If you’re one of the estimated 24 million Americans living with Chronic Obstructive Pulmonary Disease (COPD), then you know there are challenges. COPD is a progressive lung disease that makes breathing difficult due to the lung’s response to toxins, in most cases cigarette smoke. Airways then become constricted and can produce large amounts of mucus from the smoke irritation. COPD serves as an umbrella term for two respiratory conditions: emphysema and chronic bronchitis. To get diagnosed for COPD or for a specific stage of the disease, a physician administers a pulmonary function test at a clinic or doctor’s office.
As the fourth leading cause of death in the U.S., COPD is such an urgent health crisis that the National Institute of Health (NIH) created the COPD National Action Plan, a multifaceted, united fight against the disease. The goal is to raise awareness and reduce its impact on society.
Of course, life will change after a COPD diagnosis, but living with COPD doesn’t have to be an arduous experience. Unlike with many other diseases, you can slow the progression of COPD. There are actions you can take to promote health, happiness, and an elevated quality of life.
Keep Your Lungs Healthy
Because your lungs are already compromised and are in direct contact with the environment, it’s important to avoid anything in the air that might cause them further harm. This includes toxins like tobacco smoke, airborne chemicals, air pollution, and respiratory germs. However, this may not be realistic, so investing in a quality air purifier for home use is a good option.
Cigarette Smoke
Cigarette smoking leads to 85%–90% of COPD cases. If you are diagnosed with COPD, it’s important to both quit smoking and avoid secondhand smoke. A lit cigarette emits more than 7,000 chemicals, most of which are harmful. The toxins in cigarette smoke weaken the lungs’ defense against infection, narrow and cause swelling in airways, and damage air sacs—all contributing factors to COPD. We all know that quitting can be easier said than done, but thankfully, there are many resources to help. Talk with your doctor and visit Smokefree.gov for tools and tips to quit smoking for good.
Airborne Chemicals
Avoid chemicals in the air known to harm the lungs: industrial compounds such as dust and fumes, harsh cleaning products, and smog from burning fuel. Make sure to have protective equipment in the workplace and a well-ventilated home environment.
Air Pollution
To reduce the harmful effects of air pollution, people with COPD should be aware of the air quality in their area and take extra measures such as reducing their time outdoors and wearing masks when necessary. Air pollution is composed of toxins like smoke and chemicals from factories and cars that are harmful to lung tissue. Exposure to air pollution can exacerbate COPD and cause an increased need for oxygen or medications.
Most phone weather apps show air quality in your region or you can get more detailed and forecasted information from air quality map websites. Here’s a screenshot of what the data looks like when you search your ZIP code:
Respiratory Germs
People with COPD are more likely to develop colds, the flu, and pneumonia, which can cause further lung damage. Steer clear of these infections by:
Regularly washing hands and using hand sanitizer
Avoiding crowds and people you know are sick
Practicing good oral hygiene
Getting vaccinations against the flu and pneumonia for you and those around you
One way to improve lung function is with breathing exercises. The diaphragm muscle normally does about 80% of the work when you’re breathing. Lungs with COPD are less springy and potentially accumulate increased carbon dioxide levels that are normally fully exhaled by healthy lungs. This makes it harder for the diaphragm to work at full capacity and ultimately leads to reduced oxygen levels in the body.
Diaphragmatic (Belly) Breathing
If the diaphragm struggles to work at full capacity, other muscles in the chest, back, and neck will step in. This is a much less efficient way to breathe. It can be improved with a technique called diaphragmatic breathing (or belly breathing), which is aimed at retraining the diaphragm to do most of the work of breathing. To practice belly breathing:
Breathe in through your nose while paying attention to your belly filling up with air. You can set your hand or something light on your stomach to watch it rising.
Breathe out through your mouth for at least two to three times longer than the length of your inhalation while relaxing your neck and shoulders.
Pursed-Lip Breathing
Pursed-lip breathing gets more air flowing in and out of the lungs and thus more oxygen to the body, especially when you’re feeling short of breath. To practice pursed-lip breathing:
Breathe in through your nose.
Breathe out through your mouth with lips pursed (O-shaped) for at least twice as long as the length of your inhalation.
