Antibiotics are a special class of medications that specifically target, weaken, and kill bacteria. They're one of the best tools that modern medicine has to fight bacterial infections, and they're also an important tool for COPD treatment.

Unfortunately, people with COPD get respiratory infections much more easily and more often than people with healthy lungs. Lung infections also tend to be more severe in people with COPD because they worsen already-dangerous breathing problems and elevate the risk for severe respiratory complications.

Because of this, antibiotics are a regular and familiar part of many COPD patients' treatment routines. They're used to treat lung infections like pneumonia, to manage COPD exacerbations, and even to prevent future infections and exacerbations before they occur.

That's why, in this post, we're going to tell you all about antibiotics and the role they play in COPD treatment. We'll explain how antibiotics work, how they can improve exacerbations, and discuss the various uses and benefits that antibiotics can for managing COPD.

We'll also discuss how to take antibiotics responsibly and look at some of major risks and concerns that come with frequent antibiotic use among people with COPD. Our goal is to help you better understand your COPD medications and better picture how antibiotics fit into COPD treatment as a whole.

If you'd like to learn more about other COPD medication and how they work, you can find all kinds of helpful information in our other medication guides posted to our blog's Respiratory Resource Center.

Why are People with COPD Prone to Airway Infections?

People with COPD are more prone than most other people to catching all kinds of illnesses that affect the respiratory system. This includes common viruses like the cold and flu, but also more serious lung infections like pneumonia.

At the same time that COPD patients are more likely to catch these illnesses, they are also more vulnerable to serious and life-threatening symptoms if they get sick. Because lungs affected by COPD already struggle to function effectively, they are unable to compensate adequately when a respiratory illness comes along and impairs them even more.

In fact, respiratory illnesses and infections are the main cause of COPD exacerbations, which are days-to-weeks-long episodes where COPD-related breathing problems and other symptoms get worse. Although exacerbations are sometimes mild, moderate exacerbations often require hospitalizations, and severe exacerbations can cause life-threatening breathing problems and permanent lung function decline.

Even a mild cold can cause an exacerbation, but the biggest danger often comes from the risk of secondary respiratory infections. Secondary infections happen when the respiratory system has been so weakened and overwhelmed with the first illness that it makes it significantly easier for a second illness—e.g. a bacterial illness like pneumonia—to evade the body's defense systems and start another infection.

This vulnerability is, in large part, a direct result of the disease causing damage to important disease defense mechanisms in the lungs.

One of these defense mechanisms is mucus, in particular the movement of mucus up and out of the airways. This process traps and physically removes pathogens (like viruses and bacteria) that make it into the lungs.

Unfortunately, people with COPD have narrowed, blocked-up airways that make it more difficult to expel this mucus by coughing. Their mucus also tends to be thick, sticky, and more likely to cling to airway walls than healthy mucus, which is thinner, more fluid, and moves more easily out of the lungs.

Additionally, lung damage and inflammation caused by COPD significantly hinders the function of cilia, which are important hair-like structures covering the inner walls of your airways. Healthy cilia move together in coordinated, rythmic beats, a motion that pushes mucus up and out of the lungs to get expelled.

In airways affected by COPD, many of these cilia become paralyzed so that they are no longer able to effectively move mucus out of the respiratory system. This causes mucus to stay trapped within the lungs and airways where it not only obstructs airflow, but also allows pathogens to continue growing and multiplying inside the lungs.

Because of this, people with COPD have a higher chance of getting sick from any viruses, bacteria, and other pathogens that make it into their lungs and airways. It also makes them more prone to secondary respiratory infections, as the lungs' natural defense mechanisms are further impaired by the increase in COPD symptoms.

It's also important to mention bacterial colonization, a phenomenon where some people with COPD always have a small amount of infectious bacteria in their lungs. These bacteria are not as numerous as they are during an active infection, and they usually don't cause any symptoms or actual infections most of the time.

However, colonized bacteria still have the potential to multiply out of control and trigger illness and exacerbation. In fact, research shows that COPD patients with bacterial colonization have more frequent and more severe COPD exacerbations.

When Does Someone With COPD Need to Take Antibiotics?

In general, you usually only need to take antibiotics when you have an exacerbation caused by a bacterial infection. However, since it's difficult to know the cause of an exacerbation for sure, your doctor will likely prescribe you antibiotics anytime you have an exacerbation that seems likely to have a bacterial cause.

Some doctors prescribe antibiotics for people with COPD as soon as an exacerbation starts, even when the patient doesn't have a verified infection yet. This helps stop any current infection in its tracks while also reducing the chances of a secondary respiratory infection popping up later.

In this way, the benefits of taking antibiotics during an exacerbation include reducing symptoms caused by bacterial infections and preventing more serious complications that could arise from secondary infections (even the original cause of the exacerbation is a virus). This can reduce the length of an exacerbation and increase your chances to make a full and quick recovery.

Some COPD patients take antibiotics on a regular basis, even when they're not sick or exacerbating, to help prevent future COPD exacerbations. However, this type of preventative treatment is usually reserved for COPD patients with an especially high risk for infection, such as those who are hospitalized and those who have bacterial colonization in their lungs.

How Do Antibiotics Work?

One way that antibiotics treat and prevent infections is by directly killing bacteria, usually by targeting and destroying the bacteria's protective outer walls. They can also inhibit bacteria in other ways, including by interfering with their metabolism or making them unable to reproduce.

Here are some of the main methods antibiotics use to fight bacteria:

• They can injure the bacteria's outer cell wall, which causes the bacteria to burst open and die.
• They can prevent the bacteria from absorbing nutrients, which stops them from growing and multiplying (giving your immune system the upper hand in the fight).
• They can prevent bacteria from making copies of its DNA, which stops them from multiplying.

There are many different types of antibiotics, and each works in a slightly different way. Different antibiotics also have different strengths and weaknesses against different types of infections.

Some antibiotics are very specialized and only work against a few different types of bacteria, while others—known as broad spectrum antibiotics—are effective against a much wider range of bacteria types. Which antibiotic works best for a particular kind infection depends on a variety of different factors that only your doctor can know for sure.

