When you have a chronic disease like COPD, certain drugs and medications can affect your body differently than they affect healthy adults. In fact, there is a huge number of medications that can be dangerous for people with COPD because they worsen COPD symptoms or have other adverse effects.

Some drugs, for example, can have dangerous interactions with other medications that are frequently used to treat COPD. Others have the potential to cause respiratory side effects, which can cause serious breathing problems in COPD patients with vulnerable, compromised lungs.

Although some medicines are only likely to cause minor adverse effects, there are many that can put your long-term health or even your life at risk. Even common drugs like alcohol and over-the-counter cough medications—which many people are accustomed to using without a second thought—can be risky for people with COPD.

Because of this, if you have COPD or another chronic lung disease, you need to be extra cautious about what kinds of drugs and medications you take. That means never taking anything without asking your doctor first, but also knowing what to beware of so you don't accidentally take a medicine that has harmful effects.

In this guide, we're going to discuss some common drugs and medications that pose a special risk to people with COPD and other lung diseases. Our goal is to equip you with the information you need to exercise caution, including knowledge of specific categories of drugs to look out for, and what kinds of effects they can have on people with COPD.

No matter how careful you are, it's important to be able to recognize at least the general types of drugs and medications you should avoid. You don't need to remember every drug or brand name, but learning to recognize the broader categories of potentially-dangerous substances is an important safety precaution for every person with COPD; after all, this knowledge is bound to come in handy at some point, and in the right situation it could even save your life.

Respiratory Depressants: Medications that Make it Harder to Breathe

Many different types of drugs and medications—including ones that you can pick up at your local drug store—can directly interfere with your respiratory system and your overall ability to breathe. This is a common side effect known as respiratory depression, which happens when your breathing becomes “depressed”—which means that it's slower and shallower than usual.

Some common symptoms of respiratory depression include:

• Fatigue
• Drowsiness or lethargy
• Shortness of breath
• Slower breathing rate
• Shallower breathing
• In severe cases, respiratory failure or death

Respiratory depression can range from mild to severe; it can be deadly in the most serious cases, but barely noticeable in others. Of all the medications that have respiratory depression as a side-effect, over-the-counter medications (e.g. non-prescription sleeping aids) tend to have a lower risk, while prescription medications (e.g. opoids and benzodiazepines) tend to be more likely to cause severe respiratory problems.

For healthy people, mild respiratory depression from over-the-counter medications isn't usually a concern because it's unlikely to cause much harm. For people with COPD and other chronic lung diseases, however, even mild respiratory impairment can have pronounced and potentially dangerous effects.

That's because lungs affected by COPD already perform at a sub-optimal level and struggle to work efficiently enough to meet the body's oxygen needs. Any additional impairment causes the respiratory system to fall even further behind, which further reduces the limited amount of oxygen the lungs can supply.

The Dangers of Respiratory Depression for People with COPD

If your lungs are compromised by COPD, even mild respiratory depression can make it harder to breathe, worsening symptoms like shortness of breath, fatigue, hypoxemia (reduced blood oxygen levels), and hyercapnea (excess carbon dioxide build-up in the blood). In the short term, this can interfere with your ability to sleep, exercise, and do normal daily activities; over the long term, reduced breathing efficiency caused by respiratory depression could put you at risk for more serious health complications.

It's especially dangerous to take any drugs that may cause respiratory depression at night, because your body naturally decreases your breathing rate when you sleep. Further respiratory depression from drugs or medication can be dangerous, especially if you're already suffering from a respiratory condition like COPD.

Taking respiratory depressants at night can also affect sleep apnea, a condition that causes periodic lapses in breathing during sleep and can lead to a variety of health problems over time. Unfortunately, people with COPD are particularly prone to sleep apnea, and medications that cause respiratory depression can both induce sleep apnea and make existing sleep apnea worse.

Whether it causes sleep apnea or not, respiratory depression while you sleep can slow down your breathing so much that your body gets starved of oxygen, causing your blood oxygen levels drop dangerously low during the night. Even mild nighttime oxygen deprivation can cause a variety of short-term and long-term health consequences, including increased daytime COPD symptoms and higher risk for heart disease, stroke, and dementia.

Some of the most common respiratory depressants include opoids, alcohol, and central nervous system depressants like anti-anxiety and anti-seizure medications. We'll discuss these and other common respiratory depressants in more detail in the following sections, where you'll also find helpful reference lists for each drug category so you can get a better idea of what brand names to look out for.

Central Nervous System Depressants: A Major Cause of Respiratory Depression

Many respiratory depressants are also central nervous system depressants (CNS depressants for short), a broad and loosely-defined group that include many different types of medications, including sedatives, tranquilizers, painkillers, antihistamines, hypnotics, and more. All of these medications have the ability to slow down brain activity, which induces a calming or soothing effect on the body and mind.

This effect makes CNS depressants an effective treatment for a variety of different health conditions, including sleep disorders, anxiety, panic attacks, seizures, and pain. However, because the brain is responsible for controlling such a huge range of biological functions, many CNS depressants come with serious side effects and risks.

As CNS depressants slow down the brain's activity, it can cause other bodily functions—including reflexes, respiration, and heart rate—to slow down too. This can cause side effects like muscle weakness, blurred vision, slurred speech, reduced coordination, and—you guessed it—respiratory depression.

As brain activity slows, your breathing rate can slow as well, which is a concern for people who already struggle to breathe because of a lung disease like COPD. Because of this, it can be risky to take CNS depressants if you have COPD and you should never take them unless specifically instructed by a doctor; even then, you should exercise caution and make sure you understand the risks.

CNS depressants can have side effects like blurred vision, muscle weakness, and respiratory depression.

Because the effects of central nervous system depressants stack on top of one another, it can be very dangerous—even life-threatening—to take more than one CNS depressant at a time. Doing so risks slowing down brain activity so much that vital bodily functions, such as breathing and blood circulation, shut down, risking hypoxia (a large and dangerous drop in blood oxygen), coma, and death.

You should also never combine CNS depressants with opoid medications; since both cause respiratory depression their combined effects can severely suppress your breathing. The danger is even larger for people with COPD, who have a much higher risk of experiencing serious respiratory problems when taking any two or more respiratory depressants at the same time.

Can People with COPD Take Medications that Cause Respiratory Depression?

In spite of all the dangers we've discussed so far, many doctors prescribe opoids and other medications that act as respiratory depressants to treat a variety of symptoms in people with COPD, including pain, anxiety, and shortness of breath. While taking these medications still comes with risks, respiratory depressants can be safe as long you take them in carefully-controlled doses under your doctor's supervision.

That's because many of these medications only have low risk, if any, of causing respiratory depression when used correctly on their own. However, they can quickly become dangerous or deadly if you take too high a dose, or if you mix them with any other medication you shouldn't.

Unfortunately, that is very easy to do on accident, because there are just so many prescription and non-prescription drugs—including those commonly prescribed to COPD patients— that interact with respiratory depressants to cause serious adverse effects. This is one of the major reasons why these medications are dangerous, and why you should never assume it's safe to take any drug or over-the-counter medicine without asking your doctor first.

Even if you're taking a respiratory depressant prescribed by your doctor, you should still be on the lookout for adverse effects. Alert your doctor immediately if you notice new or worsened breathing symptoms, especially if they appear after beginning a new medication.

Also, don't be afraid to talk to your doctor if you have any questions or concerns about your medications, including their purpose, side effects, health risks, and how they interact with other drugs. Your doctor is the best person to explain why he's prescribed the medication, what your personal risks might be, and whether or not there are any other treatments you could try as an alternative.

On the other hand, you should never take any medication that causes respiratory depression without your doctor's permission, even if you can buy it without a prescription. Over-the-counter medications can still have serious risks, and those risks are simply not worth taking on your own when you have COPD.

Types of Medications that Cause Respiratory Depression

Now that we've discussed the risks of respiratory depressants and why they pose a risk to people with COPD, it's time to take a closer look at some specific drugs and medications that can cause it. In the sections below, we've listed many common types of medications that can cause respiratory depression—both prescription and non-prescription—separated into categories based on their use.

Even though central nervous system and respiratory depressants are such a broad and heterogeneous group, the following sections should help you get a better idea of what kinds of drugs they include; that way, you can better recognize and avoid them in the future. This is particularly important if you are already taking one of these medications (as prescribed by your doctor), since taking a respiratory depressant significantly increases your danger of experiencing serious adverse effects from other medications.

Opoid Pain Relievers

Opoids are a common group of painkillers that are frequently prescribed to people with COPD in spite of their potential to cause CNS depression and respiratory depression. That's because they are not only effective for relieving pain, but also for relieving severe shortness of breath in people with advanced-stage COPD.

As long as it's under a doctor's close supervision, taking carefully-controlled doses of opoids is generally safe for people with COPD. However, you should still be aware of the risks and be extra diligent about your medication habits: carefully keep track of your doses, never take more than prescribed, and immediately notify your doctor if you notice any respiratory side effects.

Because opoids interact with a wide range of over-the-counter and prescription medications, you also need to be extra careful about any other drugs or medications you use. Make sure to discuss anything you're currently taking with your doctor before starting an opoid medication, and never take anything else without consulting your doctor first.

You should also take some time to familiarize yourself with some common drugs and medications that are dangerous to mix with opoids, including:

• Anti-seizure medications
• Benzodiazepines
• Sleeping medications
• Muscle relaxers, including Amrix
• Certain antibiotics, including Clarithromycin
• Certain antidepressants
• Certain drugs used to treat other psychiatric disorders, including Abilify and Closaril
• Certain antifungal medications
• Certain antiretroviral drugs
• Other medications containing opoids
• Other medications that cause CNS or respiratory depression

Common Opoid Drugs and Brand Name Medications:

• Codeine, found in a large number of pain relief, cough, cold, and flu medications, including:
• Robitussin
• Tuzistra
• Colrex
• Phenflu
• Maxiflu
• Triacin
• Floricet with Codeine
• Fiorinal with Codeine
• Soma Compound with Codeine
• Tylenol with Codeine
• Prometh VC with codeine
• Hyrocodone, also sold under the following brand names:
• Vicodin
• Lorcet
• Norco
• Tussionex
• Morphine, sold under the following brand names:
• Kadian
• MS Contin
• Morphabond
• Meperidine, sold under the brand name Demerol
• Methadone
• Dolophine
• Methadose
• Hydromophone, sold under the following brand names:
• Dilaudid
• Exalgo
• Fentanyl, sold under the following brand names:
• Actiq
• Dragesic
• Fentora
• Abstral
• Onsolis
• Oxycodone, sold under the following brand names:
• OxyContin
• Oxaydo
• Percocet
• Roxicet
• For a more complete list of opoid-containing medications, check out this guide from healthline.com.

Sedative Antihistamines

Antihistamines are medications commonly sold over the counter that are best known for treating allergic reactions like hay fever. However, certain antihistamines also have sedative effects, which is why they are often used to treat other conditions like anxiety, insomnia, and motion-sickness, and why you'll find them in most over-the-counter sleep medications.

These sedative antihistamines (also known as first-generation anti-histamines), are also central nervous system depressants that can slow your breathing rate. However, other antihistamines (known as second-generation antihistamines), such as loratadine and terfenadine (often used for everyday allergy management) are much less likely to have respiratory depressant effects.

