy to digest what we eat and experience more pressure on our chest and diaphragm. The result is we experience shortness of breath.

For many, COPD causes our lungs to become hyper-inflated, which means they take up more room in our chest. This results when air gets trapped in damaged areas of the lungs. When our stomach is filled, it can actually push against the lungs causing us to feel out of breath.

So, what is the answer? It is really quite sensible. Eat several small meals throughout the day. If you are at or below ideal body weight, eat foods that are high in calories. Avoid salt as much as possible since salt can cause you to retain fluid, feel bloated, and increase the workload on your heart. Avoid simple carbohydrates as these cause CO2 build-up in your blood causing less available oxygen. If you do eat foods containing carbohydrates, keep to complex carbohydrates like those found in fruits, vegetables, and whole grain bread.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 30, 2020.

Dear COPD Coach,
I’m confused about what having an exacerbation of my COPD really means. Are there any signs or symptoms which my family and I can see that indicate I am having an exacerbation or is this just the same as an infection?

—COPD Exacerbations

Dear Exacerbations,
Knowing the early warning signs of an exacerbation is very important. As we have documented in previous letters, exacerbations are a problem with COPD, especially when you have not quite recovered from a previous exacerbation. And it’s easier to treat an exacerbation in the early stages versus when it is full blown.

First of all, exacerbations are often the result of either a bacterial or viral infection. If you are exposed to harmful pollutants, this can also cause a worsening of your symptoms. The signs to look out for are:

• Your breathing becomes harder than what is considered normal for you. During an exacerbation you may experience unusual breathing sounds like wheezing. This would indicate that your airways may be partially blocked.
• Coughing that is more severe than normal. Your cough may be dry (also referred to as non-productive) or you may be bringing up more mucus than normal. If you are bringing up mucus, it will be yellow, green or bloody if an infection is present. You may also experience increased difficulty when lying down.
• Changes in skin or nail color. A blue tint on your nails or around your lips indicate that you may not be getting enough oxygen. If this happens you should seek help right away! A change in your response to regular breathing medications. For example, if you take a fast-acting reliever medication by inhaler or nebulizer and it always helps you feel “opened up,” but one day it doesn’t seem to help, that is an early warning sign of possible exacerbation.
• Headaches are often a sign of poor oxygen processing. If you wake up in the morning with a headache, and this is a new symptom for you, it could be a sign that you may be experiencing an exacerbation.
• Swelling in your ankles and feeling of pressure on your diaphragm or ribs, are common COPD symptoms and are associated with heart complications or results of lung damage. If these symptoms are new to you or appear to be increasing suddenly, it may be a sign of an exacerbation. Note: Talk with your doctor about chest pain and ask when you should seek immediate medical attention, or when the discomfort is not urgent but may be caused by changes in your ribs or chest wall due to COPD.
• If you feel yourself breathing more from the chest, shoulders, or neck than your abdomen, this can also be a sign of an exacerbation.
• Increased difficulty sleeping or no desire to eat could also signal an exacerbation.

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Regular and correct use of inhaled medicines helps control symptoms of chronic obstructive pulmonary disease (COPD). However, your medicines will only work if you use your inhaler properly. Correct inhaler use makes sure that the right amount of medicine reaches your lungs. However, many different types of inhalers are available, and each requires a different technique. It is helpful if your doctor or a medical professional shows you how to use the inhaler prescribed to you.

What is meant by proper inhaler technique?

Your ability to use your inhaler properly, with the correct breathing technique, can affect your lung health.¹ This is referred to as “inhaler technique” and can differ from inhaler to inhaler. Using the wrong inhaler technique means that less medicine reaches your lungs.^1,2 This can make you feel worse and put you at a greater risk of hospitalization.¹ There are two main ways to take your inhaled medicine—using an inhaler or a nebulizer. Inhalers are small devices that can be held in your hand and are easy to carry.³ Three basic types of inhalers are available—a pressurized metered-dose inhaler (pMDI), a dry-powder inhaler (DPI), and a slow-/soft-mist inhaler (SMI).³ Nebulizers are machines that are usually larger than inhalers. Many nebulizers are not easy to carry around,³ but some new ones have been made to carry with you.^3,4 You probably use one or more of these inhalers or nebulizers to take your COPD medicines. This piece will focus on the non-nebulized inhalers.

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Dear COPD Coach,
My husband has been diagnosed with COPD but has not yet had pulmonary function tests to determine the type/severity. We purchased a pulse oximeter to monitor his 02 levels (he was sent home from the hospital on 4 liters but is now reduced to 2). My question is, do you take the first reading that comes up when the pulse oximeter is put on or do you wait 15 seconds and use that reading? Also, I would like to say this is one of the most informative websites I have found on COPD and I certainly appreciate the support it provides.

—Curious about Pulmonary Function Testing

Dear Curious,
A pulse oximeter can be a very useful tool for a COPD patient, providing you use it correctly and realize it has limitations.