Here are some of the most common types of antibiotics prescribed to COPD infections and exacerbations:

• Antibiotics for mild to moderate exacerbations:
• Doxycycline (Vibramycin)
• Trimethoprim-sulfamethoxazole (Bactrim DS, Septra DS)
• Amoxicillin-clavulanate potassium (Augmentin)
• Clarithromycin (Biaxin)
• Azithromycin (Zithromax)
• Levofloxacin (Levaquin)
• Gatifloxacin (Tequin)
• Moxifloxacin (Avelox)
• Antibiotics for Severe Exacerbations:
• Ceftriaxone (Rocephin)
• Cefotaxime (Claforan)
• Ceftazidime (Fortaz)
• Piperacillin-tazobactam (Zosyn)
• Ticarcillin-clavulanate potassium (Timentin)
• Levofloxacin (Levaquin)
• Gatifloxacin (Tequin)
• Tobramycin (Tobrex)

Most antibiotics work fairly quickly; once you start a course of antibiotics, a large amount of the bacteria that cause the infection get destroyed within a couple of days. Because of this, you might start to feel better after taking just a few doses of the medication.

However, feeling better does not mean that you're cured. Until you finish the full course of antibiotics, there's a good chance that there's still some bacteria remaining, and it doesn't take much to start up the infection all over again.

That's why it's so important to complete your entire course of antibiotics down to the very last dose. As with any medication, you should take your antibiotics exactly as your doctor instructs; that means taking your medication on time, not missing doses, and resisting the temptation to stop taking the medication after your symptoms go away.

Most antibiotic treatments last anywhere from 5 days to two weeks, depending on the type of antibiotic and the type of infection it's prescribed to treat. Once you complete the full course as directed, the infection and the bacteria that caused it should be thoroughly snuffed out (with the exception of “colonized” bacteria in the lungs of some people with COPD).

Sometimes antibiotics are also used as a preventative measure, in which case the antibiotics work in very much the same way. During the time that you're taking the medication, the antibiotics attack invading bacteria as they come, thwarting any potential infection before it has a chance to take hold.

How Antibiotics are Used to Treat COPD

As we've discussed briefly so far, antibiotics are used quite often in COPD treatment, especially when someone with COPD is hospitalized or has a severe exacerbation. We've mentioned their use as a preventative treatment, as well, to prevent exacerbations and infections before they ever occur.

Now, let's take a closer look at each of these different antibiotic treatments to better understand how they're administered and how they work. Then, we'll discuss some of the major risks and side-effects of using antibiotics to treat COPD, and how frequent antibiotic use can contribute to antibiotic-resistant infections.

Treating Bacterial Respiratory Infections

Antibiotics are pretty much always used to treat illnesses caused by bacteria, including respiratory infections like pneumonia that are common in people with COPD. If you develop such an infection, taking antibiotics directly treats the cause and gives you the best chance of recovery.

However, figuring out whether or not a respiratory illness is caused by bacteria is not exactly simple; it can be difficult and expensive to test for the cause of an illnesses that's deep inside the lungs. Because of this, when COPD patients get sick, doctors often have to rely on making educated guesses about whether the exacerbation is more likely caused by a virus or bacteria.

This determination is based on a variety of different factors, including specific symptoms, exacerbation history, and changes in sputum color. In general, you're more likely (but not guaranteed) to have a bacterial infection if you have the following symptoms: a fever, a COPD exacerbation that doesn't improve with time, sputum that is yellow, green, and if your symptoms don't improve or continue to get worse over time.

Sometimes, these signs are enough to show that a bacterial infection is very likely and that antibiotics are needed. In other cases, if your doctor's not sure, he may run additional tests to look for evidence of infection, including chest x-rays and testing for bacteria in your sputum.

Here are some of the most common types of bacteria that cause lung infections in people with COPD:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
• Enterobacteriaceae
• Staphylococcus aureus
• Mycoplasma pneumoniae
• Pseudomonas bacteria

Treating COPD Exacerbations

Research shows that majority of COPD exacerbations are caused by respiratory illnesses (either viral or bacterial), with bacterial infections accounting for about half of COPD exacerbations. But without further testing, it's difficult to know whether a particular exacerbation has a viral or bacterial cause.

It's important to emphasize that antibiotics only work against illnesses and infections caused by bacteria; they can't cure anything caused by a virus or a non-bacterial cause. Because of this, doctors will usually only prescribe them to sick patients who show clear signs of a bacterial infection.

However, doctors often make exceptions for people with COPD, who are both more prone to getting respiratory infections and also more prone to developing severe complications if they do. So instead of waiting to confirm that an illness is bacterial (at which point it has already taken hold), some doctors will often prescribe antibiotics at the beginning of an exacerbation “just in case.”

However, this practice is somewhat controversial, and some experts believe that people with COPD should only take antibiotics after an infection is strongly suspected or confirmed. Limiting the frequency of antibiotic use in this way reduces the risk of antibiotic resistance (a phenomenon that we will discuss more in the following sections).

Others believe that it's helpful to prescribe antibiotics for exacerbations more generally, as a precautionary measure. This may be especially effective for patients who have a high likelihood of infection due to risk factors like bacterial colonization or a history of bacterial infections.

Some doctors will even give some patients an extra course of antibiotics to keep at home until the next time they need them, at start of their next COPD exacerbation. This allows patients to start the course as early as possible while avoiding the hassle (and potential delay) of needing to go to the doctor or pharmacy after they get sick.

Studies show that beginning antibiotics soon after the beginning of an exacerbation can have several benefits, including a higher chance for symptom improvement and even a reduced chance of death. However, some patients are more likely to benefit than others; patients who are hospitalized or have moderate to severe exacerbations seem to receive more benefits from antibiotics than those with milder exacerbations.

If your doctor prescribes you preventative antibiotics, it's important to make sure understand exactly how and when to use them, and never use them for any reason other than what your doctor prescribed them for. Make sure you know the correct medication dosage, timing, and any potential risks, and seek out your doctor or pharmacist if you have any questions or concerns.

You should also ask your doctor to write down clear instructions for all your medications in your COPD action plan. This plan should tell you exactly what to do when you notice your symptoms flaring up, including how to recognize an exacerbation, what steps (and medications) you should take when you feel sick, and when you should call your doctor if your symptoms don't improve.

Preventing Exacerbations: Prophylactic Antibiotics

Some doctors use a treatment known as prophylactic antibiotic therapy (also known as long-term, continuous, or intermittent antibiotic therapy), in which COPD patients take antibiotic medications for extended periods of time. Unlike most antibiotic courses, prophylactic antibiotics are meant to be taken even when you're not sick or experiencing an exacerbation.

The main purpose of this treatment is to reduce the risk of future exacerbations by preventing bacteria from getting the chance to multiply and infect the lungs. Of course, prophylactic antibiotic therapy cannot prevent all exacerbations, since many are caused by viral infections like the flu or common cold.

However, by helping to prevent bacterial infections, continuous antibiotics can still reduce the total number of illnesses and exacerbations a COPD patient experiences.