Look out for first-generation antihistamines in wide range of over-the-counter products, including:

• Allergy medications (e.g. Benadryl)
• Cold & flu medications (e.g. NyQuil Cold & Flu Nighttime Relief)
• Sleep aids (e.g. Doxylamine)
• Motion sickness medications (e.g. Dramamine)
• Some menstrual products (e.g. Midol complete)

Common Drugs and Medications Containing Sedative Antihistamines:

• Diphenhydramine, also sold under the following brand names:
• Benadryl
• Banophen
• Siladryl
• Unisom
• Doxylamine, also sold under the following brand names:
• Equate Sleep Aid
• Unisom SleepTabs
• Equaline Sleep Aid
• Chlorpheniramine, also sold under the following brand names:
• Chlor-Trimeton
• Comtrex
• Aller-Chlor
• Chlorphen-12
• Allerest Maximum Strength
• Alka-Seltzer Plus Cold & Cough Liquid Gels
• Clemastine, sold under the brand name Tavist Allergy
• Pyrilamine
• Midol Complete
• Menstrual Relief
• Pyrlex
• Covangesic
• Histaflex
• Pamprin Multi-Symptom Menstrual Relief
• Premsyn PMS
• Dimenhydrinate, sold under the brand name Dramamine
• Cyclizine, sold under the brand names Marezine and Bonine for Kids
• Meclizine, sold under the brand names Bonine and Dramamine Less Drowsy
• You can see a more complete list of sedative antihistamines here.

Always check the active ingredient labels for all over-the-counter medications to make sure.Because of this, it's important to always check the active ingredient list on over-the-counter medications, especially combination medications.

Sedative antihistamines are also found in a wide variety of over-the-counter cold and flu medications, especially combination and night-time medications. Here are a few examples to watch out for:

• Sudafed PE Day/Night Sinus Congestion
• NyQuil Cold & Flu Nighttime Relief
• Robitussin Peak Nighttime Cold & Flu
• Mucinex Sinus-Max Day & Night
• Tylenol Sinus NightTime
• Many other combination cold & flu medications (this is not an exhaustive list)

Cough & Cold Medications

Although they might seem harmless, a large number of cough medicines contain drugs that act as respiratory and CNS depressants. Prescription cough medications often include opoid medications like hydrocodone and codeine, while over-the-counter cough medicines often contain opoid-analogues like dextramethorphan (DXM).

Because of the high risk for adverse effects, experts recommend that people with COPD avoid taking any cough and cold medications without talking to your doctor first. If your doctor approves an over-the-counter medication, make sure to carefully check the label before purchase; make sure the active ingredient list contains only the drugs you are looking for and doesn't include any unapproved or hazardous drugs.

Common Cough Medications that Can Act as CNS Depressants:

• Dextramethorphan, a cough suppressant that is sold under the following brand names:
• TheraFlu
• Nyquil
• Delsym
• Coricidin Cough & Cold
• Vicks
• Dimetapp
• Robitussin
• Benylin
• Balminil DM
• Hydrocodone, sold under the following brand name medications:
• Flowtuss
• Cycofenix
• Obredon
• Rezira
• Tussigon
• Vituz
• You can find a list of additional brand name medications containing hydrocodone in the section on opoid pain relievers above.
• Codeine (for a list of common brand name medications that include codeine, see the section on opoid pain relievers above)

If you are worried that you might have COPD, you are certainly not alone. It is a common, yet scary disease, and it's important to look out for the signs and symptoms as you age.

It's an unfortunate reality that about six percent of Americans will develop COPD at some point in their lifetime. However, many people live with the disease for many years before they get diagnosed.

The earlier you catch it, the easier it is treat and manage your COPD. Early treatment can also help you live longer by slowing down how quickly the disease progresses.

That's why it's important to pay attention if you notice the early signs of COPD. In this guide, we'll explain what those signs are and how to know when it's time to see your doctor.

First, we'll go over all the early COPD symptoms and warning signs you should look out for. Then, we'll show you how to calculate your overall COPD risk by answering a few simple questions about any lifestyle and other risk factors that could increase your chances for developing the disease.

If you'd like to skip ahead to a specific topic, click any of the following links:

• How to Recognize COPD Symptoms
• General Early Symptoms
• Symptoms Characteristic of Chronic Bronchitis
• Symptoms Characteristic of Emphysema
• Why Symptoms Often Don't Appear Until Later in the Disease
• How to Estimate Your Risk for COPD
• Smoking
• Age
• Asthma
• Respiratory Infections
• Occupational Hazards
• Family History
• Chronic Cough
• Shortness of Breath
• Should You Get Tested?

How to Recognize the Early Signs of COPD

COPD is caused by lung damage that interferes with your ability to breathe. The earliest signs are usually respiratory symptoms that start out minor but steadily get worse over time.

Remember, however, that symptoms alone are not enough to rule out or diagnose COPD. You have consider a variety of different factors in order to accurately assess your risk, including your symptoms and other risk factors related to your health, your lifestyle, and your history of smoking.

Early Symptoms of COPD

The hallmark symptoms of COPD are coughing and shortness of breath. However, there's more to it than that; COPD can cause a variety of different symptoms, and these symptoms change over the course of the disease.

It's important to know that the earliest symptoms of COPD are usually very mild and difficult to detect. It's easy to attribute these minor symptoms to something innocuous like allergies or mistake them as a normal part of aging.

According to experts, these are the most common early symptoms of COPD:

• Shortness of breath
• Excess mucus
• Other breathing difficulties
• Chronic cough
• Fatigue

You might notice that some of these ailments on that list are also symptoms of minor illnesses like the common cold. People who don't have COPD can certainly experience them, but the symptoms are temporary and go away with treatment.

On the other hand, people with COPD experience one or more of these symptoms consistently over a long period of time. COPD is a chronic disease, which means that the symptoms never truly go away, even with treatment and medication.

Every individual case of COPD is different, however, and not everyone with the disease experiences the same symptoms. What symptoms you experience, and how severe they are, depend on your individual biology, how long you've had the disease, and what kind of COPD (e.g. emphysema or chronic bronchitis) you have.

Now, lets take a closer look at each of these symptoms and how they present in people with COPD. That way, you can learn how to identify each one and how to tell whether a symptom is a sign of COPD or is caused by something less serious.

Shortness of Breath

Shortness of breath, also known as dyspnea, is the first COPD symptom that many people experience. It often starts out subtle, which is why it can be hard to notice in the early stages of COPD.

At first, you might just feel extra breathless when you exercise or do moderate-intensity activities. As it gets worse, however, it can be hard to catch your breath even during light activities like walking.

The first sign of dyspnea that many people notice is a drop in their overall exercise endurance. You might not be able to walk, bike, or do other aerobic activities as long or as intensely as you used to.

In general, people with COPD say that shortness of breath feels like struggling for air. It's often accompanied by feelings of heaviness or pressure in the chest, and the sensation that it takes extra effort to breathe.

Patients also describe dyspnea as a constricted, suffocating sensation that makes it difficult to breathe. Some COPD patients say it feels like breathing through a straw and makes it impossible to get a full, deep breath of air.

It's important to note that shortness of breath can be a sign of heart disease instead of COPD. It's easier to recognize COPD-related dyspnea if it comes with other respiratory symptoms, such as coughing and airway sensitivity.

Excess Mucus

One of the most common early symptoms of COPD is excess mucus in your lungs and airways. This causes congestion, blocks your airways, and makes it more difficult to breathe.

COPD also changes the consistency of your mucus, making it extra thick and sticky. This causes it to stick to the walls of your airways and obstruct air from flowing through.

This often first manifests as a wet, phlegmy cough or wheezing sounds when you breathe. It also traps bacteria and causes infections, which can also change the color and consistency of your mucus.

This symptom is caused by inflammation in the airways, which tends to get worse and worse as the disease progresses. This causes a chronic cough in some patients early on, but this might not show up until the later stages of the disease.

Other Breathing Difficulties

COPD can cause other uncomfortable chest and breathing symptoms besides shortness of breath. These symptoms are the result of airway constriction, trapped air in the lungs, and the fact that it takes extra effort to breathe.

For example, you might notice that your chest feels tired or sore when you breathe in and out. This happens because your breathing muscles have to work harder than usual to force air through the narrowed airway spaces.

This can also cause feelings of tightness and pressure in your chest. Some patients describe it like wearing a corset; it strains their ribs and muscles, making them hurt and making it uncomfortable to breathe.

The more severe the COPD becomes, the more the airways get narrowed and blocked, and the more effort it takes to breathe. Breathing symptoms become more frequent, persistent, and easier to trigger.

For instance, you might find that your shortness of breath gets worse when you get exposed to minor air pollutants and fumes. Things like fragrances, cleaning chemicals, and poor air quality might affect you much more than they did before.

Chronic Cough

A chronic cough is one that happens every day and lasts for months at a time. A cough is usually considered to be a strong sign of COPD if it returns frequently over the course of at least two years and doesn't respond to medication.

The cough can be wet or dry, but a wet cough is more common in people with COPD. A wet cough is a cough that brings up sputum (a mixture of mucus and saliva) from your lungs.

Certain triggers can make a COPD cough worse, such as breathing in air pollution, allergens, or second-hand smoke. The cough can also get worse when you exercise or start to feel short of breath.

The main characteristic of a chronic cough caused by COPD is that it never truly goes away. It can be managed with a proper regimen of COPD medications and other treatments, but it can never be totally cured.

Fatigue

Fatigue is a feeling of tiredness, exhaustion, or lack of energy to do normal activities. This is a common symptom of COPD that can show up in the early stages.

COPD-related fatigue is chronic, not just occasional. Everyone feels fatigued every so often, but people with COPD feel fatigued frequently, even when there's no apparent cause.

Early on, you might just notice you get fatigued more easily when you exercise or spend a long day on your feet. As your breathing problems get worse, however, you might feel fatigued for no reason and struggle to find the energy to do normal daily activities.

However, chronic fatigue can be a sign of many different things, not just COPD. It can be caused by depression, poor diet, lack of sleep, and many other health conditions.

In people who are otherwise healthy, simple lifestyle changes can often cure fatigue. However, if your fatigue won't go away and comes along with any other COPD symptoms, you should probably get tested for the disease.

Your Symptoms Might Depend on What Kind of COPD You Have

It's important to know that COPD—which stands for chronic obstructive pulmonary disease—is a generalized disorder that includes two respiratory conditions: emphysema and chronic bronchitis. Most people with COPD have both, but one condition might be more dominant than the other.

However, people with COPD generally require the same type of treatment regardless of whether emphysema or chronic bronchitis is the more dominant disease. Both conditions also tend to be caused by the same things, and lead to similar disease outcomes.

For these reasons and more, both conditions are grouped together under the umbrella term COPD and generally treated as one disease.

However, emphysema and chronic bronchitis can cause different symptoms, especially early on in the disease. It's also important to remember that each individual case of COPD is different, and different people experience different symptoms for a variety of different reasons.

However, it can be helpful to distinguish between emphysema and chronic bronchitis in many cases. Here is a quick overview of both conditions, their symptoms, and how the early signs tend to appear.

Chronic Bronchitis

Chronic bronchitis is caused by chronic inflammation in the larger airways in your lungs, called the bronchial tubes. It is usually caused by inhaling smoke or other respiratory irritants repeatedly over a long period of time.

People with chronic bronchitis have bronchial tubes that are easily irritated and inflamed. This triggers the airways to secrete extra mucus in an attempt to flush out whatever particles or bacteria that might be causing the inflammation.

Because of this, the main and earliest symptom of chronic bronchitis is excess mucus in your airways. This mucus is thicker and stickier than healthy mucus, which makes it cling to the walls of your airways and resist coming out.

Chronic bronchitis also causes changes to the tissue that lines your airways. It causes the walls to thicken, narrowing the available space inside, and paralyzes the tiny cilia that are responsible for moving mucus out of your lungs.

The result is that thick mucus builds up in the airways, blocking air from easily flowing through. As your body attempts to get the mucus out, it triggers a chronic cough that often brings up sputum (a mixture of saliva and mucus).

However, the combination of narrower airways and the lack of functional cilia makes it impossible to clear all the mucus out. This causes the airways to get narrower and narrower, making it more and more difficult to breathe.

This causes frequent shortness of breath that gets worse when you exercise but can happen even when you are at rest. It can also cause wheezing and a feeling of tightness in your chest when you breathe.

