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Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) refers to chronic lung disorders that result in blocked air flow in the lungs. The two main COPD disorders are emphysema and chronic bronchitis, the most common causes of respiratory failure. Both result from damage to the lungs over many years and predominantly affect former and current smokers. Emphysema occurs when the walls between the lung's air sacs become weakened and collapse. Chronic bronchitis occurs when the airways in the lungs become swollen and partially clogged with mucus. Chronic bronchitis may also involve muscle spasms in the airways. Many people with COPD have both emphysema and chronic bronchitis.


According to the American Lung Association, COPD is the fourth leading cause of death in the United States, with over 9 million Americans suffering from it, and over 100,000 Americans dying from it annually. Asthma is not usually considered a form of COPD because asthma can be easily treated and the lungs returned to a healthy state. The damage to the airways from COPD usually is more permanent and irreversible.

"I was so scared when I first learned I had COPD. I had no idea what it was, much less what to expect or how to cope."

-- Charlie, age 72

What causes COPD?

Tobacco smoking is the most common cause of COPD. Cigarettes contain many hazardous substances that damage the lung when inhaled, including tar nicotine, carbon monoxide, and cyanide. Long-term exposure to secondhand tobacco smoke and/or repeated respiratory infections also can increase a person's risk for COPD. Industrial exposures, such as toxic fumes or dust, can increase a person's risk of COPD as well.


What are the symptoms?

COPD has three main symptoms: coughing, breathlessness, and wheezing.

COPD is often diagnosed in the doctor's office when patients complain of difficulty breathing while doing everyday tasks or complain of a persistent cough. COPD patients often cough up thick or bloody mucus, and their skin may have a bluish tinge caused by lack of oxygen in the blood. If patients develop severe shortness of breath or swelling of the legs or ankles, they require immediate attention, as these symptoms may signify congestive heart failure.

How does a doctor make a diagnosis of COPD?

Although a definite diagnosis of COPD can be difficult, doctors rely on certain assessment procedures to help them diagnose the condition. Your doctor may:

  1. Ask the following questions about your health history
    • What is your smoking history?
    • Do you suffer from shortness of breath?
    • What worsens your shortness of breath?
    • Do you cough?
    • Do you cough up mucus, and if so, what does it look like?
    • What is your family history of lung disease?
  2. Conduct a spirometry test -- this test is a common and effective way to test your lungs. Your doctor will ask you to blow as long and as hard as you can into a small tube attached to a machine. The machine measures how much air you can blow out in one second. The more obstructed the airways, the less air you can blow out.
  3. Order blood tests and chest x-rays -- blood tests measure the amount of oxygen and carbon dioxide in your blood, which denote how efficiently your lungs are working. Chest x-rays can help determine if there is fluid in the lungs or other damage.

How is COPD treated?

Although the damage caused by emphysema is irreversible, some of the effects of chronic bronchitis can be partially improved. The progression of COPD and the severity of the symptoms can be managed through the following methods:

  • Bronchodilators -- can be administered as pills, liquids, or inhalers. They open up the air passages in the lungs.
  • Antibiotics -- COPD reduces the effectiveness of the lungs' natural defense systems. Antibiotics can get rid of bacterial infection in the lungs when they are in this compromised state.
  • Pulmonary rehabilitation -- a pulmonary rehabilitation program is provided by a team of health professionals to help COPD patients cope physically, psychologically, and socially with the disease. The program strives to help patients achieve the highest possible quality of life within the limitations of the disease.
  • Oxygen -- for severe cases of COPD, supplemental oxygen, using a tank and face mask, may be necessary.
  • Fluid clearing device -- The Flutter device is a small, drug-free unit designed to help patients easily cough out the extra fluid in their lungs.


  • Avoid smoking tobacco or exposure to secondhand tobacco smoke. Smoking is the leading cause of COPD. Although you cannot undo the damage that smoking has already caused, you can prevent further lung damage by quitting.
  • Decrease exposure to environmental irritants. Irritants such as secondhand smoke, strong odors, and fumes can lead to further narrowing of the airways in the lungs. COPD patients should avoid breathing the fumes from perfume, paints, and cleaning supplies.
  • Use appropriate protective gear (e.g. face mask) in the workplace to avoid inhaling hazardous substance.
  • Get plenty of physical activity for good lung health.
  • If you already have COPD, avoid colds and flus, which can worsen the disease. Get annual flu and pneumococcal vaccinations to avoid such infections


Ways to Reduce the Health Risks of Secondhand Smoke

In the home

  • Don't smoke in your house or permit others to do so.
  • If a family member insists on smoking indoors, increase ventilation in the area where smoking takes place. Open windows or use exhaust fans or ions air cleaner.
  • Do not smoke if children are present, particularly infants and toddlers. They are particularly susceptible to the effects of passive smoking.
  • Don't allow baby-sitters or others who work in your home to smoke in the house or near your children.