Research on long-term antibiotic treatment (PDF link) confirms that it can be a viable way to prevent exacerbations in people with moderate to severe COPD. Studies show that prophylactic antibiotics can increase the time interval between exacerbations, reduce the overall frequency of exacerbations, and even shorten the length of exacerbations when they do occur.

As we discussed already, however, taking antibiotics for any reason except to treat an existing bacterial infection is controversial in the medical community. Many experts believe that antibiotics should be used as sparingly as possible, since the risk of antibiotic resistance increases the more often they are used.

Because of this, most doctors avoid prescribing antibiotics for prophylactic use except in special cases where a patient shows a particular need for that extra protection. This sometimes includes “frequent exacerbators” that don't respond to other treatments meant to reduce the frequency of exacerbations.

Other COPD patients who might need continuous antibiotics include those with a higher-than-usual risk for infection, such as those with a history of exacerbations caused by bacterial infection. This also includes people who have an “infective phenotype,” meaning they show signs of long-term bacterial colonization in their lungs.

There are several different methods for prescribing prophylactic antibiotics that differ mainly on how the medication doses get spread out. Some patients take antibiotics daily (the continuous method), some take them just a few days out of every week (the intermittent method), while others take breaks for several weeks in between antibiotic treatments that last for several days (the pulsed method).

Benefits and Risks of Antibiotics to Treat COPD

There is no question that antibiotics are effective against many types of bacterial infections as long as the bacteria hasn't developed antibiotic resistance. If you have COPD and develop a respiratory infection for any reason, your doctor will almost certainly prescribe antibiotics to help you get better.

However, the role of preventative antibiotics for COPD patients are mixed, even though research shows that antibiotics can both prevent COPD exacerbations (when taken continuously), and treat COPD exacerbations (when taken soon after one begins). The main topic of dispute is not whether preventative antibiotics work, but whether or not their benefits are worth their risks.

This is a question that, for now, can only be answered on a case-by-case basis. It's up to you and your doctor to decide—based on your disease severity, infection risk, and other personal health factors—if taking continuous or preventative antibiotics is right for you.

One of the main risks of taking antibiotics is antibiotic resistance; this happens when bacteria mutate and become less susceptible to the effects of an antibiotic medication. This is a problem that affects everyone—not just those currently taking antibiotics—which is why antibiotic resistance is such a serious public health concern.

Antibiotic-resistant bacteria cause antibiotic-resistant infections, which can be very difficult to treat and recover from. In severe cases, bacteria can become resistant to multiple types of antibiotics, causing infections that are deadly or impossible to cure.

The more that people use antibiotics in general, the more prevalent antibiotic-resistant bacteria become, which increases everyone's

The primary purpose of most COPD medications is to help relieve the normal, everyday symptoms of COPD, such as coughing and shortness of breath. Steroid medications, however, contribute to COPD treatment in an entirely different way.

Corticosteroids, the main type of steroid medication used to treat COPD, are mainly used to treat COPD exacerbations, which occur when COPD symptoms temporarily get worse. Steroids don't help much with daily, baseline COPD symptoms, but they are effective for managing the episodes of abnormally severe symptoms that occur during exacerbations.

That's not to say that steroids aren't an important part of COPD treatment, because they are; managing exacerbations is an integral part of controlling COPD symptoms and slowing lung function decline. Steroid medications play a vital role on this front, as both a treatment for exacerbations and as a preventative to reduce the risk of future exacerbations.

There are two main types of steroid medications used in COPD treatment: inhaled corticosteroids (the kind you take via inhaler or nebulizer) and systemic corticosteroids (the kind you usually take as a pill). Using systemic steroids during an acute exacerbation can help you recover faster, while using inhaled steroids daily can reduce how frequently you experience acute exacerbations of COPD.

In this post, we're going to tell you all about steroid medications and COPD so you can better understand the role that they play in COPD treatment. We'll discuss how inhaled and systemic steroids differ, how they help stabilize COPD symptoms, and explain how they work in the body to combat inflammation and keep exacerbations under control.

COPD & Inflammation: An Inflammatory Disease

The main purpose of corticosteroid medications in general is to fight inflammation, and inflammation just so happens to be inextricably intertwined with COPD. Because of this, you won't be able to fully appreciate the importance of steroids in COPD treatment until you first understand the massive role that inflammation plays in the disease.

Research shows that inflammation is a defining characteristic of COPD; people with COPD have inflammation in their lungs, in their airways, and even in their bloodstreams. In fact, COPD is defined by some researchers as an “inflammatory airway disease,” and exerts believe that unchecked inflammation might be a fundamental cause of the disease.

Let's take a closer look at the relationship between COPD symptoms and inflammation to help you better understand how steroid medications help people with COPD.

Lung and Airway Inflammation

Inflammation affects many aspects of COPD, but perhaps the most obvious is the way it triggers respiratory symptoms like coughing, shortness of breath, and excess mucus build-up in the airways. In fact, many of the respiratory symptoms associated with COPD are related in some way to inflammation.

Inflammation, also known as the inflammatory response, is part of the body's natural immune response. Its purpose is to help your body recover and repair itself whenever cells are harmed by injury, irritation, or infection.

Usually, the inflammatory response is only temporary, and eventually shuts down on its own—this is known as acute inflammation. However, it can be harmful if it goes on too long—causing a condition known as chronic inflammation—and even cause serious damage to healthy tissues and cells in your body.

People with COPD have lungs and airways that stay continually inflamed, even when there's no external “reason” for the inflammation such as breathing in an irritant like tobacco smoke. This is one of the reasons why COPD symptoms don't go away even if you quit smoking (though it does have many other benefits); the inflammation—and the lung damage caused by inflammation—continues to persist even after you remove any obvious sources of lung irritation.

This chronic inflammation triggers a variety of different changes in the lungs and airways that cause COPD symptoms to appear. Many of these changes occur on the insides of the small airways in your lungs, which are called your bronchial tubes.

When the bronchial tubes get inflamed, they respond by secreting more mucus than usual. This is a defense mechanism meant to trap and neutralize any pathogens (e.g. viruses and bacteria) or other particles that make it into the lungs to prevent them from causing any further damage to lung and airway tissues.

Usually, that mucus and anything trapped in it gets moved up and out of the airways, where it eventually leaves the body as sputum: the mucus-saliva mixture that comes up when you cough. However, COPD—and the constant inflammation that comes with it—causes additional problems that make it difficult to get this extra mucus out of the airways.

First, COPD damages tiny hair-like structures (called cilia) that line the insides of your airways, which are usually responsible for moving mucus up and out of the lungs. Second, inflammation causes your airways to swell, which narrows the space inside; this causes mucus to get stuck inside the airways, causing even more obstruction that prevents air from flowing through.