The pulse oximeter measures two distinct things: The first number that comes up is most often the pulse rate. Usually this number is marked by a small heart. The second number that comes up is the level of oxygen in the blood. Both numbers are needed to assess your present levels.

At this point, it is important to discuss the limitations of the device. The pulse oximeter only gives you a limited amount of information, and is in reality just a snapshot of your functioning at that particular time. For example, it does not tell you the concentration of CO2 (Carbon Dioxide, the waste product of your breathing and something that is not healthy in high levels) in your blood stream. This means that you could be retaining a large amount of CO2, which could be limiting the amount of usable oxygen in your blood.

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This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on January 31, 2020.

Dear COPD Coach,

After having a spirometry test in September, I visited my doctor a week ago for the results. I am a smoker–but I have cut back from one pack a day to two cigarettes a day. The results of the test were that I have mild to moderate COPD. The doctor prescribed medication and gave me a peak flow meter with instructions to take a reading twice a day.

My doctor told me that there is no cure for COPD, but that I should have no further progression if I do not smoke. I went home and since, have not smoked another cigarette. What would be my prognosis for getting to Stage Three? Why would you label the disease as a stage if it can be managed?

Thank you,
—Wanting Answers

Dear Wanting,

First of all, congratulations on being able to quit smoking! That’s a huge first step and often the hardest! Not smoking will not only be better for your breathing but will also offer a lifetime of benefits to your overall health!

You doctor is right in saying that there is no cure for COPD, but that COPD can be managed. Your ability to slow the progression of your symptoms will depend on several factors. Managing COPD will involve working closely with a pulmonary professional–taking your medications as prescribed and very importantly, learning to recognize the signs of an exacerbation (times when your symptoms get worse) and getting prompt treatment before small symptoms escalate into a full-blown episode or illness (COPD exacerbation).

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You may know that COPD is an “umbrella term” describing progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma and chronic bronchitis.* But there is another lung condition that is often overlooked because of its similarity to COPD: Bronchiectasis (brong-ke-EK-ta-sis). To help raise more awareness of this condition and who it may be impacting, we’ll be sharing six posts over the upcoming year.

What is bronchiectasis?

Bronchiectasis is a disease of the small airways that leads to damage of the airway walls. This makes it difficult for people to clear out mucus from the lungs by coughing. One of the key differences from chronic bronchitis is that in bronchiectasis, the inner diameter of the airway can actually get wider. That may seem like a good thing but it isn’t. With scarring and thickening of the airway walls, widening of the airways is what makes it harder to clear out mucus. When mucus is not cleared out bacteria can start growing, which can lead to severe and repeated infections.

How severe?

Some people live with both COPD and bronchiectasis and don’t know it. One study found that in one year alone, 93% of these people had at least two health events (or exacerbations) like needing antibiotics, or a hospitalization relating to respiratory infections. Frequent events often result in major flare-ups in symptoms, and can lead to permanent loss of lung function, increase in additional symptoms, higher rates of disability or even loss of life. Even in those who did not experience frequent flare-ups, 90% of those who had pneumonia were found to have some bronchiectasis.

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This post was authored by Barbara Yawn, MD, MSc, FAAFP of the University of Minnesota; M. Bradley Drummond, MD of the University of North Carolina at Chapel Hill School of Medicine; and Carol Rubin, MEd, MS of Cliffside Park, NJ.

What is spirometry?

Spirometry is a common breathing test that assesses how well your lungs work. The test measures how quickly and how much air you can breathe in and out.¹ It is part of the testing done with full pulmonary function testing which may include other assessments (see below). During normal breathing, air flows in and out of your lungs freely. However, people with chronic obstructive pulmonary disease (COPD) have a hard time breathing out, and therefore too much air stays in their lungs.² This is known as “air trapping” and is one of the causes of feeling short of breath.² Spirometry is an important test that should be done in addition to asking about your symptoms and medical history when COPD is diagnosed.² Spirometry can help decide what medicines you will take and it can be used to follow your lung health over time.²

What happens during spirometry?

On the day of your test, your doctor may ask that you do not take your COPD medicine, do not wear tight clothing, and do not eat a large meal for two to four hours before your test. When you arrive, a person in your doctor’s office will explain the test and what you need to do. The test takes about 30 to 45 minutes to complete.¹ Here is what to expect during your spirometry test^1,3:

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This post was authored by Barbara Yawn, MD, MSc, FAAFP of the University of Minnesota; M. Bradley Drummond, MD of the University of North Carolina at Chapel Hill School of Medicine; and Carol Rubin, MEd, MS of Cliffside Park, NJ.

As a person living with and being treated for COPD you have your own “normal” (or baseline) symptoms, which can change in type and severity over time as your lungs age.^1,2 Knowing your baseline symptom level using the COPD Foundation patient app³ allows you and your clinician to understand when the symptoms are getting worse or becoming uncontrolled (See: What does it mean when COPD symptoms are “controlled”? Part 1 for more information). Following your symptoms and what you can do daily may also encourage you to try and improve your ‘normal,’ giving you a better quality of life.