Another distinct symptom of chronic bronchitis is repeated lung infections, such as pneumonia. This happens because the mucus that stays stuck in your airways creates an environment where bacteria can multiply and thrive.

Here's a quick summary of the most common COPD symptoms associated with chronic bronchitis:

• Chronic cough
• Wet cough with sputum
• Excess mucus production
• Wheezing (especially during physical activity)
• Fever (from lung infections)
• Symptoms that come and go

Emphysema

Unlike chronic bronchitis, which is caused when your larger airways get obstructed, emphysema (PDF link) is caused by direct damage to the air sacs—or alveoli—in the lungs. This damage usually occurs because of repeated inflammation, most often caused by breathing in smoke.

Emphysema causes the alveoli to change so that there are fewer air sacs and less surface area to absorb oxygen. This is a process researchers call “airway remodeling,” and the result is that the damaged alveoli cannot function as well.

The damage spreads and gets worse over time, making it more and more difficult for your lungs to absorb enough oxygen when you breathe. It also causes the lung tissue to become less elastic, preventing the air sacs from deflating all the way when you exhale.

One side-effect of this is that stale air gets trapped in the lungs, a symptom that's characteristic of emphysema. This leaves less space for fresh, oxygen-rich air, and makes it difficult for the lungs to completely deflate.

Over time, this causes the lungs to expand, or hyperinflate, in an attempt to make more space for fresh air. However, this forces the lungs to work harder to push even more air out with every breath.

This ultimately weakens the lungs and puts extra strain on the muscles you use to breathe. Over-inflated lungs also cause uncomfortable chest pressure and discomfort because they press on the chest cavity.

As the lungs continue to lose their ability to process air and absorb oxygen, classic COPD symptoms like dizziness and shortness of breath get worse. This leads to low blood oxygen levels, which causes physical symptoms like headaches, fatigue, and blue or grey fingernails.

However, symptoms of low blood oxygen levels tend to be more common in people with emphysema than chronic bronchitis. That's because the alveoli responsible for absorbing oxygen are damaged, which puts a hard limit on the amount of oxygen the lungs can absorb at a time.

This causes the body to get deprived of oxygen easily, especially after physical exertion. This lack of oxygen can have noticeable effects on the brain, causing mental fogginess, dizziness, reduced alertness, and even problems with memory and concentration.

Here's a quick summary of the most common COPD symptoms associated with emphysema:

• Shortness of breath
• Fatigue
• A blue or grey tint to the fingernails (or lips)
• Fogginess and reduced mental alertness
• Difficulty doing tasks that require focus and concentration
• Chest pressure and discomfort

It is important to note that blue or grey fingernails and blue-tinted lips are very specific symptoms of oxygen deprivation. If you experience any of these symptoms, you should see your doctor right away.

Blue fingernails and lips can also be a sign of other health problems besides COPD, such as heart disease or congestive heart failure. However, it is sometimes difficult to tell the difference, since heart disease and COPD are very strongly linked.

In people with COPD, these symptoms of oxygen deprivation are almost always accompanied by noticeable breathing symptoms. If you experience blue fingernails along with shortness of breath or a chronic cough, this is a very strong indicator that you have COPD.

If you are interested in learning more about the differences between emphysema and chronic bronchitis, check out this comprehensive guide we posted previously on this blog.

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Many People With COPD Don't Experience Symptoms Until Later on in the Disease

The lungs are vital organs for survival, and they are very resilient. They are pretty good at functioning and providing your body with oxygen even when conditions aren't ideal.

Because of this, COPD doesn't usually affect you in a noticeable way until the disease has already done a significant amount of damage to your lungs. In fact, research suggests that most people with COPD lose about 50-70% of their lung function before the first breathing symptoms appear.

That's because COPD is chronic, progressive disease, meaning it slowly gets worse over time. It is caused by repeated lung inflammation—most often from smoking—that gradually damages your lung and airway tissue over the span of many years.

When your airways become too obstructed or too many of the tiny air sacs in your lungs have been damaged, that's when breathing problems start. At that point, the lungs have so little healthy tissue left that they are struggling to absorb enough oxygen to meet your body's needs.

Noticeable symptoms start when the lungs can no longer compensate for the damage they've sustained. At first, your symptoms may only flare up when your lungs have to work harder than usual, such as when you do strenuous physical activity.

The first signs might be losing your breath more quickly when you exercise, or finding that activities that used to be easy now leave you struggling for air. Another early sign is a excess mucus in the airways, which can result in a wet, chronic cough.

What if You Have COPD But Don't Have any Symptoms?

It is certainly possible to have COPD and not show any symptoms, especially in the earliest stages of the disease. Even when symptoms do begin to show up, they are often ignored or misdiagnosed.

Unfortunately, it's generally impossible to diagnose COPD until noticeable lung damage has occurred. Before that point, the damage is mostly hidden and difficult to detect.

By definition, you have COPD when you score an 80 percent or less on a specific lung function test called spirometry. This test measures your ability to force air out of your lungs, and it's a good measure of how obstructed your airways are.

It usually takes many years for your lung function to decline to this level, which is why most people aren't diagnosed until they are over the age of 40. However, spirometry tests can still catch COPD earlier than other methods, since it can detect reduced lung function even it starts to cause symptoms.

If you are worried you might have COPD, the only way to know for sure is to get tested by your doctor. Unfortunately, even if your test is negative, there is no way to know for sure if you will develop COPD in the future.

However, you can estimate your overall risk for developing the disease.

How to Estimate Your Risk for COPD

If you are worried that you or someone you love might have COPD, there are some simple ways you can estimate the risk on your own. While this isn't a substitute for going to the doctor, it can help you decide whether or not you should get tested for COPD.

All you have to do is answer some basic questions about your health, lifestyle, and any respiratory symptoms you experience. Your answers will reveal whether or not you have any major COPD risk factors and give you a better idea of how likely you are to develop the disease.

Do You Smoke Now, or Have You Ever Smoked in the Past?

People with a history of smoking are more likely to develop COPD and more likely to die from the disease. In fact, the vast majority—up to 90 percent—of COPD cases are caused by smoking.

That's why “do you smoke” and “have you ever smoked” are usually the very first questions a doctor will ask a patient suspected of having COPD. The length of time that you've smoked, the number of cigarettes you've smoked, and whether or not you've quit smoking all influence your risk.

Your risk is higher the more cigarettes you smoke and the more years you have been a smoker. Women smokers are also somewhat more likely to develop COPD than men who have smoked for the same length of time.

Quitting smoking, however, can reduce your risk for both developing the disease and dying from COPD. The earlier you quit the better, and the risk is lower if you haven't smoked for at least ten years.

Even if you end up developing COPD anyway,

If you have COPD, your number one responsibility as a patient is to do what your doctor says and take all your medications as prescribed. This might sound simple on the surface but, in reality, it's much easier said than done.

Like most chronic diseases, COPD is not an easy condition to treat. Many COPD patients have a laundry list of medications and other treatments they have to manage every day.

These medications and treatments are life-saving; they make it easier to breathe and help keep serious COPD symptoms and complications under control. Unfortunately, far too many people with COPD don't take their medications as correctly and consistently as they should.

That's why we've created this guide to show you a variety of practical tips and techniques for managing COPD treatments. We'll show you all the steps you need to take to make sure you use your medications correctly and how to avoid common COPD treatment mistakes.

The more you know about your treatments, the more active role you can take in your health, and the better you will be able to manage your disease. That's why it's important to learn everything you can about your COPD medications and how to use them in the most correct and effective way.

Most People are Bad at Taking Their Medications

How well you take your medications and do the treatments your doctor recommends is a concept known as treatment compliance or medication adherence. Good compliance or adherence means that you follow your doctor's instructions, complete all your treatments, and take all your medications correctly and on time. Poor compliance or adherence simply means that you fail to do at least one of those things consistently.

Unfortunately, a large percentage of people in just about every health and disease category fail to take their medications properly. This is a problem that affects older adults in particular; up to 58% of seniors make mistakes when taking their medication, and more than 25% make a serious mistake.

Studies also show that as many as 63 percent of COPD patients don't take their medications correctly, and that percentage may be even higher if you include improper inhaler use. This high failure rate results in a great deal of unnecessary suffering for those who don't take their medication as prescribed.

In many ways, these statistics are understandable, even as they are still a major cause for concern. COPD treatment regimens can be confusing, time-consuming, and involve many types of medications, which makes them particularly challenging to get right.

COPD Treatment Plans are Complex

COPD is not a static disease; the symptoms get steadily worse over time and they can vary from day to day. What's more, the risk of exacerbation is always around the corner, especially in the later stages of the disease.

Because of this, COPD treatment plans usually change several times over the course of the disease. Many people with COPD also have to follow dynamic treatment plans that involve adjusting their daily treatment according to certain symptom changes.

This type of treatment plan—known as a COPD action plan—helps you keep your symptoms under control when they flare up. However, it also makes treatment more complex and introduces more opportunities to do things wrong.

COPD patients also have a high risk of making mistakes simply because of the sheer number of treatments they have to manage. It's not uncommon for someone with severe COPD to have to take half a dozen medications in addition to supplemental oxygen therapy.

It's Easier to Mess Up Than It Is to Do it Right

When it comes to taking medications, there's a lot that can go wrong. It's easy to make mistakes without realizing it, such as taking the wrong dose or using an empty inhaler.

Every step and instruction for taking your medication is important, and there can be a lot of them to remember. But skipping even one of them can have dangerous consequences that range from worsened symptoms to life-threatening complications.

Unfortunately, people with COPD tend to take medications that are particularly difficult to use, including inhalers, nebulizers, and supplemental oxygen therapy. Doing these treatments correctly can be a difficult skill to master, requiring several steps and precise technique.

Keeping up with these complex treatments is even more challenging for those who are struggling with serious physical or mental symptoms caused by COPD. When you are struggling just to get out of bed, go up the stairs, or remember things, having to adhere to a strict schedule of multiple medications and treatments can be a lot to handle.

What Happens When You Don't Use Medications Correctly: Does it Really Matter?

At this point, you might be wondering if it's really that big of a deal if you don't follow your treatment or medication instructions exactly. The answer is yes, it is a big deal if you don't adhere to your treatment consistently.

You shouldn't mistake the fact that poor treatment compliance is so common for meaning that it's nothing to worry about. It's actually a major issue, which is why COPD doctors and researchers have dedicated so much time and effort to understanding and solving this problem.

However, nobody is perfect, and there's usually no reason to worry if you only make a mistake every once in a while. On the other hand, you should always make it a top priority to take your medications on time and adhere to all the other treatments your doctor prescribes.

If you don't comply with treatment or forget to take your medication too often, it can make it much more difficult to control your symptoms and manage your disease. This leads to worsened breathing problems, exacerbations, and other COPD complications that can hurt your quality of life.

For instance, one study showed that COPD patients who didn't use their inhalers correctly had worse symptoms, including coughing and more severe shortness of breath, than patients who practiced proper inhaler technique.

Other research shows that poor medication adherence can have a variety of serious consequences, including:

• Less ability to control COPD symptoms
• Increased shortness of breath
• Increased risk for COPD exacerbations
• Increased risk of death (poor treatment adherence can double or triple your mortality risk)
• More frequent hospitalizations
• Increased health care needs and disease-related costs
• Reduced quality of life

Even things that seem minor, like skipping a step when you use your inhaler, can have a major effect on how well your medication works. You could end up getting too small a dose, too large a dose, or not getting any medication at all.

In some cases, using medications incorrectly can cause dangerous side effects or life-threatening complications. If your supplemental oxygen flow is not set right, for example, it can lead to dangerous breathing problems, including severe hypercapnea (high blood carbon dioxide levels) and death in the most extreme cases.

Are You a Compliant Patient?