All of this together results in the classic airway obstruction associated with COPD: narrowed airways and excess mucus block the flow of air, limiting how much can flow in and out of your lungs at a time. This, in turn, is a major reason for COPD symptoms: shortness of breath, chronic cough, and excess sputum production.

Inflammation also makes the airways hyper-sensitive, causing them to over-react to any irritants breathed into the lungs. This is why people with COPD are so vulnerable to pollution and other airborne irritants; even slight exposure can trigger elevated inflammation that worsens respiratory symptoms.

While inflammation is part of your immune system's defensive response, chronic, unchecked inflammation—like that caused by COPD—can actually do serious harm, causing permanent scarring and other damage to healthy tissues over time. In people with COPD, chronic lung inflammation causes permanent lung and airway damage that is largely responsible for the inevitable and irreversible lung function decline that occurs as the disease progresses.

Systemic Inflammation

Research shows that COPD-related inflammation is not just limited to the lungs and airways; COPD causes chronic inflammation all throughout the body. This type of inflammation, known as systemic inflammation (“systemic” meaning “affecting the entire body"), is measured by looking for specific substances called inflammatory markers in the blood.

Long-term, systemic inflammation can have many negative health effects, and it's associated with a wide range of chronic diseases, including cancer, diabetes, cardiovascular diseases, and autoimmune disorders. There's even some evidence that the chronic inflammation associated with COPD can raise your risk for other diseases that are characterized by chronic inflammation, including heart disease.

The severity of systemic inflammation can vary from person to person, though it tends to increase during COPD exacerbations. Systemic inflammation also tends to increase as COPD gets worse (PDF link), as patients with more severe symptoms and more advanced disease tend to have more inflammatory markers than those with mild disease.

However, researchers are not exactly sure why COPD causes systemic inflammation, or how it fits into the mechanisms of the disease as a whole. It is clear, however, that systemic inflammation is closely related to COPD symptoms, and particularly to COPD exacerbations.

Research on inflammatory markers in people with COPD shows that both airway inflammation and systemic inflammation increase during COPD exacerbations. Other studies find similar links between exacerbations and systemic inflammation, including that patients with higher levels of inflammatory markers in their bloodstream have a higher risk for COPD exacerbations along with a tendency to have exacerbations that are longer and more severe.

Inhaled Steroids Versus Systemic Steroids: A Major Difference

Before we dive into the details of how different steroid medications work, it's important to discus some very important differences between inhaled and systemic corticosteroids. Both types of steroids are used in COPD treatment, but they differ significantly in why they're used and how they work in the body.

Systemic steroids come in two different forms: the most common is an oral pill that you swallow, but in some cases doctors administer systemic steroids through an injection. Both routes cause the medication to get absorbed into your bloodstream, where it circulates through all your organs and tissues, having wide-reaching (“systemic”) effects on the whole body.

Inhaled corticosteroids, on the other hand, come in an inhaler so they can be breathed directly into the lungs and airways. This allows them to act directly on the surfaces of your lung and airway tissues, which results in much more localized effects.

Inhaled corticosteroids essentially work as topical medications; they primarily affect the lung and airway tissues that they physically come into contact with. Studies show that, unlike systemic steroids, only very small amounts of inhaled steroids actually make it into the bloodstream, significantly limiting their effects on other parts of the body besides the respiratory system.

Because systemic steroids affect the whole body, they can have a lot unintended, and potentially serious, side effects. On the other hand, inhaled corticosteroids tend to be less risky and have fewer side effects (PDF link) since they are limited mainly to the lungs.

Another major difference between these two types of steroid medications is what they're used for:

Inhaled steroids are used by many COPD patients long-term as a daily maintenance treatment to prevent exacerbations. In some, rare cases, some doctors will prescribe high-dose inhaled corticosteroids (PDF link) to patients during an exacerbation if their symptoms are not too severe.

Systemic steroids, however, are used to treat existing COPD exacerbations, and help patients recover from exacerbations faster. Unlike inhaled steroids, systemic steroids can have very serious side effects with prolonged use, which is why doctors only prescribe them for short periods of time and discontinue them as soon as the exacerbation is gone.

Inhaled Steroid Medications: For Daily COPD Maintenance and Exacerbation Prevention

Inhaled corticosteroid medications are used pretty frequently in COPD treatment because of their ability to prevent COPD exacerbations. They're almost always prescribed in combination with a long-acting bronchodilator, either in a separate inhaler or in a combination steroid-bronchodilator inhaler.

However, unlike bronchodilator medications, which are broadly used by people with COPD, steroid inhalers are typically prescribed much more selectively. Usually, they're reserved for COPD patients who show a particular need for protection from exacerbations, particularly those who have had exacerbations frequently in the past.

While bronchodilators have a direct, relaxing effect on bronchial tissues, steroid inhalers work indirectly by reducing inflammation in the lungs and airways. Over time, this can help reduce a variety of symptoms associated with airway inflammation, including coughing and shortness of breath.

Steroid inhalers can also reduce airway hyper-responsiveness, a common COPD ailment in which breathing in airborne irritants (like air pollution, allergens, and even common household cleaners) can easily trigger COPD symptoms. By inhibiting inflammation, inhaled steroids can make your airways less sensitive to these and other irritating airborne particles you inevitably encounter in daily life.

However, steroid inhalers aren't routinely prescribed for symptom relief alone, partially because they are not as reliable or effective at reducing COPD symptoms as broncodilators are, and partially because of their potential for side effects. What inhaled steroid are best at—and primarily used for—is preventing COPD exacerbations, and their ability to stabilize respiratory symptoms is more like an added bonus.

Common Steroid Inhaler Medications Used to Treat COPD (brand name in parentheses)

• Flunisolide (Aerospan)
• Ciclesonide (Alvesco)
• Mometasone (Asmanex)
• Fluticasone propionate (Flovent)
• Budesonide (Pulmicort Flexhaler)
• Beclomethasone dipropionate (Qvar Redihaler)

Using Inhaled Steroids to Treat COPD

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There are two main types of steroid inhalers used to treat COPD: steroid-only inhalers, and combination inhalers that contain both a steroid medication and a long-acting bronchodilator. Some patients use a nebulizer instead of an inhaler to take their steroid medications.

Which method or medication is best for you depends on a variety of factors, including whether the inhaled steroid treatment is meant to be temporary or a permanent addition to your daily treatment routine. It's also important to note that inhaled steroids can take up to several weeks to begin working, so you shouldn't expect any noticeable results right away.