Aim for 5–10 minutes of both exercises daily and additionally when feeling particularly short of breath.
Nutrition
You may be surprised to learn that what you eat can affect your COPD and breathing. Proper nutrition affects overall health, mood, and energy levels. Nutrition is so important that many doctors will recommend a diet plan or refer you to a registered dietician nutritionist (RDN) if you are diagnosed with COPD. There are even RDNs who specialize specifically in COPD.
“The available scientific evidence indicates that some foods and nutrients, especially those nutraceuticals endowed with antioxidant and anti-inflammatory properties and when consumed in combinations in the form of balanced dietary patterns, are associated with better pulmonary function, less lung function decline, and reduced risk of COPD.”
Oxygen and food are the fuel that our bodies use to produce energy. You have probably heard that food always falls into one of three types of nutrients: protein, carbohydrate, or fat. Carbon dioxide is a waste product produced by your body’s breakdown of food. It must be expelled through the lungs. Those with COPD have more difficulty ridding their bodies of built-up carbon dioxide. The correct combination of nutrients in your diet can help you breathe better.
Low-carbohydrate, high-fat diets tend to help those with COPD. That’s because the breakdown of carbohydrates produces the highest amount of carbon dioxide while the breakdown of fats produces the lowest amount. This is not to say that you shouldn’t consume any carbohydrates. It’s important to choose complex carbohydrates like whole grain pasta and breads, fruits, and vegetables and to avoid simple carbohydrates like sugar, soda, and sweets. Complex carbohydrates are usually high in fiber which is great for getting to the recommended 20–30 grams of fiber per day.
Getting enough protein is also important—but not too much protein. Too much protein can create an excess of calories, which can produce excess carbon dioxide. Aim for 20% of your calories to come from protein in order to maintain lung strength and prevent muscle atrophy.
When consuming fats, try to choose mono- and poly-unsaturated fats without cholesterol. Avoid trans and saturated fats like butter, lard, and hydrogenated oils. However, a high-fat, low-carbohydrate diet is not for everyone and would not be advised for someone with heart disease.
Supplements may be recommended, especially if you take steroids, because long-term use of steroids can lead to osteoporosis. Studies found that 36%–60% of patients with COPD eventually develop osteoporosis. At-risk patients should take at least 1,200 milligrams of calcium and 800–1,000 international units (IU) of vitamin D daily to limit bone loss.
Additionally, sodium may be problematic for those with COPD because of the swelling, water retention, and increased blood pressure it can cause. Avoid foods with more than 300 milligrams of sodium per serving. Drinking water throughout the day helps thin secretions.
It’s also important to avoid feeling too full or bloated which makes it difficult for the diaphragm to move freely. Eating four to six small meals a day, avoiding foods that cause bloating and gas, eating slowly, and chewing food thoroughly will help keep you comfortable.
If energy levels are a problem, eating more food in the morning will help you get in enough calories before feeling too tired to eat later in the day. Also, choosing foods that are easy to prepare and chew will spare energy. Resting before meals and wearing oxygen while eating (if it is prescribed full-time) will also help with stamina.
Weight management is important for anyone—but especially those with COPD. Unwanted weight loss is common due to inability to eat and the high caloric demands of labored breathing. Low BMI (body mass index) is associated with a poor prognosis because it can impair lung function, increase susceptibility to infection, lower exercise capacity, and increase overall risk for mortality and morbidity.
On the flip side, being overweight is also a problem for those with COPD because it puts excess pressure on the lungs, making breathing more difficult. The best thing you can do from a weight standpoint is to maintain a BMI in the “normal weight” category with a BMI of 18.5 to 24.9. You can easily calculate your BMI by simply plugging in your height and weight. Alternatively, there are phone apps with BMI calculators.
As you can see, nutrition is complicated and should be personalized for the individual. A diet aimed at treating COPD should never be attempted on your own, but rather managed with the guidance of your doctor or nutritionist.
Exercise
Another way to improve COPD symptoms over time is to exercise. A 2016 study of the effect of exercise on patients with COPD found: “Exercise training as part of a comprehensive pulmonary rehabilitation programme, can make a profound difference in the lives of patients with COPD. Indeed, exercise training reduces daily symptoms of dyspnoea [labored breathing] and fatigue, improves physical fitness, reduces symptoms of anxiety/depression, and improves quality of life in patients with COPD.”
