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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
According to the American Lung Association,
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
|"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
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
- Ask the following questions about your
- 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
- 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.
- 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:
-- 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
- 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
- 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
- Get plenty of physical activity for good
- If you already have COPD, avoid colds and
flus, which can worsen the disease. Get annual
flu and pneumococcal vaccinations to avoid such
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
- Don't allow baby-sitters or others who work
in your home to smoke in the house or near your
Where children spend time
EPA recommends that every organization dealing
with children have a smoking policy that effectively
protects children from exposure to environmental
- 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
- 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
- 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
- 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
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
- 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