Where children spend time

EPA recommends that every organization dealing with children have a smoking policy that effectively protects children from exposure to environmental tobacco smoke.

  • Find out about the smoking policies of the day care providers, pre-schools, schools, and other care-givers for your children.
  • Help other parents understand the serious health risks to children from secondhand smoke. Work with parent/teacher associations, your school board and school administrators, community leaders, and other concerned citizens to make your child's environment smoke free.

In the workplace

EPA recommends that every company have a smoking policy that effectively protects nonsmokers from involuntary exposure to tobacco smoke. Many businesses and organizations already have smoking policies in place but these policies vary in their effectiveness.

  • If your company does not have a smoking policy that effectively controls secondhand smoke, work with appropriate management and labor organizations to establish one.
  • Simply separating smokers and nonsmokers within the same area, such as a cafeteria, may reduce exposure, but nonsmokers will still be exposed to re-circulated smoke or smoke drifting into nonsmoking areas.
  • Prohibiting smoking indoors or limiting smoking to rooms that have been specially designed to prevent smoke from escaping to other area of the building are two options that will effectively protect nonsmokers. The costs associated with establishing properly designated smoking rooms vary from building to building, and are likely to be greater than simply eliminating smoking entirely.

If smoking is permitted indoors, it should be in a room that meets several conditions:

  • Air from the smoking room should be directly exhausted to the outside by an exhaust fan. Air from the smoking room should not be re-circulated to other parts of the building. More air should be exhausted from the room than is supplied to it to make sure ETS doesn't drift to surrounding spaces.
  • The ventilation system or ions air cleaner should provide the smoking room with 60 cubic feet per minute (CFM) of supply air per smoker. This air is often supplied by air transferred from other parts of the building, such as corridors.
  • Nonsmokers should not have to use the smoking room for any purpose. It should be located in a non-work area where no one, as part of his or her work responsibilities, is required to enter.
  • Employer-supported smoking cessation programs are an important part of any smoking policy. Approximately 25 percent of American adults still smoke. Many smokers would like to quit, but cigarette smoking is physically and psychologically addictive, and quitting is not easy. While working in a smoke-free building may encourage some smokers to quit, a goal of any smoking policy should be to actively support smokers who want to kick the habit.
  • If there are designated outdoor smoking areas, smoking should not be permitted right outside the doors (or near building ventilation system air intakes) where nonsmokers may have to pass through smoke from smokers congregated near doorways. Some employers have set up outdoor areas equipped with shelters and ashtrays to accommodate smokers.

In restaurants and bars

  • Know the law concerning smoking in your community. Some communities have banned smoking in places such as restaurants entirely. Others require separate smoking areas in restaurants, although most rely on simply separating smokers and nonsmokers within the same space, which may reduce but not eliminate involuntary exposure to ETS.
  • If smoking is permitted, placement of smoking areas should be determined with some knowledge of the ventilation characteristics of the space to minimize nonsmoker exposure. For example, nonsmoking areas should be near air supply ducts while smoking areas should be near return registers or exhausts with ionising machine installed.
  • Ask to be seated in nonsmoking areas as far from smokers as possible.
  • If your community does not have a smoking control ordinance, urge that one be enacted. If your local ordinances are not sufficiently protective, urge your local government officials to take action.
  • Few restrictions have been imposed in bars where drinking and smoking seem to go together. In the absence of state or local laws restricting smoking in bars, encourage the proprietor to consider his or her nonsmoking clientele, and frequent places that do so.

In other indoor spaces

Does your state or community have laws addressing smoking in public spaces? Many states have laws prohibiting smoking in public facilities such as schools, hospitals, airports, bus terminals, and other public buildings. Know the law. Take advantage of laws designed to protect you. Federal laws now prohibit smoking on all airline flights of six hours or less within the U.S. and on all interstate bus travel.




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