The most common reason that doctors prescribe steroid inhalers to people with COPD is to reduce their risk for future exacerbations. Because of this, they're most often prescribed to “frequent exacerbators” and other patients who have a higher-than-usual risk for exacerbation,.

Steroid inhalers are also sometimes prescribed to patients who struggle more than others to keep their daily COPD symptoms under control. This includes patients with very severe disease symptoms as well as those who—for whatever reason—don't respond well enough to bronchodilators alone.

One of the main ways that doctors predict a patient's exacerbation risk—and thus their need for inhaled steroid medication—is by looking at the patient's exacerbation history. Research shows that past exacerbations are one of the strongest predictors of future exacerbations, though other factors also come into play.

One of those factors is a specific type of airway inflammation, known as eosinophilic bronchial inflammation, that is known to increase patients' risk for COPD exacerbations. Anyone with COPD can have this type of inflammation, but it's particularly common in those with a history of asthma.

The only way to confirm whether or not you have eosinophilic bronchial inflammation is to take a blood test that detects high levels of eosinophils in the bloodstream. Research shows that COPD patients with high blood eosinophil counts are more likely to see benefits (in the form of reduced exacerbations) from taking inhaled steroid medications.

For reasons that are not fully understood, some COPD patients respond better to oral steroids and inhaled steroids better than others. Because of this, your doctor might monitor you and your symptoms more closely for awhile after you begin using a steroid inhaler to ensure that the medication is having the desired effect.

Here is list summarizing the major risk factors associated with an increased risk for COPD exacerbations:

• Exacerbation History: The more exacerbations you have had in the past year, the higher your risk for exacerbations in the future.
• Exacerbation Recency: Because exacerbations tend to cluster, you're more likely to have a repeat exacerbation if you've had an exacerbation within the past two months.
• Exacerbation Severity: If you have had severe exacerbations in the past, you have a higher risk of experiencing severe exacerbations in the future.
• Disease Severity: Advanced COPD and severe COPD symptoms increase your risk for exacerbations.
• Asthma: People with asthma-COPD overlap syndrome (a diagnosis of both asthma and COPD) have a higher risk for COPD exacerbations.

How Inhaled Steroid Medications Work

We already know that the purpose of inhaled steroid medications is to reduce inflammation and reduce COPD exacerbations. In these next sections, we're going to dig just a little bit deeper to understand more about how inhaled steroids achieve their anti-inflammatory effects.

Inhaled steroids work by dampening the inflammatory response in the lungs, which is significantly elevated in people with COPD. This inflammatory response is controlled by the body's own immune system, and generally works like this:

The immune system triggers an inflammatory response in the lungs by telling the cells in the lung and airway tissues to produce inflammatory chemical signals. These chemical signals do two main things: they cause inflammatory immune cells to flock to the area and cause blood flow to the area to increase (causing swelling).

When you inhale a steroid medication, it absorbs into the cells of the same lung and airway tissues that produce those inflammatory signals. There, the medication essentially “turns off” the specific genes inside those cells that allow them to create inflammatory signals, reducing their ability to continue triggering the inflammatory response.

Inhaled steroids can also activate anti-inflammatory genes, which causes the cells to produce chemicals that directly suppress inflammation. Together, these effects help to reduce inflammation in the airways and make the the airways less sensitive to inflammation triggers (e.g. allergens, air pollution, and other respiratory irritants).

The reduced inflammation and reduced airway hyper-responsiveness both help to reduce COPD symptoms that stem (at least in part) from inflammation, including excess mucus production, coughing, and shortness of breath. This can help stabilize everyday symptoms and make the lungs less susceptible to increases in inflammation.

It's also important to note that airway inflammation tends to worsen significantly during COPD exacerbations, and reducing this inflammation (through oral steroids) can speed up exacerbation recovery time. This link could at least partially explain how inhaled steroids can prevent exacerbations; if using steroid inhalers continually keeps lung inflammation suppressed, it could prevent the sharp increases in inflammation that researchers believe are at least partially responsible for triggering COPD exacerbations.

However, it's important to note that COPD-related inflammation doesn't seem to respond to steroid medications as well as other inflammatory diseases like asthma (it still responds, but to a lesser degree). Because of this, there is some disagreement in the research literature about whether or not steroids can effectively reduce inflammation in people with COPD, especially those who don't have asthma-COPD overlap syndrome.

On the other hand, research suggests that using an inhaled corticosteroid might help COPD patients by directly increasing the effectiveness of long-acting bronchodilator medications. This would explain a phenomenon researchers have long observed—that combined steroid-bronchodilator therapy is generally more effective than either medication on its own.

Here's how researchers believe this phenomenon works: First, long-acting bronchodilators work by activating specific receptors in your cells called beta-2 receptors. Studies show that inhaled steroids can increase the total number of beta-2 receptors in your cells, which could allow long-acting bronchodilators to activate more receptors than they would otherwise be able to, amplifying their effects.

Unfortunately, researchers are still not sure exactly how inhaled corticosteroids reduce COPD symptoms and exacerbations on a fundamental level, though their anti-inflammatory and beta2-agonist effects of

Living with a chronic lung disease like COPD means dealing with a lot of uncertainty. This includes small, everyday uncertainties (like “will my symptoms act up today?”) and broader unknowns about the long-term future of your health.

These uncertainties are amplified by the fact that COPD is progressive, which means that the disease inevitably gets worse over time. COPD patients have to live with the knowledge that their condition will worsen without knowing when or how it will happen, or what additional complications might eventually arise.

This is further complicated by the fact that COPD is, well... complicated. Every case of COPD is different, making it difficult to predict a patient's future outcomes or get an accurate timeline for the course of their disease.

What's more, COPD symptoms tend to fluctuate frequently, often without any obvious warning or explanation. This makes it difficult for many COPD patients to interpret their symptoms, which can cause a great deal of anxiety anytime those symptoms change.

That's why we created this guide to answer the the oft-asked question, “Is my COPD getting worse?” We'll start by exploring COPD progression, including how it works and what it looks like. Then we'll show you how to tell the difference between permanent COPD progression and the kinds of temporary symptom flare-ups that affect all COPD patients, even those with “stable” COPD.

Next, we'll walk you through a series of questions and real-life scenarios that can help you evaluate the progression of your own (or a loved one's) COPD. Then, we'll send you off with some practical tips to help you take a more active role in monitoring and managing your disease.

By the end of this guide, you'll know how to spot the signs of COPD progression and how to work with your doctor to get the best possible outcomes for your disease. But before we get too far ahead, let's take a moment to examine some key dynamics COPD progression, including how it happens, why it happens, and what you can (and cannot) do to slow it down.