When you're taking several medications and have a complex disease, it's normal—and even expected—to make small mistakes here and there. However, those mistakes should be few and far between, and overall you should be following your treatments exactly as prescribed.

Unfortunately, many people don't even realize how poorly they are complying with treatment or how frequently they make mistakes. You might make more mistakes than you realize, which is why it's important to give it some serious consideration.

You can get a better idea of your overall compliance by answering a few yes or no questions about your medication habits. The following questions are part of the Medication Adherence Questionnaire (PDF link), a scale that is used often by doctors and researchers to measure how well a patient is adhering to their medication.

To use this scale, choose either “yes” or “no” as an answer to each question or statement. Choose the answer that is most accurate based on your actions and beliefs during the past week.

Medication Adherence Questions:

• Do you ever forget to take your medication?
• Are you careless at times about taking your medication?
• When you feel better, do you sometimes stop taking your medication?
• Sometimes if you feel worse when you take the medication, do you stop taking it?

If you answered yes to any of these questions, then you probably aren't taking your medication as consistently and correctly as you should. The more questions you respond “yes” to, the poorer your medication adherence is.

You can use these questions to help you identify where things are going wrong, and use that insight to find solutions. You should also tell your doctor if you're having trouble taking your medications as prescribed for any reason; this will not only help your doctor make better decisions about your treatment, but will also give your doctor the opportunity to offer solutions and advice.

Common COPD Medication Mistakes to Avoid

We've talked already about how poor treatment adherence is alarmingly common among people with COPD. However, we haven't talked much about what kinds of mistakes patients are making and what exactly they are failing to do.

Research shows that there are several specific areas of treatment that tend to be the most problematic, including taking medication consistently and using proper inhaler technique. If you or someone you love has COPD, it's important to be aware of these common problems so you can avoid making the same mistakes.

Taking Medications Based on How You Feel

One common, yet dangerous, mistake that patients make is stopping their medication when their COPD symptoms start to get better. Some people think that, because they feel fine, they don't need to continue taking their medication.

However, this is not true; you should always take your medication exactly as your doctor tells you to, regardless of how good or bad your COPD symptoms are. If you notice your symptoms improve, you should take it as a sign that your medication is working, and continue to take it as prescribed.

It's important to trust your doctor's advice and remain diligent about your treatment, even if you sometimes feel like it's not necessary to take your medication. If you have any problems or concerns, bring them up with your doctor instead of trying to take things into your own hands.

You need to take your medications consistently every day in order to keep your symptoms under control. Reducing your dose, stopping your medication, or taking it inconsistently will only make it more difficult to manage your disease.

Not Reading the Instructions

When you pick up your medication from the pharmacy, it usually comes with a packet of papers with detailed information about your medicine. Many people simply ignore this packet or throw it in the trash as soon as they get home.

However, this packet contains all kinds of valuable knowledge meant to help you take your medicine correctly and avoid dangerous mistakes. While it might seem like a lot to go through, you should take the time to read through the whole packet for each medication you take.

If you don't, you could miss vital health warnings or important information about dosages, side-effects, drug interactions, and more. It's also a good idea to keep these information packets in a file at home in case you need to reference them later.

Medical stuff can be tricky, however, and reading about your medication will only help you if you understand what it means. That's what your doctor and pharmacist are there for; they can help you go through the information and explain anything else about the medication that you need to understand.

Not Using Your Inhaler Correctly

Even though inhalers are the main line of treatment for COPD symptoms, the vast majority of people don't actually use them correctly. The numbers are actually quite alarming: up to 90% of COPD patients fail to use proper inhaler technique.

Research also shows that improper inhaler use can significantly affect how well the medication works. It can worsen respiratory symptoms, increase your risk of being hospitalized, and may even double your chances of developing a COPD exacerbation.

Here is a list of some of the most common inhaler mistakes you should avoid (note that some only apply to certain types of inhalers):

• Not using the spacer correctly
• Using an empty inhaler (e.g. not checking the dose counter or making sure there is a spray)
• Not priming the inhaler before use
• Not exhaling before taking a dose
• Not inhaling at the correct time when taking a dose
• Inhaling too quickly
• Not aiming the inhaler correctly (it should spray toward the back of your throat)
• Not holding your breath after taking a dose
• Not using correct head and body posture
• Not rinsing out your mouth after using a steroid inhaler

All of these mistakes can affect your dosage and how well your medication works. That's why it is vital to learn how to use your inhaler correctly and avoid making blunders like these.

Not Using Oxygen As Often As You Should

Poor treatment compliance is a major issue among people with COPD who use supplemental oxygen therapy. This is often due to inconvenience, discomfort, and worries about how it might look in public.

Research shows that a large percentage COPD patients who use long-term supplemental oxygen therapy use oxygen for fewer hours per day than their doctor prescribed. Another 23% of patients refuse to ever use their oxygen outside their homes, in spite of their doctor's instructions to do so.

But even though oxygen therapy can be difficult and uncomfortable, it's very important to use it exactly as you're supposed to. If your doctor prescribes it, then you need it to keep your blood oxygen levels from dropping dangerously low (a condition known as hypoxemia).

Failing to use oxygen correctly will worsen hypoxemia, which can lead to serious health conditions including heart problems, cognitive impairment, respiratory failure, and even death. That's why it's imperative to use your oxygen, and use it correctly, despite how challenging it might be.

It's easy to focus on the negatives, but you should instead try to focus on the fact that oxygen is a life-saving medication that can make your life better rather than worse. It's not always easy to integrate oxygen therapy into your life, but for many people it is a necessary part of treating COPD.

Not Using a COPD Action Plan

Any person who takes medication for COPD should have a proper COPD action plan. This ensures that you always have a clear set of instructions to guide you when taking your daily medications and treatments.

COPD treatment is rarely simple, which is why verbal instructions from your doctor and basic medication schedules aren't enough; you need a clear and thorough written plan. If you don't have a proper COPD action plan to guide you, you will be much more likely to take your medication incorrectly and make other risky mistakes.

Unlike a simple medication schedule, an action plan is dynamic; it tells you how to treat your symptoms based on how severe they are that day. It is essentially a set of several medication schedules with instructions for how and when to use each one.

For example, you would have a plan for typical days, when your symptoms are at baseline, and a different plan for atypical days when you feel worse than you usually do. Each plan tells you which medications—and how much—to take, as well as how you should adjust your activity level and other treatment-related advice.

Once you have an action plan, it's important to make sure you understand it and remember to follow it every day. That means means paying close attention to your symptoms, knowing how to choose the right plan, and knowing what the instructions in each plan mean.

To learn about COPD actions plans and see some examples of what they look like, take a look at our guide on the topic here.

Important Things to Know About Your Medications

In order to take your medications properly, you should have a thorough understanding of each medication and treatment you use. That includes basic things like the correct way to take your medications and how much you're supposed to take, and more detailed information like any interactions they have with other drugs and medications.

Ideally, most of the practical information you need to know about your medication should be included in your COPD action plan. However, your action plan is simply an overview of your treatment, and it won't give you all of the detailed information you need to use your medications responsibly.

The more you learn about your medications, the less likely you are to make errors that could affect your medication or put your health at risk. Here's a quick overview of what you should know and where to get the information you need.

Know the Name and Purpose of Your Medication

First of all, it's important to know the name and the general purpose of each medication you take. In other words, you should be able to answer the following questions: What is your medication called, what do you take it for, and what is it supposed to do?

You need this knowledge to understand your treatment plan and why you need to take your medications. It will also help you better communicate with your doctor and others about your treatment.

Fortunately, this kind of basic information is generally easy to find. You can get it from your doctor, your pharmacist, your prescription info packet, or the information printed on medication bottle or packaging.

However, it's best to get this information first hand from your doctor, who can explain the purpose of your medication in easy-to-understand terms. He can also help you understand how the medication benefits your specific condition, and what kinds of outcomes you can expect.

Know Your Dosage and Frequency

Dosage is everything in medicine; if you get too much or too little of a medication, it can significantly change its effects. That's why, in order to take your medication correctly, you need to know exactly how much medicine you're supposed to take.

This is known as your dosage, and getting it right is vital for ensuring your medication works as it should. Your dose frequency is also important, which simply means you need to know how long you're supposed to wait between each dose.

For example, your medication instructions might say to take a dose every certain number of hours, or give you a maximum number of doses you can take in a 24-hour period. Your doctor might also give you more specific instructions for how often you should take your medication every day.

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Know When to Take Your Medications

In many cases, you should take your medication at a specific time every day. For example, your doctor might tell you to use your daily inhaler right after you get up in the morning.

These time-based instructions are important to know and follow, because when you take your medication can affect how well it works. It's also important to keep the dose schedule for each different medication straight; that's where having a detailed medication schedule really comes in handy.

You also need to know when to take medications that are reserved for specific circumstances, such as when your symptoms get worse. You'll likely have a set of medications to take every day (e.g. long-acting bronchodilators), medications you can use as-needed (e.g. a short-acting rescue inhaler), and a set of medications you're only supposed to use when you notice the signs of an oncoming exacerbation (e.g. antibiotics and corticosteroids).

Make sure you know the differences between all these different medications, and know when to use them per your COPD action plan. Pay special attention to as-needed medications like rescue inhalers (and sometimes supplemental oxygen), which can be particularly tricky to use correctly.

Know What to Do if You Miss a Dose

No matter how careful you are, you're bound to accidentally miss a dose sooner or later. Whenever that happens, you'll need to know what to do next.

For example, let's say you just realized that you forgot an inhaler dose that you were supposed to take earlier. Should you go ahead and take the missed dose now, or wait until the next dose you have scheduled?

The answer will likely depend on a variety of things, including the type of medication and how long it's been since the missed dose. If you ask your doctor, he can tell you what to do in a specific case, and how to handle similar situations in the future.

The information that comes with your medication may also give you advice for what to do when you miss a dose. Whatever you do, it's b

Inhaled medications form the backbone of COPD treatment, and they're vital tools for keeping the respiratory symptoms of COPD under control. If you're like most people with COPD, you probably have at least one inhaler to help you manage your symptoms at home.

COPD inhalers come in many different shapes, sizes, and brands, each with their own unique dosages and medicine combinations. Most of these inhalers fall into one of three main types: maintenance inhalers (for daily use), rescue inhalers (for as-needed use), and steroid inhalers (for reducing exacerbations).

Many people with COPD use more than one type of inhaler, especially those whose symptoms are continuous and at least moderate in severity. In fact, typical treatment for the more advanced stages of COPD includes a daily maintenance inhaler, for baseline symptom control, and a rescue inhaler for quick relief when symptoms get worse.

But despite the fact that these medications are such an integral part of COPD treatment, many patients who use inhaled medications don't really understand how important they are or even how they work. That's why we've created this guide to tell you all about COPD inhalers, including how they affect your lungs and how they help your manage your disease.

In this post, we're going to go over the two main types of inhalers used to treat COPD—maintenance inhalers and rescue inhalers—to explain what they do, how they differ, and how they fit into COPD treatment as a whole. We'll also explain how these medications actually work inside your body that makes it easier to breathe.

If you or someone you love has COPD, it's worth taking the time to learn as much as you can about these key COPD medications, even if you're not taking them yet. After all, knowing what to expect can make it easier to adjust as your COPD symptoms, prescriptions, and COPD treatment needs inevitably change over time.

Learning about your medications and familiarizing yourself with these treatments can even help you use your medications more effectively and be more pro-active about managing your disease. The more knowledge you have, the easier it will be follow your COPD treatment plan, understand your medication instructions, and avoid common medication mistakes.

COPD Inhaler Basics: What Do They Do & Why Are They Important?

