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The Basics of COPD
By Debbie Uzarski

Chronic obstructive pulmonary disease – most often referred to simply as COPD – is a serious lung disease. COPD – which can also be called chronic bronchitis, or emphysema – is a condition caused by exposure to airway irritants such as smoke or air pollution. Occupational exposure to chemicals can also be a cause.

The main symptoms are shortness of breath, a chronic cough, and feeling tired. Most people who have it are over 40 and are either current or former smokers. But people who worked in an industry where they've been exposed to chemicals are also at risk.

In rare cases, COPD can also be caused by a genetic condition. In such instances, people can have COPD even if they never smoked or were never exposed to air irritants.

In addition to a chronic cough and shortness of breath, other signs of COPD include wheezing, excessive sputum production, and feeling like you can't take a deep breath.

Although COPD affects 20 percent of U.S. adults over age 45, half of the people who have it remain undiagnosed, even though they may have symptoms. According to a survey conducted by the National Heart, Lung, and Blood Institute, about 41 percent of smokers don't talk to their doctor about their symptoms because they don't want to be told to quit smoking. A simple, non-invasive test which involves breathing into a mouthpiece can determine if you have COPD.

If you have COPD, the sooner you treat it, the better off you are. Medication and lifestyle changes can prevent more lung damage from occurring.

How to avoid COPD triggers

Certain activities and substances can trigger flare-ups of COPD. In order to avoid triggers, you must be proactive.

Here are the most common triggers and how to avoid them:

  1. Cigarette smoking. One of the most important steps you can take to control COPD is to stop smoking. By smoking, you breathe in poisonous substances that stay in your lungs and airways. One is carbon monoxide which makes your blood less able to carry oxygen. Smoke irritates airways, which then can become more inflamed and produce more mucus.
  2. Infections. Avoid people who have a cold, sore throat, the flu, or pneumonia. Get a flu shot every year. Get lots of exercise, fluids, healthy food and rest. Discuss exercise with your doctor.
  3. Air pollution. Outdoor and indoor air pollution in your lungs can trigger shortness of breath and create tightness in your chest. You may feel you cannot exhale properly. Pollutants can also make you more susceptible to an infection.
  4. Weather. Cold air puts a strain on your lungs. When outside in cold weather, breathe through a scarf that covers your nose and mouth.
  5. Second-hand smoke. Breathing second-hand smoke can change how your lungs and airways perform. Airways may become more sensitive to irritants. Your lungs may not work as well.

Ways to control breathing

When you have shortness of breath, there are several methods you can use to help control your breathing. Controlling your breathing enables you to get more air in and out of your lungs.

  1. Pursed-lip breathing. This method helps keep your air sacs and smallest airways always open longer so that air is not trapped into your lungs. This helps stale air to get out of your lungs so that fresh air with oxygen can get in.
  2. Diaphragmatic (belly) breathing. Diaphragmatic breathing helps make the diaphragm muscle stronger. That enables more fresh air to get in and more stale air to get out of your lungs.
  3. Relaxation. Shortness of breath can cause fear and anxiety and often leads to panic. To prevent this cycle from happening, you can learn specific ways to relax such as trying yoga, positive imagery, and alternate tensing and relaxing of muscles. Belly breathing also helps you to relax.
  4. Saving energy. When you manage your energy better, it is easier to stay active.
  5. Clearing mucus. Clearing mucus from your lungs will help to keep the airways open and make it easier to breathe. This will help to prevent infections. One way to help clear mucus is a special way to cough called "controlled coughing."

Medicines for COPD

Here are some medicines that you can use to treat COPD.

  • Bronchodilators – Bronchodilators open airways to increase the flow of air. The first time these are used there may not be much improvement, but over time it can become more effective.

    • Short-acting bronchodilators —Often these are used as a first step in treating stable COPD in someone with intermittent symptoms. These include anticholinergics such as ipratropium and Beta2-agonists.
    • Long-acting bronchodilators – Used to prevent breathing problems, these are best for people with persistent symptoms. These include anticholinergics such as tiotropium and Beta2-agonists such as salmeterol, formoterol and arformoteral.
  • Phosphodiesterase-4 (PDE-4) inhibitors – These are taken daily to help prevent COPD from worsening. Corticosteroids (such as prednisone) – Used to treat or prevent flare-ups.

Remember: Learning how to correctly use inhalers is not easy. You may need assistance form a doctor or a nurse to get the right amount of medication.

Debbie Uzarski, UPMC Health Plan, Health Manager, can be reached at uzarskida@upmc.edu.

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