COPD Progression: The Unfortunate Reality of Living With COPD

COPD progression is a fact of life for COPD patients, and this naturally causes a great deal of anxiety for many people with COPD. A major source of that anxiety is uncertainty about the future—the sense of not knowing when and how the disease will worsen, or how you will deal with those changes when they come.

And while it's not possible to get rid of that uncertainty entirely, knowledge can be a powerful mitigating force. The more you learn about COPD progression, the more prepared you'll be when it happens, and less scary and unfamiliar the future will seem.

In the following sections, we're going to take a closer look what COPD progression looks like and what causes COPD symptoms to get worse over time. We'll also look at some of the ways doctors and researchers predict future COPD progression, and how certain symptoms and risk factors are linked to slower or faster progression in people with the disease.

How COPD Progression is Measured: The 4 Main Stages of COPD

Doctors have a variety of ways to measure how severe a person's COPD is and, thus, how far the disease has progressed. Methods include tracking patients' symptoms, analyzing data from lung function tests, and using other data (e.g. symptoms, exacerbations, and medical imaging) to estimate the severity of the disease.

The most common method for determining COPD progression is known as “staging” or “grading,” which is a standardized technique for ranking the severity of COPD on a scale from 1-4. The most widely-used staging guidelines (known as the GOLD Criteria) allow doctors to quickly judge a person's COPD stage based primarily on the results of simple lung function tests.

In general, COPD symptoms get more severe and more numerous as you progress upward through the stages. For example, you might start out in stage 1 with some occasional breathlessness and coughing, but then acquire additional symptoms (e.g. persistent breathlessness, coughing, and fatigue) by the time you reach stage 3.

Other data can also be used to get a more in-depth picture of a patient's condition or to pinpoint specific health problems and complications. For example, doctors can often learn specifics about a patient's lung condition and function from x-ray images, CT scans, and analyzing other tissues and bodily fluids (e.g. lung fluids, sputum, and blood).

To learn more about the different stages of COPD progression, including what kinds of challenges, symptoms, and treatments to expect at each stage, check out the following guides from our Respiratory Resource Center:

• What You Need to Know About the 4 Stages of COPD
• 6 Things You Should Know if You're Diagnosed with Stage 1 COPD
• End Stage COPD: How to Plan and What to Expect
• 11 Things You Should Do After You're Diagnosed with COPD

Why Does COPD Progress?

Unfortunately, we simply don't know a lot about why COPD progresses and why it cannot be cured. For example, we don't know exactly why some people who smoke get COPD (and continue to degenerate) while others don't.

However, we do understand many of the mechanics involved in COPD progression, even if we can't always explain why they occur. These mechanics include chronic lung inflammation and the gradual accumulation of damage to tissues in the lungs.

Most of the time, COPD occurs after long-term exposure to lung irritants (like tobacco smoke) that damage sensitive lung tissues over time. In people with COPD, those damaged lung tissues never heal completely, but instead are left weaker and even more sensitive than before.

As a result, the lungs become extra susceptible to inflammation and disease, which causes even more damage and scarring in the lungs. This triggers a vicious cycle in which the lungs are perpetually inflamed and more and more tissues get damaged, making the lungs ever weaker and more sensitive with time.

Unfortunately, there's currently no way to stop or reverse this cycle, which is why COPD is a chronic, life-long, and incurable disease. Of course, that doesn't mean COPD is untreatable; there are many COPD treatments and medications that are effective at controlling COPD symptoms and even slowing down the progression of the disease.

It's important to note that COPD progression is not a smooth or linear process; it can speed up, slow down, or move in stops and starts. Some patients have faster disease progression than others, and some people stay “stable” for months or years at a time before experiencing any significant progression or worsening of their COPD.

Can You Predict COPD Progression?

There are a number of measurable factors that can help predict the likely short-term and long-term health outcomes (or prognosis) for people with COPD. For example, there are a number of risk factors that are linked to quicker disease progression, including:

• Severe COPD symptoms
• Lack of exercise
• Poor nutrition
• Frequent exacerbations
• Frequent hospital stays
• Heart disease

By analyzing these and other factors, it is possible to make educated guesses about things like life expectancy, the speed of disease progression, and how likely you are to develop certain health complications associated with COPD.

However, making these kinds of predictions is both difficult and imprecise. You would need a trained medical expert to come up with any kind of meaningful prediction about the future of your COPD, and even then it would only be an educated guess.

If you want to know more about your COPD prognosis and/or future health risks, you should ask your doctor or respiratory medicine specialist to go over your prognosis with you. An expert who's familiar with your health history and medical records should be able to explain your future health prospects and offer some insight into what your health future might be.

Can You Slow Down COPD Progression?

There has been a lot of research dedicated to figuring out how different COPD treatment methods affect patients' long-term outcomes, including whether or not they can slow down the progression of COPD. This research has identified a number of different treatments and lifestyle changes that are associated with slower progression of COPD, including:

• Quitting smoking
• Getting adequate exercise
• Maintaining a healthy weight
• Completing a pulmonary rehabilitation program
• Minimizing exposure to lung irritants (e.g. air pollution)
• Getting early treatment
• Taking COPD medications consistently and correctly
• Keeping symptoms under control
• Avoiding illnesses and exacerbations

It's important to note, however, that while all of these factors are associated with slower disease progression, it's not always clear whether or not they are directly causing progression to slow. It's difficult to tease apart the exact nature of the relationship; for example, does having well-managed COPD symptoms cause the disease to progress slower, or does having a slower-progressing disease make the symptoms easier to control?

Hopefully, future research can give us more insight into this question and provide new avenues for slowing disease progression in people with COPD. In the meantime, however, most experts agree that you can improve your COPD prognosis by doing the following things: quit smoking, stay active, get treated by a a qualified health professional, and be diligent about taking your medications and following your doctor's advice.

If you'd like to learn more about how to slow down COPD progression and improve your long-term prognosis, check out our guide: How to Take Control and Slow the Progression of Your COPD

What's Causing My Symptoms? How to Tell the Difference Between Permanent COPD Progression, Temporary Flare-Ups, and Acute Exacerbations of COPD

As we mentioned earlier, it's normal for COPD symptoms to fluctuate from day to day without any apparent reason, or to get worse for a period of months or weeks during a COPD exacerbation. This can make it hard to pinpoint the reason why your symptoms are acting up, including whether it's caused by a temporary or permanent change in your COPD.

Luckily, it is possible to determine the likely cause of an uptick in symptoms if you know what to look for. You just have to pay close attention to the nature, severity, and length of your symptoms, as well as the context in which they occur.