Because COPD has no real cure, the main purpose of most COPD medications—including COPD inhalers—is symptom management. That is, COPD medications can be used to reduce, delay, or prevent the negative symptoms (especially respiratory symptoms) caused by COPD, even if they can't fully stop or get rid of the disease

As we mentioned before, there are three main types of COPD inhalers, and each uses a different type of medication or combination of medications. Each medication is designed to target specific biological processes in the lungs and airways, and how they alter those processes determines their specific therapeutic effect.

These are the three main categories of COPD inhalers:

• Rescue inhalers use short-acting bronchodilators, a type of medication that works very quickly to relax and open up your airways.
• Maintenance inhalers use medications known as long-acting bronchodilators, which also relax your airways but have subtler, longer-lasting effects.
• Steroid inhalers contain corticosteroid medications, which target the body's immune system to suppress inflammation in the lungs. These are mainly prescribed to reduce COPD exacerbations, and we discuss them in more detail in a separate guide.

As you can see, each type of inhaler plays a unique role in COPD treatment, which is why many patients need to use a combination of two or more types of inhalers to keep their symptoms in check. The most commonly used are the two types of bronchodilator medications, which are widely prescribed as a mainstay of treatment for people with moderate to severe COPD.

It's also important to note that some people with COPD use steroid combination inhalers, which contain both a corticosteroid medication and a long-acting bronchodilator. If you're interested in learning more about steroid inhalers, you can check out our guide on steroid medications and how they are used to treat COPD.

What Are Bronchodilator Inhalers?

The focus of this guide is bronchodilator inhalers, which include both rescue inhalers and maintenance inhalers. Both of these medications have similar effects on the lungs and play vital roles in the everyday management of COPD symptoms.

Both short-acting and long-acting bronchodilators help your airways open up wider by forcing the smooth muscles that surround your airways to relax. This effect is known as bronchodilation and it makes it easier to breathe by improving airflow to and from the lungs.

The “broncho” part of the word bronchodilation refers to the bronchial tubes, which are the main, large airways that carry air to and from the lungs. “Dilation” simply means to make something—in this case, the bronchial tubes—wider, larger, or more open.

Bronchodilation is the opposite of bronchoconstriction, which happens when the smooth muscle surrounding the airways contracts, squeezing the airways down tight and reducing the size of the space inside. Bronchoconstriction is a major cause of breathing problems in people with COPD, and it's what bronchodilator medications are mainly designed to correct.

There are two main types of bronchodilator medications: beta-2 agonists and anticholinergics, both of which come in both short-acting and long-acting varieties. Many COPD inhalers contain only one type of bronchodilator (a beta-2 agonist or an anticholinergic), while others use a combination of both.

We'll discuss these bronchodilator inhalers in more detail in just a bit, but first you need to understand why people with COPD have problems with bronchoconstriction in the first place. That's why, in this next section, we're going to give you a brief explanation of how COPD triggers the chronic bronchoconstriction that COPD inhalers are meant to relieve.

Of course, COPD is a complex disease, and there are many complex factors contributing to COPD symptoms that are beyond the scope of this guide. However, a general knowledge of how airway inflammation and constriction happen is vital for understanding how bronchodilator inhalers work

If you've learned about these topics already (perhaps from other guides in our Respiratory Resource Center), feel free to skip ahead to the section “How Bronchodilators Work in the Body to Make it Easier to Breathe.”

Airway Inflammation & Bronchoconstriction: Major Causes of Breathing Problems in People with COPD

You might already know that COPD affects not only your lungs, but also your airways, including the large bronchial tubes that carry the air to and from your lungs when you breathe. COPD causes your airways to be frequently—if not continuously—inflamed, which is one of the main causes of COPD symptoms, especially those associated with chronic bronchitis.

Bronchoconstriction is, in part, the body's reaction to this inflammation, and one of the major reasons for restricted airflow and shortness of breath in people with COPD. Inflammation also triggers the airways to produce more mucus than usual, which causes congestion in the airways that restricts even more air from flowing through.

This extra mucus is especially problematic when the airways are already constricted, because it makes it more difficult to remove the mucus from the lungs. Instead of allowing the mucus to move up and out of the airways (which is the main purpose of coughing and other mucus clearance techniques), bronchoconstriction causes the mucus to get stuck inside the narrow airspace, creating a particularly stubborn source of obstruction.

In this way, airway constriction is one of the main reasons why people with COPD experience symptoms like coughing and shortness of breath, which are the defining symptoms of the disease. The excess mucus and airway inflammation triggers the need to cough, while the bronchoconstriction and mucus obstruction makes it more difficult to breathe.

Additionally, it takes extra energy to breathe air through narrowed and obstructed airways, which wears out the muscles in your chest that you use to breathe. This breathing muscle exhaustion, in addition to bronchoconstriction, also makes it more difficult to empty your lungs completely when you exhale.

The air that you cannot push out stays trapped inside the lungs, preventing them from collapsing all the way. The stale air also takes up valuable space that's needed for the fresh, oxygen-rich air that you take in when you inhale.

This, in addition to other damage caused by inflammation, can eventually cause irreparable damage to the lungs, including a complication known as lung hyperinflation. This occurs when the lung tissue loses its elasticity, becoming too stiff to expand and collapse fully when you breathe; this essentially “stretches out” and enlarges the lungs, causing even more air trapping and making it more difficult to breathe.

All of these effects, which are largely a consequence of bronchoconstriction, are a major cause of shortness of breath and general breathing difficulties in people with COPD. Because of this, many COPD medications—including bronchodilators—are designed specifically to reduce bronchoconstriction.

In the next section we'll build on these concepts—particularly bronchoconstriction—to explain how bronchodilators work in your respiratory system to make it easier to breathe. Then, we'll discuss how long-acting and short-acting bronchodilators are used to treat COPD, including what they're prescribed for, why they're effective, and what you should know about their benefits and risks.

How Bronchodilators Work in the Body to Make it Easier to Breathe

As we've mentioned already, all bronchodilators have a similar effect, which is to “open up” or widen the space inside the airways. This reduces airway obstruction and allows air to flow through more freely, making it both easier to breathe and easier to move mucus up through the airways and out of the lungs.

This is the main way in which bronchodilators reduce shortness of breath, but they can also help mitigate other long-term complications related to airway constriction. This includes things like breathing muscle fatigue, air trapping, and lung hyperinflation.

However, the question of how bronchodilator medications are able to relieve airway constriction through biological mechanisms is a bit more complex. This is further complicated by the fact that there are three main classes of bronchodilator medications: beta-2 agonists, anticholinergics, and methylxanthines.

Beta-2 agonists and anticholinergics are the most widely used bronchodilators, while methylxanthines (such as theophylline) are sometimes also prescribed. However, the use of methylxanthines to treat COPD symptoms is somewhat controversial, partially due to their high toxicity and partially due to a lack of research and understanding of their effects.

Because of this, we're going to limit our discussion here to the two main types of bronchodilator medications: beta-2 agonists and anticholinergics. Both classes of medication work by reducing airway constriction, but they differ significantly in how they achieve this effect.

Beta-2 Agonists Bronchodilator Medications

The first major type of bronchodilator is a class of drugs known as beta-2 agonists. These medications work by activating a specific type of receptor, known as a beta-2-adrenoreceptor (or beta-2 receptor, for short), which is found in the airway tissues as well as other parts of the body.

This receptor has the ability to affect the smooth muscles in the airways; these are the same muscles that contract in response to inflammation, causing airway constriction in people with COPD. When the beta-2 receptor gets activated, it stops those smooth muscles from contracting, forcing them to relax, resulting in bronchodilation that opens up the airways and makes it easier to breathe.

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Taking a beta-2 agonist medication via an inhaler or nebulizer delivers the medication directly to your lungs and airways, where it absorbs into the cells lining the insides of your airway walls. Once inside, they can activate the beta-2 receptors in those cells, triggering airway muscle relaxation.

However, not all of the beta-2 agonist medication stays in the lungs; some of it inevitably gets absorbed into your bloodstream as well. The bloodstream carries the drug to beta-2 receptors located in other parts of body (e.g. the smooth muscle of the heart and blood vessels); this can trigger unwanted side effects like an increased heart rate and blood vessel dilation.

If you use a short-acting beta-2 agonist, this relaxation happens very quickly, providing almost instant relief from shortness of breath. Long-acting beta-2 agonists, however, work much more slowly, taking several hours to begin working, and often taking days to provide noticeable symptom relief after you first start taking the medication.

Anticholinergic Bronchodilator Medications

Anticholinergics (also known as muscarinic antagonists) are a second type of bronchodilator medication that are used in COPD treatment. It's common for anticholinergics to be combined with a beta-2 agonist in a single inhaler.

Unlike beta-2 agonists, which relieve airway constriction by triggering airway muscles to relax, anticholinergics help prevent airway constriction by inhibiting a certain signal that triggers bronchoconstriction.

This “certain signal” is produced by an important type of receptor—known as a muscarinic receptor—which is found in cells all over the body, including the lungs and airways. These receptors are responsible for triggering the parasympathetic nervous system response, which affects different parts of the body in different ways.

In the lungs and airways, the parasympathetic response does two main things, both of which make it more difficult to breathe. First, it triggers the airway tissues to secrete more mucus (causing obstruction), and second, it triggers the airway muscles to contract (causing bronchoconstriction).

Here's where anticholinergics come in; these medications work by blocking muscarinic receptors in your lungs and airways, essentially rendering them inactive. This prevents the parasympathetic response from getting triggered in the first place, thereby preventing the airway narrowing and mucus obstruction it causes.

Just like beta-2 agonists (and other inhaled medications), a small amount of the anticholinergics you breath in will get absorbed into your bloodstream, even though most of it gets absorbed in the lungs. This leads to some muscarinic receptor activation in other parts of the body, which can cause negative side effects like constipation, confusion, and an irregular heartbeat.

There are several types of both short-acting and long-acting antocholinergics, which are used in short-acting and long-acting bronchodilators respectively. The quicker-acting versions work for up to 6 hours, while longer-acting anticholinergics can work for more than 24 hours.

Bronchodilators in COPD Treatment

Long-Acting Bronchodilators: Long-Term Symptom Relief

The purpose of long-acting bronchodilator inhalers in COPD treatment is to provide long-term relief from persistent COPD symptoms, particularly shortness of breath. They're considered a cornerstone of COPD treatment, and they're one of the most frequently-prescribed medications to treat COPD.

Long-acting bronchodilators are often referred to as “maintenance inhalers” because they help control the “stable,” everyday symptoms of COPD. This helps to reduce and stabilize symptoms, and helps prevent them from flaring up, which are some of the primary goals that doctors and people with COPD strive for with long-term disease maintenance.

Long-acting bronchodilators take a while after you start taking them (up to several days or weeks) to reach full effect, but they continue working for a long time (about 12-24 hours) once they do. This makes them essentially useless for immediate symptom relief, but extremely effective for sustained, long-term COPD symptom control.

Long-Acting Bronchodilator Therapy in COPD Treatment

Some people begin long-acting bronchodilator therapy as soon as the get diagnosed with COPD, but not everyone does. Some people who get diagnosed in the early stages of the disease don't require long-term treatment (or sometimes any treatment, yet) because their symptoms are still very mild or infrequent.

However, almost everyone who has COPD will need a long-term maintenance treatment eventually. As the disease progresses and COPD symptoms become more frequent, more persistent, and more severe, many patients need long-acting bronchodilators to keep their symptoms under control.

Most of the time, if you're prescribed a long-acting bronchodilator inhaler, you will need to use it once or twice a day, every day. Because long-acting bronchodilators take so long to work, it's vital to take them consistently so they can stay active in your body throughout the day.

This is why it's important to use your maintenance inhaler on a regular schedule; it ensures that the medicine works constantly and reliably to keep your symptoms suppressed. Try to avoid skipping or delaying your daily inhaler doses and do your best to follow the treatment plan precisely.

Unfortunately, some people mistakenly believe that they only need to use their maintenance inhaler when they're actively experiencing symptoms. This misconception leads them to use their inhaler inconsistently, or to stop using their inhaler altogether when their COPD symptoms improve.