Exercise strengthens the muscles, including the breathing muscles, and promotes blood circulation, helping oxygen travel to all parts of the body. There are three types of exercise that are beneficial for people with COPD (and beneficial for anyone, for that matter): stretching, aerobic exercise, and resistance (strength) training.
Exercise does not have to be done in a gym—walking, gardening, housework, and using resistance bands are all forms of cardiovascular exercise. Yoga and Tai chi are especially suited to those with COPD because they involve gentle physical activity with a breathing focus. Physical benefits of exercise include increases in:
Cardiovascular fitness
Muscle strength
Oxygen utilization
Energy levels
Not only does exercise help the body improve symptoms of COPD, it also helps the mind. Mental benefits of exercise include:
Reduced stress, anxiety, and depression
Increased self-esteem
A reasonable goal would be 150 total minutes of exercise per week—that’s five 30-minute sessions. It’s important for people with COPD not to overexert themselves and stay in the mild-to-moderate range while exercising. An easy way to make sure you aren’t exceeding the moderate intensity level is to check that you’re able to carry on a conversation. Talking will be more difficult than normal but remains doable. Also, you don’t want to exercise if you’re sick, have a fever, have chest pain, feel nauseated, or have worsening shortness of breath. As always, before beginning any exercise regimen, you should get the approval of your doctor.
Medications
Just like the other therapies listed here, treating COPD with medication is aimed at lessening symptoms and gaining better control of your breathing so you can be comfortable and take part in the activities you love. Medicating COPD can be complicated and involve multiple types of medications taken multiple times a day. Some commonly prescribed medications include:
Bronchodilators: These work to relax the muscles around the airways, opening them up and making it easier to breathe. They are usually administered with an inhaler or nebulizer, delivering the medicine directly to the lungs.
Inhalers and nebulizers can be tricky to use at first so it’s important to get a thorough explanation of how to use them from your doctor or respiratory therapist. Bronchodilators may be short- or long-acting. Short-acting bronchodilators work quickly but don’t last very long (4–6 hours), so they’re best used when you’re having symptoms and before exercise. Some examples are albuterol (ProAir FFA, Ventolin HFA) and ipratropium (Atrovant). Long-acting bronchodilators are taken daily and last up to 12 hours. Examples are salmeterol (Serevent) and tiotropium (Spiriva).
Steroids: These reduce swelling, inflammation, and mucus in the airways and are usually administered through an inhaler or nebulizer, although sometimes are given in pill form. Inhaled corticosteroids like fluticasone (Flovent HFA) are useful for people with frequent exacerbations of symptoms. Oral steroids will help with severe exacerbations but are often prescribed only for a short period of time (less than a week) due to serious long-term side effects.
Combination medications: A mixture of two or three bronchodilators and/or steroids may be combined in order to achieve quick-acting and long-lasting, multi-symptom relief. Some common combination drugs are Symbicort and Advair.
Antibiotics: Respiratory infections are more common in individuals with COPD and can make symptoms worse, so antibiotics are often prescribed and even kept on hand for use as needed.
Other: There are a few other medications that may be used in combination with any of the above to treat more severe COPD. They include drugs such as roflumilast (Daliresp), which reduces swelling and opens airways, and theophylline, a less-expensive but often less-effective bronchodilator.
Oxygen Therapy
COPD often leads to low levels of oxygen in the blood. This has serious consequences for the body and should be treated with oxygen therapy (supplementation). Supplemental oxygen can be delivered with a few different types of machines. There are stationary home units that use replaceable or refillable oxygen tanks, stationary units that produce their own oxygen from the air (oxygen concentrators), and portable oxygen concentrators (POCs) that are small and mobile and can be taken almost anywhere.
Oxygen supplementation requires a doctor’s prescription and may be needed around the clock or only during increased physical activity or sleep. A study in the National Library of Medicine, found that oxygen therapy was “the first treatment shown to prolong life in people with COPD.”