Minor Symptom Flare-Ups

Here we're using the term “minor symptom flare-up” to refer to the normal COPD symptom fluctuations that happen in just about everyone who has COPD. Essentially, we're talking about those days when you wake up and your symptoms are worse than usual, but then they get better within a couple days.

This can happen for all kinds of reasons—maybe the air pollution was especially bad that day or you exerted yourself too much the day before. Flare-ups can also happen for seemingly no reason at all; sometimes you just have bad COPD days.

Most of the time, flare-ups are nothing to worry about and you can get over them on your own. You might need to make some minor changes, like getting some extra rest or using your quick-relief inhaler more often, but you probably won't need any other medical intervention.

That doesn't mean you should take minor flare-ups too lightly, however; sometimes what seems like a minor flare-up can turn into a full-blown COPD exacerbation. It's best to treat flare-ups as a “watch and wait” situation: you shouldn't worry too much, but you shouldn't ignore it either in case it turns out to be something more serious down the line.

COPD Exacerbations

COPD exacerbations usually occur when you get sick with a respiratory illness, such as a bacterial lung infection or a simple cold or flu. This results in severe lung inflammation that causes COPD symptoms to worsen significantly for a period of time.

COPD exacerbations can last for weeks or months, and recovery usually requires extra medication or medical intervention. The increased symptoms usually go away when the exacerbation is over, though it can take a long time before they totally get back to baseline.

You can usually tell exacerbations apart from temporary symptom flare-ups because they last longer and tend to be more severe. However, exacerbation severity can vary quite a bit; some are minor and only require minimal intervention, while others are life-threateningly severe.

As a general rule of thumb, you should suspect an exacerbation if you experience worse symptoms (e.g. you feel more breathless, more fatigued, your coughing gets worse, etc.) that don't get better within a few days' time. If they get worse or persist without getting better, you should get in contact with your doctor or follow the corresponding instructions in your COPD action plan.

It's also important to not that, while COPD exacerbations in and of themselves are not a sign of COPD progression, they are linked to permanent COPD progression in a couple of different ways.

First, the frequency and severity of COPD exacerbations are often used as a measure of COPD progression, as they tend to get worse in the later stages of COPD. If you're having more frequent exacerbations, or having more severe symptoms during exacerbations, this could be a sign that your COPD is getting worse.

Exacerbations can also play a direct role in COPD progression, as severe exacerbations can cause irreversible lung damage and lung function loss. In general, the fewer exacerbations you experience, the lower your risk for the additional lung damage associated with exacerbations that, cumulatively, can result in quicker progression of COPD.

This is why preventing exacerbations is such a critical priority for doctors and patients managing COPD. It's also why it is so important to identify and treat exacerbations early, before they get to the point that they become difficult to treat and control.

COPD Progression

Compared to minor flare-ups and exacerbations, which tend to come on quickly, COPD progression is a long-term process that tends to happen over the course of months or years. That means you can't judge COPD progression based on just a few days or weeks of symptoms; you have to think long-term, on the order of several months, at least.

So if you've only been experiencing elevated symptoms for a few days or weeks, it's likely much too early to tell if they're caused by permanent disease progression. But if the symptoms persist for months and months without any sign of getting better, it could be a sign that your COPD is getting worse.

Unlike symptoms caused by minor flare-ups and exacerbations, elevated symptoms resulting from permanent COPD progression don't ever really go away. Instead, those symptoms become part of your new baseline—part of your normal, everyday symptoms that you experience as part of the disease.

Elevated baseline symptoms aren't the only sign of COPD progression, however. There are other changes that tend to come hand-in-hand with permanent COPD decline, namely more frequent exacerbations and lung function loss.

Research has well-established that people with COPD tend to experience more severe and frequent exacerbations as the disease progresses. In fact, exacerbations are considered to be “one of the most important predictors of the progression of COPD.”

Lung function is also closely tied to COPD progression. It's the primary criteria used to grade COPD severity and measure how quickly the disease get worse over time. Generally, the quicker your lung function declines, the quicker your COPD is progressing, and the quicker your symptoms will get worse over time.

Clues that Your COPD is Getting Worse: Signs to Watch Out For

In the following sections, we're going to go through some common scenarios that people with COPD experience. Each scenario reflects a situation or circumstance that could be a red flag that your COPD is getting worse.

While none of these scenarios is decisive on its own, each addresses a specific symptom, health complication, or another known indicator of worsening COPD. We hope that, by reviewing these life-like scenarios, you'll get a better idea of what worsening COPD can look like and be better able to recognize the signs of progression in your own life.

You're Spending More Time at the Hospital

Most people with COPD will have to be admitted to the hospital at some point to get treatment for an exacerbation or another complication of COPD. However, people with mild COPD rarely need hospital treatment; it's much more common in the mid-to-late stages of the disease.

People with moderate COPD might occasionally need to be hospitalized for exacerbations, though (depending on doctors' advice) some exacerbations can be treated at home. Those with severe disease tend to be hospitalized more frequently—and have longer hospital stays—both because their exacerbations tend to be more severe, and because treatment can be complicated by the presence of other health complications.

So, if you've been hospitalized for COPD for the first time recently, or have needed hospital treatment more often than usual, it could be a sign that your COPD is getting worse. Of course, it's also possible that you just had bad luck, especially if it's an isolated incident and not an ongoing trend.

More frequent exacerbations can also be a sign that you're not getting (or keeping up with) the treatment you need to properly manage your COPD. But if you're doing everything you're supposed to, and you're still having exacerbations more frequently than before, it's a strong indication that your COPD might be getting worse.

You Can't Get Around As Well as You Used To

People with COPD often struggle with physical exertion, including walking and standing for long periods of time. Mobility problems like this can be both a cause of COPD progression as well as a consequence of worsening COPD.

For example, worsening COPD symptoms (like breathlessness and fatigue) can make it harder to exercise, causing many patients to avoid physical activity. However, lack of exercise tends to make those symptoms even worse, leading to even more mobility issues and quicker physical decline.

This can make it difficult to tell whether mobility problems in COPD patients are simply a symptom of COPD progression or if it's the lack of physica

Home oxygen therapy is a normal part of daily life for many people with COPD. But if you're new to oxygen therapy, or about to begin using it soon, having to make that change can seem daunting or even downright scary.

After all, home oxygen therapy is a big responsibility and having to use it can feel like a major intrusion into your life. There's a lot to learn and a lot to adjust to—but the good news is you don't have to do it completely on your own.