However, this can be very dangerous; it can increase your risk for exacerbations, cause your symptoms to rebound, and make it more difficult to control your COPD symptoms in the long run. That's why, if your doctor prescribes you a daily maintenance inhaler, you need to follow his instructions exactly, and never stop taking your medication unless your doctor says it's okay.

Common Long-Acting Bronchodilator Medications Used to Treat COPD

Here we've listed some of the most common long-acting bronchodilator medications used to treat COPD. The brand names are listed first, and the pharmaceutical drug name is in parentheses.

Beta-2 Agonist Only:

• Arcapta Neohaler (indacaterol)
• Brovana (arformoterol)
• Perforomist (formoterol)
• Serevent (salmeterol)
• Stiverdi (olodaterol)

Anticholinergic Only:

• Incruse (umeclidinium)
• Seebri (glycopryrrolate)
• Spiriva Respimat (tiotropium)
• Tudorza (aclidinium)

Combined Beta-2 Agonist and Anticholinergic:

• Anoro (umeclidinium and vilanterol)
• Bevespi Aerosphere (glycopyrrolate and formoterol)
• Stiolto (olodaterol and tiotripium)
• Utibron (indacaterol and glycopyroolate)

Short-Acting Bronchodilators: Short-Term Symptom Relief

Short-acting bronchodilators (also known as “quick-relief inhalers” or “rescue inhalers”) are important in COPD treatment because they can provide immediate, short-term relief from COPD symptoms. Just like maintenance inhalers, quick relief inhalers work by relaxing airway muscles to reduce airway obstruction and make it easier to breathe.

However, unlike long-acting bronchodilators, which take hours to work and require regular, scheduled doses, short-acting bronchodilators can be used as-needed throughout the day. That's because they work almost immediately (within seconds or minutes) and their effects usually wear off within just a few hours after use.

The quick-yet-temporary nature of short-acting bronchodilators makes them ideal for treating incidental COPD symptom flare-ups, such as the temporary bouts of increased breathlessness that most people with COPD experience occasionally, if not often. At the same time, rescue inhalers are not effective for long-term symptom management due to the short length of their effects.

How Short-Acting Bronchodilators are Used in COPD Treatment

Short-acting bronchodilators are often prescribed along with long-acting bronchodilators in a kind of dual therapy that works like this: The long-acting bronchodilator manages the baseline symptoms of COPD, reducing the risk of exacerbations and offering stable, long-term symptom relief. The short-acting bronchodilator is used for additional symptom relief, particularly for stopping sudden symptom flare-ups that inevitably occur.

However, some people with COPD are only prescribed short-acting bronchodilators and use them as the primary means to manage their symptoms.

This is most common in the early stages of the disease, when many patients only experience intermittent symptoms and thus don't need long-term symptom control. At this stage, COPD symptoms can sometimes be adequately spot-treated with quick-acting rescue inhalers whenever they occur.

Rescue inhalers are very effective at stopping sudden, severe symptom flare-ups, which can show up without warning and even be life-threatening in some situations. Because of this, if you've been prescribed a quick-relief inhaler, you should do your best to take it with you everywhere you go.

But though some flare-ups happen unpredictably without an obvious cause, many symptom flare-ups are at least somewhat predictable. For example, it's common to experience sharp increases in breathlessness during physical exertion or after breathing in lung irritants like allergens and smoke; when this happens, you'll definitely want to have your rescue inhaler nearby.

Most of the time, rescue inhalers are meant to be used during a symptom flare, especially ones that won't go away on their own. This can be particularly helpful when usual coping techniques—such as stopping to rest and using breathing technique

COPD is serious, chronic, and life-threatening disease, but it doesn't always look that way. Many people with COPD don't appear to be as sick as they are, and the worst aspects of the disease are not always visible on the outside.

This makes COPD a “hidden” or “invisible” illness in many situations, which makes it hard for those who don't have the disease to understand those who do. Because of this, many people with COPD have their struggles dismissed or misunderstood, or even downright negative responses from others who doubt or shame their illness.

These reactions can make it difficult for people with COPD to ask for help, especially for those who already struggle with coming to terms with their limitations. When they do ask for support, others around them might still resist understanding or fail to grasp the seriousness of the disease.

Unfortunately, many people with COPD rely on accommodations in the workplace and support from family and friends at home. In order to get that support, however, they first have to get past the obstacle of convincing others to accept the reality of their hidden, chronic disease.

That's why we created this guide explaining how COPD can act as an invisible illness, and how to cope with the challenges that brings. Inside, we'll discuss how to cope with the social stigma surrounding hidden illness and show you a variety of practical tools and strategies for getting support, countering common misconceptions, and communicating with others about your condition and your needs.

What is An Invisible Illness?

An “invisible illness” (also known as “hidden illness” or “invisible disability”) is any kind of long-term health problem that is difficult to see. People with invisible illnesses do not look sick or disabled to people looking in from the outside, as opposed to people with more visible health conditions, such as people who use a wheelchair or show more obvious symptoms.

Essentially, people with invisible illnesses tend to have the following things in common:

• Their condition is not obvious or visible on the outside
• Their health condition is chronic and needs long-term management (it is not an illness that can simply be “cured.”)
• They experience symptoms or other challenges related to their condition on a frequent or daily basis
• Others often have trouble recognizing or understanding their condition, symptoms, or general struggles related to their condition

The term invisible illness includes a wide spectrum of physical and mental conditions, including physical disabilities, mental health disorders, and diseases like cancer and COPD. There are so many invisible diseases, disabilities, and other hidden health conditions that it would be impossible to come up with an exhaustive list.

However, here are a few examples of invisible illnesses to put the term in context:

• Chronic Pain
• Chronic Fatigue
• Diabetes
• Arthritis
• Cancer
• HIV/AIDs
• Traumatic Brain Injury
• COPD
• Cystic Fibrosis
• Learning Disabilities
• ADHD

Many invisible illnesses are conditions that don't cause obvious, outward symptoms that other people can see. Because they don't fit many other people's pre-conceived notions of what a sick person should look or act like, they often have trouble getting others to recognize or understand their illness.

In fact, people with invisible illnesses are sometimes treated with overt suspicion or disbelief by those who doubt that their ailments are real or as serious as they say. However, it's usually a more subtle prejudice that people with invisible illnesses have to deal with the most.

This can cause a great deal of stress anytime someone with a hidden illness needs to discus their condition with others, and make it difficult for them to ask others for the help and support they need.

Unintentional, subconscious biases cause others to treat people with hidden illness differently than those who fit the stereotype of someone suffering from a chronic disease. Because the condition isn't visible, outsiders are much more likely to act insensitively, downplay their suffering, or make false assumptions about their behavior.

For example, someone with an invisible illness might be perceived as lazy or attention-seeking if they ask for special accommodations or need extra time off to rest. On the other hand, when you have an illness that others can actually see, others are more likely to realize that certain behaviors and limitations are caused by a real health condition rather than poor work ethic or a lack of good character.

Many people with invisible illnesses are used to getting insensitive comments like, “but you don't look sick” or “maybe it's all in your head,” or “shouldn't you feel better by now?” This can be extremely frustrating and discouraging for people struggling with chronic diseases who have no way to “prove” their illness or make others truly understand.

How is COPD an Invisible Illness?

Even though COPD is a serious chronic disease, many people who have COPD don't actually look sick. After all, COPD symptoms vary widely from person to person, and even more serious symptoms might not be obvious to someone looking in from the outside.

Despite the toll that COPD takes on their body, many people are able to manage their COPD symptoms well much of the time and live active, fulfilling lives that make them appear just as healthy as anyone else. Under the surface, however, they could be fighting every day against lung function decline while also dealing with all the pain, stress, and other difficulties that come with managing a chronic lung disease.

What's more, COPD symptoms are not always stable or predictable, and it's common for them to fluctuate from day to day. Symptom flare-ups and exacerbations can come out of nowhere, causing even the most well-functioning COPD patient to decline into debilitating breathlessness and fatigue.

Because of this, someone who normally only has mild COPD symptoms can suddenly get worse, or even need to be hospitalized for an extended period of time. Even minor flare-ups can take a huge toll on everyday life, turning normally-simple activities into extremely difficult tasks.

Even when close friends and family members know about the illness, it can be difficult for them to understand what the person with COPD is going through. They might appear to have their symptoms and daily life well-managed, but in reality they could be struggling with any number of less-visible symptoms, psychological stressors, and other medical challenges.

On top of being an invisible illness itself, COPD can cause other chronic conditions that are often considered invisible, including several that we listed in the previous section. Hidden ailments like chronic pain, chronic fatigue, and mental illness, for example, are all common complications of COPD.

For all these reasons and more, some people with COPD struggle with their illness much more than it appears to those on the outside. That's why it's important for others around them to understand how COPD works, and why someone with the disease might need more help and support at some times than others.

Sometimes COPD is More Hidden than Others

There are certain circumstances in which COPD is particularly unnoticeable, or especially difficult for people on the outside to understand. For example, many people find it difficult to comprehend that someone who is young or who “seems healthy” could still be struggling with a serious, chronic disease.

Misconceptions about what COPD looks like can also make others less likely to believe or sympathize with someone who doesn't show the symptoms that others' expect someone with COPD to have. Because of this, people who don't fit the classic COPD stereotype are more likely to be dismissed or misunderstood.

Let's take a closer look at some of these circumstances to better understand why they happen and how they affect people with COPD. Then, in the following sections, we'll discuss some effective strategies for overcoming these obstacles and helping others' better understand the aspects of the COPD that are not so easily seen.

The Invisible Early Stages of COPD

COPD symptoms tend to start out mild in the beginning and gradually get worse over time. These symptoms are often subtle in the early stages of the disease, but they can still have a major effect on how you feel and how you live.

For example, someone with mild COPD might have to ration their energy and take special care to avoid respiratory irritants that make them feel sick. They may also have to make major changes to their lifestyle, schedule, and living environment to accommodate their medical needs.

Still, many people with mild COPD don't look sick on the outside, even as they face the physical and emotional challenges of adjusting to life with a chronic disease. This can make it difficult for others to understand the seriousness of the disease and the huge toll it can take on your life.

When Exacerbations Suddenly Occur

If you have COPD, you know some days are worse than others, and that your symptoms can flare up without much warning. These variations are normal, but people who aren't familiar with COPD might not realize this, and wonder how you can seem fine one day but then feel very sick the next.

Unfortunately, this can cause others to be skeptical of someone with COPD who experience these ups and downs. They might think you are exaggerating or lying when you say you're not feeling well, or simply not take your pain as seriously as they would if you had a more “visible” disease.

People may also not believe that it can take weeks to recover from exacerbations, and shame someone with COPD for needing to take so much time off to rest. This causes unnecessary guilt and stress, and pressures patients who are still recovering to return to work and normal activity sooner than they should.

All of this ignorance can lead to a great deal of conflict and resentment among less-understanding colleagues, family, and friends, and colleagues. It often causes people with COPD to feel isolated and misunderstood, and can take a major toll on their social lives and careers.

Early-Onset COPD in People Who Seem “Too Young”

While most people don't get diagnosed with COPD until after the age of 40, some people develop it much earlier. In fact, it's somewhat common for the first symptoms to start between ages 30 and 40, at a time when many people would assume you are too young to get a degenerative lung disease.

In rare cases people develop COPD even earlier than that, in their twenties or even teenage years. COPD this young is usually caused by a major lung injury (e.g. severe toxic chemical exposure), or a serious genetic disease such as cystic fibrosis or AAT (Alpha-1 Antitrypsin Deficiency).

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Unfortunately, people who develop COPD early are often met with surprise or even doubt when they tell others about their condition. Even when others don't express any suspicion outright, they might be less likely to understand the severity of the disease, or be less sympathetic of their struggles.