Symptom and Treatment Tracker
It’s important to have a system for keeping track of your symptoms, treatments (especially medications), and discussions with your doctors. You will likely have a multidisciplinary team with visits to multiple medical professionals. Make sure to take notes and ask questions whenever clarification is needed. Keep all of your information organized and in one place. You can make your own or find online forms for the tracking of appointments, symptoms, and treatments. The American Lung Association has a Medication Tracker Form available online. They also provide COPD Action and Management Plans that you can fill out with your doctor in order to have your entire treatment plan in one place. You can then update yours with each visit so you are always up to speed on your current treatments.
Pulmonary Rehabilitation
Pulmonary rehab (PR) is an educational program designed to help those with COPD reduce the severity of their symptoms, build strength, improve lung function, and improve overall quality of life. PR generally involves all of the treatment strategies that we have mentioned in one place.
“I’ve seen patients have a complete change in attitude and outlook on life with pulmonary rehab, I’d recommend it for anyone recently diagnosed with COPD.”
Delano Chalez, a pulmonary diagnostics therapist at UC Health in Denver, Colo.
Pulmonary rehab programs vary in structure and length. Most programs utilize a small group format, fostering a sense of community and connection with others. As with exercise, the benefits of pulmonary rehab are mental as well as physical. PR programs may include:
Education about COPD, its symptoms, management, and treatments
Exercise classes
Breathing exercise instruction
Nutritional counseling
Mental health support
Smoking cessation support
PR helps patients learn to manage their breathing issues in the hopes of avoiding supplemental oxygen and staying out of the hospital. A 2018 study found that pulmonary rehabilitation leads to an increase in exercise capacity as well as improved quality of life, resulting in a decrease in emergency admissions and hospitalization rates. Because COPD is a lifelong diagnosis requiring ongoing management, many PR programs will include a maintenance program for long-term support.
Speak with your doctor or visit the American Thoracic Society’s Pulmonary Rehab Directory to find a PR program near you.
Frequently Asked Questions
A COPD diagnosis does not have to mean that you can no longer live a “normal” life. COPD is one of the few diseases that can be slowed with just a few lifestyle changes. If you are diligent about taking care of your health, there is no reason you can’t continue to do almost everything you love to do. Having an organized, coordinated care plan and open communication with your care team will help you keep your COPD under control.
It’s important to avoid anything that might make your symptoms worse, like:
– Smoking and other airborne irritants
– Preventable illnesses, especially respiratory illnesses
– Being sedentary
– Large meals and overeating in general
– Foods that cause gas and bloating
– Anything that tires you out so much that you are unable to eat or be active
– Becoming underweight
The three most common treatments for COPD are medication, oxygen therapy, and breathing exercises. They are all aimed at lessening symptoms and maintaining an active life.
1. Medications may be in nebulizer, inhaler, or pill form. There are many different medications to help treat the symptoms of COPD including bronchodilators, steroids, combination medications, and antibiotics.
2. Oxygen therapy is delivered from an oxygen machine or concentrator through a tube into your mouth or nose. There are portable machines allowing you to go almost anywhere with your oxygen therapy.
3. Breathing exercises help keep the lungs and diaphragm strong. There are two simple exercises—belly breathing and lip-pursed breathing—that only need to be done for 5–10 minutes per day or when symptoms are flaring up.
Shortness of breath is usually the first sign of COPD. It may worsen over time, especially during physical activity. Additional symptoms that may worsen over time include a persistent, productive cough; wheezing, squeaking, or whistling while breathing; and tightness in the chest.
A sudden aggravation of symptoms is called an exacerbation. Signs of an exacerbation include worsening:
Medications and breathing exercises can help during an exacerbation. You should always contact your doctor if your symptoms are getting worse. There are many therapies to get you back on track and feeling better.
Lauren Sherman, M.S., is a health content writer with a master's degree in human genetics from the University of Colorado Anschutz Medical Center, laboratory experience at National Jewish Health, and clinical experience at Children’s Hospital Colorado. She has extensively researched products to help those wanting to age in place such as medical alert systems, walk-in tubs, adjustable beds, and oxygen concentrators.
Rebecca Tucker, LRT, RRT is a registered respiratory therapist and COPD educator with over 40 years of practice in acute, sub acute, and chronic disease management. She has successfully initiated and managed CPAP, BiPAP, oxygen, and noninvasive ventilation programs for numerous entities throughout her career.
