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Understanding Chronic Obstructive Pulmonary Disease (COPD)

Man breathing

The All-Important Lungs

The delicate, branching structures of the lungs bear a striking resemblance to trees. The air you breathe travels down your windpipe, or trachea, and enters the lungs through two large tubes known as bronchi. Just like the roots and limbs of a tree, these tubes divide again and again into smaller bronchioles before finally ending in clusters of tiny air sacs called alveoli—what you might consider the leaves. 

Chronic obstructive pulmonary disease (COPD) is a long-term inflammatory condition that obstructs the airflow from the lungs and makes it difficult to breathe. Although it's the third leading cause of death in the U.S., the good news is that it can be prevented and treated to slow the progression and maintain quality of life. Here’s what you need to know about keeping your lungs healthy to avoid or manage COPD. 

How COPD Affects the Lungs

COPD refers to a group of progressive lung diseases, meaning the condition becomes worse over time. The most common are emphysema and chronic bronchitis, and many people with COPD have both of these conditions. 

Emphysema destroys the fragile air sacs in the lungs, which impairs the airflow. The air carrying carbon dioxide out of the body cannot be adequately expelled and some remains trapped in the lungs. Fresh, oxygen-rich air is then blocked from entering the lungs, causing gradually worsening shortness of breath, even while at rest.

According to the Mayo Clinic, most people with emphysema also have bronchitis, which causes inflammation and narrowing of the bronchial tubes. With bronchitis, mucus builds up in the lungs, spurring a persistent cough. 

The CDC reports that sixteen million Americans have trouble breathing due to COPD. However, they estimate that the actual number includes millions more who have not yet been diagnosed. 

What causes COPD?

In the vast majority of people with COPD, lung damage is caused by cigarette smoking. According to the COPD Foundation, about 90% of people with COPD are current or former smokers. However, damage can also be caused by long-term exposure to irritating gases or particulate matter, including air pollution and workplace exposure to dust, smoke, or fumes. 

An estimated five percent of people with COPD have a deficiency in a protein known as alpha-1-antitrypsin, which causes the lungs to deteriorate and can also affect the liver. People with severe asthma can also progress into COPD. 

Signs and Symptoms of COPD

The most telling—and distressing—symptom of COPD is difficulty breathing. According to the Mayo Clinic, another major symptom is a constant cough that produces a lot of mucus. Additional symptoms may include chest tightness, wheezing, frequent respiratory infections, and fatigue. Severe COPD can cause swelling in the ankles, legs, and feet and weight loss. 

As a progressive disease, symptoms often begin mildly and may be confused for the common cold. But rather than clearing up after a week or two, the coughing and shortness of breath will continue to worsen over time and make daily activities more difficult. 

Unfortunately, by the time COPD symptoms appear, there may already be significant lung damage. Symptoms will continue to escalate, particularly if smoking or exposure to lung irritants continues. With proper intervention and treatment, however, most people with COPD can slow the disease’s progression and maintain their quality of life. 

People with COPD often experience flare-ups known as exacerbations. During these episodes, symptoms become much more severe for several days or weeks and may require treatment with antibiotics, oral corticosteroids, and even hospitalization. 

Respiratory infections or inflammation triggers—such as air pollution, secondhand smoke, dusts, fumes, or other toxic substances—are common causes of exacerbations. Anyone who experiences a marked increase in coughing, difficulty breathing, or mucus in the lungs should seek immediate medical attention. 

Protecting Your Lungs

The best way to prevent COPD is to never smoke or stop smoking now. Quitting isn’t easy for most people, so it’s a good idea to enlist your healthcare provider’s support.  They may recommend nicotine replacement products or medications that can help. 

The CDC offers a variety of resources that can help you quit smoking, including a free text message program (text QUIT to 47848) and their quitSTART app, which is available for both Android and iOS. The Mayo Clinic outlines ten tips to help you resist the urge to smoke that you may find helpful as you get started. 

It’s also important to avoid secondhand smoke exposure and occupational exposure to chemical fumes and dust. If you work with any type of lung irritant, the Mayo Clinic advises talking with your supervisor about the best ways to protect yourself, like using respiratory protective equipment. 

Staying active will not only improve your overall health; it will also strengthen your lungs. The American Lung Association recommends getting thirty minutes of moderate physical activity five days a week. Both aerobic and muscle-strengthening exercises will benefit your lungs, so you can include anything from brisk walking to weight lifting to vigorous household cleaning. 

Lastly, make sure to get your annual flu vaccine each fall, as well as a pneumococcal vaccine, to prevent infections that can weaken your lungs. 

Treating COPD

While there is no cure for COPD, treatment can ease symptoms and lower the risk of complications like heart disease, lung cancer, respiratory infections, pulmonary hypertension, and depression. 

COPD can be treated with medications, supplemental oxygen therapy, and surgery. However, many people with mild forms of the disease may only need to quit smoking and avoid other inflammation triggers. 

The most common medications used to treat COPD include: 

  • Bronchodilators, which usually come in inhalers and relax the muscles around the airways to make breathing easier. 
  • Inhaled corticosteroids, which help to reduce airway inflammation and prevent exacerbations. 
  • Oral steroids are sometimes used in short courses during periods of exacerbation to prevent further worsening of symptoms.
  • Phosphodiesterase-4 inhibitors are used for severe COPD. These medications decrease airway inflammation and relax the airways.
  • Theophylline may be used when other treatments are ineffective or if cost is a factor. It may help improve breathing and prevent exacerbations but can cause side effects like nausea, headache, rapid heartbeat, and tremors.
  • Antibiotics may also be used to treat respiratory infections but are generally not recommended for prevention. 

Often, a combination of these medications is used to treat COPD. Inhaled medications are taken using a device called an inhaler, which allows the medication to be absorbed straight into your lungs. If you’re prescribed a new inhaler, one of Alto’s pharmacists can walk you through how to use it.  Not all inhalers work the same way, so learning the proper technique is crucial for ensuring adequate therapy.

People with COPD are also generally prescribed a pulmonary rehabilitation program. These individually tailored programs combine exercise, nutrition advice, and counseling to prevent exacerbations, slow the progression of symptoms, and improve quality of life.

Those with insufficient oxygen reaching their blood may benefit from supplemental oxygen therapy. It involves using a lightweight, portable device to deliver oxygen directly to your lungs as needed.

Surgery may be an option for those with severe COPD, particularly severe emphysema. It’s usually reserved for when other types of treatment have failed. 

Seeking Out Support

Because breathing is so elementary, it’s easy to take it for granted. But so many of the activities we enjoy—and life itself—depend on the healthy function of our lungs. 

When breathing becomes difficult, life can change drastically, so it’s important to find support. That may mean sharing your feelings with a close friend or family member, joining a support group for people with COPD, or enlisting the help of a mental health professional. 

Above all, it’s critical to follow your treatment to avoid worsening symptoms. At Alto, we want to make getting the COPD medications you need as easy as possible, so we offer free hand-delivery, automatic savings investigations, and user-friendly medication management through our website and app. We always have a team of pharmacists on-call to answer your questions by phone, text, or chat, and we’ll even remind you when your inhaler or other medications are due for a refill, then schedule a time to drop them off. 

If you’re interested in learning more about how Alto can support your COPD treatment plan, our team is available from 9 am - 9 pm PT Monday - Friday, and 10 am - 6 pm PT on weekends; call or text 1-800-874-5881, or download the mobile app for secure messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.