After all, there is an expectation in most societies that younger people should be thriving, energetic, and free from serious health problems, a standard that usually isn't applied to older adults. People who don't fit that bill are often misunderstood, and may find it more difficult to get support from others.

For example, a person who appears elderly might seem more in need of help, and more likely to get assistance from others when they need it. In fact, proper etiquette often dictates that people offer help and accommodations to older adults without even being asked.

On the other hand, most people would assume that someone who is young is also healthy and doesn't need any help with physical tasks. This makes it easier to ignore or overlook a young person who is visibly struggling, and might make a young person with COPD less likely to receive assistance if they ask.

How to Make Your Disease More Visible and Get the Support You Need

In many cases, overcoming biases regarding invisible diseases comes down to communication. Because of this, it's important to learn how to discuss your disease with others effectively and get your message across in a clear and compelling way.

It's also important to have backup when you need it, in the form of educational materials, an advocate, or even the force of the law. In the following sections, we'll show you how utilize all of these tools and strategies and more to get the support, accommodations, and visibility you deserve.

Communicate With Others More Effectively

Explain What You're Going Through

When you tell someone that you have COPD, there is a good chance that they will not know exactly what it is. And unless you explain it to them, there's no way for them to know how the disease affects your life.

That's why taking the time to explain your situation directly can be so valuable. It helps others better understand you and what you're going through, and helps correct any misconceptions or false assumptions they might have.

This can go a long way toward strengthening relationships and helping you feel less alone or misunderstood. It can also help avoid tensions or misunderstandings that are based on a lack of knowledge or empathy for your disease.

Of course, you shouldn't have to explain yourself to everyone; you can live your life and ask for help without justifying your illness to everyone you meet. However, in many situations, explaining your condition and what it's like for you is necessary, and it can help you build stronger, healthier, and more understanding relationships.

Here are some tips for dispelling misconceptions and helping others understand your invisible chronic disease:

• Think about what you would like people to know and understand about your health condition. When you have to explain it to someone, stick to the most important things and keep it as clear and simple as possible.
• Try to explain your symptoms in terms that others can relate to or understand. (e.g. “I feel so fatigued in the morning. It's kind of like that feeling you get after a really long, stressful day of work, only it's the beginning of the day.)
• Be specific; instead of saying something vague like “walking too much makes me breathless” you could explain more precisely how the symptom affects you. For example, you could say, “Because of my COPD, I can only walk short distances without having trouble breathing. I have to stop and take breaks often just to catch my breath.”
• You might want to take the time to directly address any misconceptions they might have or any specific aspects of your disease that people tend to misunderstand. For example, you might explain the concept of flare-ups and exacerbations so those around you won't be surprised when one comes up,
• Explain (when relevant) what your physical limitations are, and what you are able and unable to do. This lets others know what to expect from you, makes it easier for them to accommodate you, and may even help others be more patient with any inconveniences caused by your disease.

Be Explicit About Your Needs

As the common advice says: if you want something, you're not likely to get it unless you ask. That counts doubly for seeking help or support with an invisible illness like COPD.

That's why the best way to get help when you have a hidden illness is to ask explicitly for the support and assistance you need. Whether you need physical assistance, emotional support, or specific accommodations, let those around you know exactly what they can do to help.

Remember that other people can't read your mind, and they might not know you need something even if it seems obvious to you. Even if you've told them before, people forget and make mistakes, and might overlook your needs without any bad intentions.

Still, it might seem frustrating when others don't seem sensitive to your needs; for example, if someone invites you to an activity that requires more walking than you can do. But instead of getting hurt or defensive, you could try to remedy the situation with better communication.

In the present example, you could politely explain to the planner or attendees why you cannot come along, and offer to help them find a more accommodating activity for future plans. By speaking up and being pro-active, you give others the opportunity to be more inclusive and considerate of your needs.

When you ask others for help, try to make your requests as simple and clear as possible; this will make it easier and more convenient for others to oblige. You're likely to find that most people are willing to help you out when they know exactly what they can do.

Here are some extra tips for successfully asking for help:

• Take some time to make a list of specific things you need help with (e.g. small tasks around the house like cooking, cleaning, or laundry), that way you'll have an answer ready whenever someone asks you what they can do to help.
• Don't be too general or vague (e.g. “I need help around the house”); instead, give people clear, specific tasks to do (e.g. “Could you come over to help me clean up the house once every couple of weeks?)
• Try to give others flexibility to do tasks according to their availability, and try to match them with tasks that fit their abilities and schedule.
• When others are making plans or decisions that affect you, tell them if there's anything specific they can to do (or any constraints they need to consider) in order to better accommodate your needs.

Learn How to Say No

COPD can make it difficult to keep up with social activities and engagements, especially when your symptoms can flare up at any time without warning. Some days you might just not have much energy, or feel too sick to go out, which can be stressful if you have plans or commitments to keep.

It can also be difficult for friends and family to understand why you can't always participate in activities and events. However, you shouldn't let anyone else pressure you to commit to anything that you don't feel well enough to do.

That's why it's important to learn how to say no to plans and requests when necessary, even when it's difficult to do. Managing your disease, your health, and your own well-being should be your first priority, even if others find it frustrating or disappointing when you have to decline or cancel plans.

It helps to give others advance warning about your condition and explain ahead of time that you might need to cancel plans if you feel ill. That way, if you do have to cancel, it won't be a surprise, and it will be easier for others to accept and understand.

Let Someone Else Do the Talking

Refer Others to Informational Materials about COPD and Invisible Illnesses

As hard as you might try to help someone understand COPD and what you're going through, sometimes it just doesn't resonate or sink in. It can be difficult for some people to understand a disease that they've never experienced, and even harder to fathom what it would be like to live with that disease.

What's more, it can be tiring explaining your condition over and over and answering the same types of questions time and time again. Fortunately, there are all kinds of great informational resources out there that can inform others so you don't have to.

You can find books, blog posts, video lectures, and more that explain anything that you or anyone else would need to know about COPD, chronic diseases, and living with invisible illnesses. Then, whenever you need to explain your disease or your struggles to friends, family, coworkers, or anyone else, you can give them supplementary reading or viewing materials to help them learn more.

These materials can be more than just educational, however; they can make a deeper impression that goes beyond learning new information. Talented writers, speakers, and video-producers can deliver powerful, poignant messages that help others better understand and empathize with what it is like to live with a chronic disease.

Here are some examples of online resources about COPD and chronic diseases to get you started:

• The video COPD Patients and Everyday Activities demonstrates the hardships of living with COPD by contrasting how a healthy person and a person with COPD completes normal, daily activities. This video does a great job of both explaining and demonstrating what everyday life is like for many people with COPD.
• The British Lung Foundation's Youtube channel features several interviews with COPD patients who talk about their experiences and how COPD affects their lives, including this interview with Jim and this interview with Chris.
• The animated video What is COPD? explains the basics of COPD—including symptoms, disease progression, and COPD exacerbations—in a simple and easy-to-follow way, using hand-drawn cartoon figures and diagrams. https://www.youtube.com/watch?v=5fFNGH4U6mI
• The 20-page document Life is Calling: Insights into living with COPD (PDF link) provides tons of in-depth information about COPD and what it's like to have the disease. It includes many case studies, testimonials, and direct quotes from patients living with COPD.
• The article What's It Like to Live with COPD? Offers compassionate insight into what day-to-day life with COPD is like, featuring interviews with a variety of different people with COPD.
• The article 'You Don't Look Sick': What to Say (and Not to Say) to Someone With a Chronic Illness discusses some of the most common insensitive comments people with invisible illnesses hear. It also offers practical tips for how to avoid saying insensitive things and use more kind and understanding words instead.
• The articles 15 Things People Want You to Know About Living With an Invisible Illness and How to Be There for Someone With an Invisible Illnesses both contain lists of more

Whether you've tried to stop smoking before or you're just now considering it, it's often difficult to quit on your own. Fortunately, you don't have to go it alone; there are tons of quit-smoking experts, techniques, resources, and programs that can help you quit.

About 1.3 million people in the US are able to quit smoking every year, and with the right tools and support, you could be one of them! Even if you're not trying to quit cold-turkey yet, it's good to know what kind of help is out there in case you ever decide that you're ready to quit in the future.

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Utilizing public programs and other smoking cessation tools can give you the extra boost that makes all the difference in success, whether it's your first quit attempt or you've tried and failed before. For people with chronic health conditions that can get much worse when you smoke (e.g. heart disease, asthma, and COPD), an effective quit-smoking strategy could even mean the difference between life and death.

Even though it's far from easy, stopping smoking is one of the best things you can do to improve your health and prevent chronic diseases. Because of this, it's worth it to take advantage of any and all options that can improve your chances of quitting for good.

How to Use This Quit Smoking Guide

This is part one of a comprehensive, three-part guide on how to quit smoking for good. Our goal is to touch on all the important tools and strategies you need to create a successful quit-smoking plan, and to help you tackle your next attempt to quit smoking with confidence and finesse.

In this first post, we're going to introduce you to the wide variety of both public and private resources designed specifically to help smokers quit. We've included a large number of free smoking cessation tools and programs as well as some that are paid, including online support groups, counseling, mobile accountability apps, educational resources, and more.

In parts 2 and 3, we'll cover other important quit-smoking strategies and tools, including how to cope with withdrawal, how to choose a nicotine replacement therapy, and how to put together a personalized quit-smoking plan. We'll even walk you through the first steps of quitting and show you how to utilize a variety of everyday strategies to keep yourself on track.

If you are a smoker who's thinking about quitting, or you know someone who is, then the information in this guide could be a valuable resource on your journey to stop smoking.

Here are some ways you can use this guide:

• As a reference for smoking cessation programs, resources, and support
• To compare and contrast different types of quit-smoking medications and tools
• To learn what you can expect after you quit smoking
• To remind yourself of the benefits of quitting smoking
• To learn how to put together an effective and comprehensive quit-smoking plan
• To prepare for and make it through your quit day
• As a reference to a variety of different practical strategies and techniques you can use in everyday life to resist cravings and stay smoke free

But before we get started with programs and resources to help you stop smoking, let's first take a moment to address some of the things that might be holding you back. It's normal to have doubts and apprehensions about quitting, and dispelling them might make you feel better about the idea and help you strengthen your resolve to quit.

Frequently Asked Questions About Quitting Smoking

Even when you have the right tools to quit smoking, there are lots of little questions and concerns that can get in the way. Can I do it? Is it worth it? Will it even make that big of a difference in my health?

It can be difficult to plan for a major lifestyle change with all these apprehensions rolling around in your brain. That's why, in this first section, we're going to answer these and other common concerns that people have about quitting smoking.

Once you put your worries to rest, you can approach the challenge with a clearer head and open mind. Instead of dwelling on reservations, you can focus instead on the positive ways that quitting smoking can improve your life.

What if I've Tried to Quit Before, But Couldn't?

Just about everyone who smokes knows that it is not good at all for their health, and research shows that more than half of smokers have tried to quit at least once in the past year. In spite of this, most quit attempts fail, and more than 34 million people in the US continue to smoke every day.

While this might seem discouraging at first, it's important not to let the possibility of failure discourage you from trying to quit. Studies also show that at least forty percent of all adults who have ever smoked have quit, and that most people fail at least several times (or up to 30!) before it eventually sticks.

You can't ignore the fact that it's hard to quit smoking, but you can realize that failure is a normal, and potentially necessary, step on the way to success. Just because you didn't succeed last time, or even if you don't succeed this time, it definitely doesn't mean that any future attempts are doomed.

For many people, quitting smoking is a game of persistence; if you just keep at it for as long as it takes, you're bound to eventually win. The main challenge is not losing hope, and not letting slip-ups and failures derail your efforts for good.

Is it Even Worth Quitting When I've Been Smoking for Such a Long Time?