How are you affected over time with the changes in COPD symptoms?

Many of us cut down on our activity level, whether we realize it or not, to avoid certain COPD symptoms like feeling short of breath.⁴ Cutting down on physical activity like avoiding stairs or even avoid getting up to get a glass of water can actually work against you - decreased activity can lower your ability to do the things you want to do. It can also increase the chances of having a COPD exacerbation or even being hospitalized.⁵ Exacerbations or COPD “attacks” lead to more decrease in activity, more shortness of breath and then to greater difficulty doing daily activities, and loss of fitness.⁶

What is the impact of an exacerbation of COPD?

During a COPD flare up or an acute exacerbation, symptoms worsen, and breathing becomes even more difficult. Exacerbations decrease your overall health, comfort, and happiness (also known as quality of life) and can speed up lung function decline.⁷ Also, exacerbations can increase your risk of future exacerbation or hospitalizations, and can even be life threatening.⁷ So, all possible steps should be taken to prevent symptoms from becoming uncontrolled (Suggested reading: Avoiding exacerbations and pneumonia; Staying healthy and avoiding exacerbations; Staying healthy and avoiding Pneumonia).

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The COPD National Action Plan, released in 2017, is a guide to how we can improve COPD outcomes in the United States. On November 13th, the community came together to share the progress that has been made against the Plan’s goals and to discuss how we collaborate and track progress moving into the next decade.

The COPD Foundation team was joined by five advocates who ensured the perspectives of those most affected by COPD were heard throughout the discussions. The day was broken into two parts, a morning session full of informative presentations from federal partners, advocacy organizations and health systems, and afternoon discussion sessions to brainstorm on how to effectively collaborate and track progress moving forward.

The day started with Dr. Tony Punturieri from the National Heart, Lung and Blood Institute’s (NHLBI) overview of their priorities and areas of progress such as the groundbreaking results coming from the COPDGene Study. Dr. Punturieri also discussed progress in understanding the role of smoking in COPD development, in dispelling the notion that COPD treatment is a one-size-fits-all approach, and in pushing early-stage disease-modifying research. He noted that they feel “the future and the present for COPD is bright.”

The next panel of speakers from federal agencies highlighted the progress made possible by the National Action Plan and your advocacy efforts. The Centers for Disease Control and Prevention (CDC) presented new data on the burden of COPD and how they are using the Behavioral Risk Factor Surveillance System (BRFSS) data to understand factors that may be associated with COPD outcomes in different areas of the country.

We dedicated much of the first years of our advocacy efforts to getting COPD questions on the BRFSS. Hundreds of patients contacted their state officials to make this happen. The results have yielded treasure troves of data about the burden of COPD in different geographic areas, but that isn’t all it can do. As more attention is focused on COPD in the public health space, the BRFSS COPD questions can now be layered with other data that show patterns of smoking history, comorbid diseases, and other health risk factors. The more we make COPD a part of the conversation in other health priority areas, the greater likelihood it lands on the radar of state and federal agency partners and the greater likelihood we can reach affected individuals.

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How much do you know about nontuberculous mycobacteria (NTM) lung disease and how people living with COPD can be more susceptible to the disease? These informative new videos will help you learn more about NTM lung disease and what steps you can do to limit exposure. Our expert speaker, Dr. Pamela McShane, provides valuable insights on the causes and signs of NTM lung disease as well as information about how those with the disease can participate in a research registry designed to increase knowledge of NTM lung disease.

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This post was authored by Barbara Yawn, MD, MSc, FAAFP of the University of Minnesota; M. Bradley Drummond, MD of the University of North Carolina at Chapel Hill School of Medicine; and Carol Rubin, MEd, MS of Cliffside Park, NJ.

Chronic obstructive pulmonary disease (COPD) is not a single condition¹ but includes emphysema (damage to the air sacs of the lung) and chronic bronchitis (chronic cough with mucus production caused by inflammation of the breathing tubes) and leads to shortness of breath.² Symptoms of COPD vary from person to person and from day to day or by the time of day³ and can include difficulty in breathing (shortness of breath), increased mucus, frequent coughing, chest tightness, and wheezing (whistling sound) when breathing out.²

What does it mean when your COPD symptoms are controlled?

Symptoms are considered under control, or stable, when they are about the same day to day, and allow you to do what is normal for you—functioning at your best.² Understanding what is “normal” for you—meaning when symptoms are under good control—can be assessed by following your day-to-day symptoms using the COPD Foundation patient app.⁴ (Suggested reading: The COPD Pocket Consultant Guide Mobile App) Knowing what is normal can help you and your doctor or nurse decide when you are in control or when things are getting worse or out of control. This helps you know if a visit is needed to receive more or different treatments. (See our upcoming post What does it mean when COPD symptoms are “controlled”? Part 2 for more information about baseline COPD symptoms and how to improve your ‘normal.')

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