All experts agree that quitting smoking is pretty much always a good idea, no matter how old you are or long you've been smoking. Whether you're 25 or 65, you can gain a wide range of health benefits once you successfully quit.

When you stop smoking, your heart, your lungs, your skin, your nose, and many other parts of your body will benefit. It can also make you feel better in general by reducing anxiety and improving your overall mood.

In part 3 of this guide, we will discuss these benefits in more detail and give you a timeline you can use to estimate when certain benefits will appear. If you keep that section handy, or take notes on the benefits that mean the most to you, you can look over them again to remind yourself whenever you find yourself doubting whether or not it's worth it to quit.

As soon as you find the resolve to stop smoking, don't let it fade by putting it off; stopping sooner is always better because it reduces your chances of developing a smoking-related disease.

If that sounds like too much pressure, try to think of it this way: the earlier you quit, the longer you get to enjoy the benefits of living a smoke-free life!

What if I Gain Weight After I Quit?

Weight gain is a relatively common side effect of quitting smoking, usually due to an increased appetite and slower metabolism (because of the absence of nicotine). This makes some smokers apprehensive about quitting, and even turns some smokers away from the idea altogether.

It's common—and natural—to worry about gaining weight when you quit smoking, but you shouldn't let it discourage you from trying to stop. While some ex-smokers end up gaining some weight, it's far from guaranteed to happen to you.

In fact, some research suggests that the majority of ex-smokers don't gain weight after they quit. One study, for instance, found that only about 32-42 percent of study participants who quit smoking gained any weight at all.

Even those that do struggle with weight gain, however, still have many opportunities to prevent it and to lose any extra pounds they put on. As long as you think ahead, you can put a plan and support system in place to help you maintain your current weight.

For example, using a nicotine replacement therapy can prevent you from gaining weight after you quit—at least until you stop using the medication. However, this gives you some extra time to develop healthy eating and exercise strategies as you gradually taper down your nicotine dosage.

You can also reduce your risk of weight gain by working with your doctor or a quit-smoking counselor. These professionals can help you manage your weight-related anxiety and develop healthy skills and habits for maintaining your current weight.

Even if you do gain a few extra pounds, remember that it doesn't have to be permanent. The good thing about weight is that you can always lose it eventually with the right diet and exercise changes.

However, even if you gain a little bit of weight and keep it, you'll still be much healthier living a smoke-free lifestyle than you were before you quit. Instead of focusing on the potential negative side effects, think instead about all the guaranteed health benefits you will get if you quit smoking for good.

Is it Worth Quitting if I Already Have COPD or Another Lung Disease?

Quitting smoking is always worth it, at any age and in any health condition. There is pretty much no situation you could be in that continuing to smoke would ever be a good idea.

Even if you have already been diagnosed with COPD or another lung condition, your lungs will still be significantly better off if you stop smoking. Frankly, COPD makes it incredibly important and especially urgent to quit, since continuing to smoke can worsen your symptoms, cause life-threatening exacerbations, and increase your risk of dying from the disease.

While it cannot heal the damage you've already done to your lungs, stopping smoking can reduce further lung tissue damage and allow you to keep the breathing function you still have for longer. In fact, smoking cessation is one of the only known treatments that can slow down the progression of COPD.

Research shows that there are many other tangible benefits of quitting for people with COPD, including fewer symptom flare-ups, fewer hospitalizations, and a reduced risk of death. Quitting smoking can also improve your quality of life by making it easier to manage your symptoms in general

The health benefits of living a smoke-free lifestyle are simply too great to give up on, especially if you suffer from a chronic lung condition like COPD. You shouldn't let anyone or anything—including your own reservations—discourage you from trying to quit.

Quit-smoking Programs and Resources

When you decide to try to stop smoking, you don't have to start from scratch and you don't have to do it alone. Quitting for good takes a lot effort and planning, but you'll always have access to a wide variety of quit-smoking programs, support groups, and other helpful resources at every step along the way.

After all, there's no reason to re-invent the wheel when you can utilize all kinds of effective tools and resources that have already been established to help smokers quit. Between quit-smoking counseling, phone hotlines, mobile apps, online support communities, and more, you can get the advice and support you need both before, during, and long after the day you quit smoking.

In fact, there are so many quit-smoking programs and resources out there you can use, it can be hard to narrow them down! That's why we've collected some of the best quit-smoking resources from every category and put them together in this easy-to-reference guide.

There are several main types of quit-smoking programs we will cover: quit-smoking counseling, quit-smoking hotlines, online communities and support groups, structured online quit-smoking programs, and both text- and app-based programs you can complete on your mobile phone.

Text and App-Based Mobile Quit-Smoking Programs

Mobile-based quit smoking programs are a great way to get information and motivation delivered to you on-the-go. Most of them involve either receiving daily text messages or accessing quit-smoking tools and advice via a mobile application.

Here are some app-based quit smoking programs you can try:

• The QuitGuide app from Smokefreegov: This is a free application (available for both android and iPhone) packed with seriously useful tools for quitting smoking. It allows you to track things like your mood, cravings, slip-ups over time, and journal about your experiences. You can also use the app to keep track of your goals, triggers, and progress staying smoke-free, and to get tips for motivating and distracting yourself whenever you have a craving.
• The QuitStart app from Smokefree.gov: This is another free application (available for both android and iPhone) that you can use to help you quit. It provides tips for staying smoke-free, tools for tracking your progress over time, and rewards you with badges for achieving certain milestones and goals.
• QuitNet: This is a community-based support app for ex-smokers and smokers who want to quit. The free version lets you participate in the social community, where you can share advice and encouragement with others like you anywhere you go. It also provides a range of paid services including personal counseling and medical advice.

Here are some text message-based quit smoking programs you can try:

• SmokefreeTXT from Smokefree.gov: This 6-week program helps you quit for good by giving you advice and encouragement via 3-5 text messages every day (Available in English and Spanish).
• Specially Tailored SmokefreeTXT programs: Smokefree.gov offers it's quit-smoking text support program in several different versions, each tailored for different needs. You can visit their website here to sign up for one of these programs, including: SmokefreeMOM for women who are pregnant, SmokefreeTeen for young adults, SmokefreeVET for veterans with VA benefits (available in English and Spanish), and DipfreeTXT for young adults who want to stop using smokeless tobacco.
• Smokefree Daily Challenge from Smokefree.gov: If you're not quite ready to quit yet, you can try these daily text-message challenges to start building skills that can help you stop smoking.
• Smokefree Practice Quit from Smokefree.gov: If you're not ready to quit forever yet, you can use this text message program to do a “practice quit” (abstaining from smoking for just 1-5 days at a time) to help you build up resilience and work on coping mechanisms.
• You can get on-demand help by texting a specific keyword to the SmokefreeTXT program number: 47847. Text CRAVE for help getting through a craving; text MOOD for help improving your emotional state; or text SLIP if you slip up and need support to help you stay smoke free.

Online Quit-Smoking Programs and Support Groups

There are a variety of structured quit-smoking programs and support groups you can access online. These programs are open to everyone, and all you need is a computer and internet access to participate from anywhere in the world.

Most of these programs cost money, but they are sometimes cheaper than in-person classes and counseling. You might also be able to get your health insurance to pay for your online class, or you can check to see if your workplace offers any health incentives that would cover the costs of your quit-smoking program.

Here are some online quit-smoking programs you can participate in:

• The Quit For Life Program from the American Cancer Society: This is a paid online program that gives you one-on-one support to help you quit smoking. It includes an email support system, an on-demand online chat service with quit-smoking counselors, and more. You can also use their website to track your progress and network with other smokers who are participating in the program.
• Freedom from Smoking Plus Program from The American Lung Association: This is a paid online course ($99.95) that you can complete on your computer, tablet, or smartphone over the course of six weeks. It consists of nine sessions that teach you how to quit smoking with evidence-based strategies and techniques. The program also hosts an online community you can use to socialize with other participants.
• LiveHelp from cancer.gov: You can visit the LiveHelp website to get on-demand support from specialists who are trained to offer advice on how to quit smoking. (service available Monday-Friday between 9am and 9pm Eastern Time)

Quit-Smoking Phone Hotlines

Quit-smoking phone hotlines connect you instantly to experts and counselors trained in providing support to smokers who want to quit. They can help you create a quit-smoking plan, give you great tips for staying quit, and help you find other quit-smoking resources to meet your needs.

Quitlines are also a great source for in-the-moment advice and support when you need a little help or motivation to stay smoke free. If you're feeling overwhelmed or need help riding out a craving, the volunteers on the other end of the quitline are always ready to help.

Here are some quit-smoking hotlines you can use to help you quit:

• Connect to the quitline for your state: 800-QUIT-NOW (800-784-8669)
• The National Cancer Institute's Hotline (English and Spanish): 877-44U-QUIT (877-448-7848) Available between 9am and 9pm eastern time
• The American Lung Association's Tobacco Quitline: 1-800-LUNGUSA (1-800-586-4872) Available Monday-Friday between 1am and 9pm, and on Saturday-Sunday from 9am to 5pm

Quit-Smoking Counseling

Quit-smoking counseling is a great way to start your quit-smoking journey, whether you've already decided to quit or you're still struggling to make the commitment. In counseling, you'll have a trained guide to help you through the quitting process and provide you with advice and support to help you succeed.

Quit-smoking counselors can help you work through worries and other roadblocks that make it difficult to quit. They can also walk you through the process of making an effective quit-smoking plan and support you through the first steps.

Once you finally quit, your counselor can help you cope with difficulties like cravings, anxiety, and nicotine withdrawal in healthy ways. Even months after you quit, long-term counseling can help you stay on track and avoid common pitfalls and mistakes.

There are a few different types of quit-smoking counseling you can choose from:

• One-on-one therapy
• Group therapy
• Phone counseling (via quitlines or through a long-term provider)
• Online counseling (via online chat service or through a long-term provider)

Group therapy is a great way to get advice, support, and learn from other smokers and ex-smokers under the guidance of trained counselors. One-on-one therapy, on the other hand, allows you to get more personalized therapy in a much more private setting.

Phone counseling and online counseling give you access to quit-smoking therapy from the comfort of your own home. While these methods tend to be less effective than in-person counseling, they are often cheaper, more convenient, and they can still increase your chances for success.

If you want to give counseling a try, you can always talk to your doctor to learn more about counseling and other quit-smoking programs available in your area. You may also be able to find information about local quit-smoking options on the official website for your county, city, or state.

Here are some quit-smoking counseling resources to consider:

• The American Lung Association's Freedom from Smoking Clinics: These clinics offer structured, in-person group therapy courses that last for eight weeks. (Call 1-800-LUNGUSA to find a clinic near you)
• Nicotine Anonymous: Borrowing a similar format to alcoholics anonymous, nicotine anonymous hosts quit-smoking support group sessions for people all across the country. You can attend meetings in-person, online, and by phone.
• You might be able to get free or discounted quit-smoking counseling through your employer or your health insurance provider

Counseling for Other Psychiatric Problems

Many people smoke as a way to cope with other psychological issues, like anxiety, depression, and ADHD. Even smokers without a diagnosed mental disorder often depend on smoking to relieve stress, boost their mood, and cope with negative emotions.

Unfortunately, smoking is not a healthy coping mechanism, and it's important to find new, healthier strategies to get you through the day. This is especially important because withdrawal can cause your psychological problems to get worse temporarily once you quit.

If you use smoking to cope with negative moods and emotions, it's important to treat any underlying psychological issues before you try to quit. If you find a counselor who can help you both before and after you stop smoking, you'll be much more likely to succeed and you'll have better mental health.

Online Educational Resources

There are a variety of websites and guides you can access online that provide a wealth of information and practical advice to help you quit smoking. You can use them to learn more about smoking addiction, what it's like to quit smoking, and how to successfully stay smoke free.

Here are some links to some of the most useful