In this guide, you'll find all kinds of helpful tips and information that everyone using home oxygen therapy should know, including how to use oxygen safely, how to prepare for emergencies, and what kinds of side-effects you can expect. You'll also find lots of helpful advice for easing the transition to long-term oxygen therapy, including how to make your home more oxygen therapy-friendly, and how to make your oxygen equipment more comfortable to wear.

With all this information at your disposal, you'll be able to get a jump-start on learning the ropes and hopefully feel more confident about having to use supplemental oxygen. Our goal is to give you a good idea what to expect and how to prepare for oxygen therapy so it won't feel quite so difficult or overwhelming to do.

Throughout this guide, you'll find links to a variety of helpful online resources, including guides to related topics that we've published in the past. To see these and many of the other practical guides we've posted on oxygen therapy and COPD, check out our Respiratory Resource Center.

Using Oxygen Can Create a Serious Fire Risk

One of the first things you should know about oxygen therapy is that concentrated oxygen can be very dangerous if you don't handle it properly. The percentage of oxygen you get during oxygen therapy is much higher (up to 100 percent) than the oxygen in ambient air (about 21 percent), and at such high concentrations, it is a major fire risk.

Contrary to popular belief, oxygen itself isn't actually flammable; however, concentrated oxygen makes other substances that it comes into contact more flammable in a couple of different ways. First, it makes substances that are already somewhat flammable much easier to ignite; second, it causes fires to burn bigger and hotter, and can even cause explosions.

For example, petroleum jelly is not generally very flammable in normal situations, but, in the presence of concentrated oxygen, it can catch fire if exposed to an errant spark or flame. That's why doctors advise patients not to use petroleum-based products on their lips while using supplemental oxygen and to use water-based products (e.g. KY jelly) instead.

Because of this risk for fire, you need to be extremely careful about keeping your supplemental oxygen at least 10 feet away from flames, high heat, and other fire hazards. This applies to your oxygen tanks when they're in storage or in use, and to the concentrated oxygen that flows through the tubing and into your mouth or nose.

Even a small flame or spark can cause an accidental fire if it happens near the stream of oxygen coming from your oxygen supply. Even cooking over the stove while using oxygen is risky, as is using electronic devices that have the potential to produce sparks (this is why you should never use an electric shaving razor while using supplemental oxygen).

This is also why it's important to never, ever smoke (PDF link) while you're using oxygen; it could ignite the concentrated oxygen as it flows from your nasal cannula or mask and cause severe burns. Additionally, you should never allow anyone else to smoke near you while you're using oxygen nor anywhere inside your home.

You should be cautious about potential oxygen leaks, which can cause oxygen to build up in high enough concentrations in the air to pose a serious fire risk throughout your home. Leaks can come from oxygen tanks in storage or from your oxygen delivery system; that's why you should always assemble your oxygen delivery equipment carefully and never leave your oxygen running when it's not in use.

Experts also advise anyone who uses supplemental oxygen—or has an oxygen supply in their home—to put up warning signs in, around, and even outside their house. This helps remind household members and visitors to be cautious, but also to warn emergency personnel about the hazard in the case they need to enter your home during a fire or other emergency.

You also need to be careful about how any oxygen tanks you are using or keeping in storage are positioned and secured. You should always store oxygen tanks in a well-ventilated space (never in an enclosed area like a closet) where they will not be in danger of shifting, falling, or getting damaged in any way.

These are some of the most basic safety considerations, but there is much more you should know. Luckily, you can find much more detailed oxygen safety instructions and advice in our comprehensive oxygen safety guide.

You can also find many more resources online, including this one (PDF link) from the New York State Office of Fire Prevention & Control and this guide on oxygen cylinder safety (PDF link) from Intermountain Healthcare.

Whatever you do, make sure to learn everything you can about how to use your oxygen safely, ideally before you begin oxygen therapy at home. Make sure you understand their hazards and take the time to familiarize yourself with all the best practices for preventing accidents, leaks, fires, and burns.

Not Using Your Oxygen as Prescribed Can Be Detrimental to Your Health

If your doctor puts you on long-term oxygen therapy, it's because you actually need it. This might seem extremely obvious, but it's important to keep in mind anytime you're tempted to skip out on your oxygen therapy because it's difficult or inconvenient to do.

It's important to always do your best to use your supplemental oxygen exactly as your doctor prescribes, even if you don't want to and even if you don't feel like you need it that day. Home oxygen therapy isn't just about helping you breathe; it's also about protecting all the organs in your body from becoming oxygen deprived.

Unfortunately, research shows that only about 60% of COPD patients using supplemental oxygen actually use it for as many hours a day as their doctor prescribed. Most of the remaining 40% don't use their supplemental oxygen enough, and by doing so put their health at risk.

When someone with COPD has to use long-term oxygen therapy, it's because their lungs are too damaged to take in enough oxygen on their own. This results in hypoxemia, which happens when the amount of oxygen in your bloodstream falls below what's considered to be a healthy level (which can include blood oxygen saturation levels below 95 percent).

Usually, people with COPD don't need to begin long-term oxygen therapy until their blood oxygen saturation falls below about 90%. Having blood oxygen levels that low, especially over a long period of time, can cause a variety of serious health problems, including cognitive decline, cardiovascular disease, and pulmonary hypertension.

Severe hypoxemia also puts you at risk for tissue hypoxia, a serious condition that occurs when there's so little oxygen available in your blood that some parts of your body can't get the minimum amount of oxygen they need to function normally. In severe cases, tissue hypoxia can cause extensive, permanent organ damage and even death if it's left untreated for too long.

However, using supplemental oxygen helps reverse hypoxemia and return blood oxygen saturation to healthier levels, preventing tissue hypoxia and the various other health complications that hypoxemia can cause. And that is why using your supplemental oxygen exactly as you're supposed to is so important and so vital for your health.

Supplemental Oxygen Has Side-Effects and Risks

It's important to remember that supplemental oxygen is a drug that comes with some potentially serious risks. It might seem harmless because it's “just oxygen,” but, in reality, supplemental oxygen is a medicine just like any other and you should always treat it that way.

Supplemental oxygen works because it provides your lungs with air that has much more oxygen in it than the regular, ambient air you normally breathe. This makes it easier for your lungs to absorb oxygen from the air, raising your blood oxygen levels and making it easier to breathe.

However, breathing in highly-concentrated oxygen can, in some cases, cause dangerous respiratory imbalances, including oxygen toxicity, excess carbon dioxide build-up in the blood (a condition known as hypercapnia), and—in rare cases—an increased risk for death. These problems are most likely to happen if an error, such as incorrect dosing, causes you get an excessive amount of oxygen.

This can happen due to patient error (e.g. setting the flow rate on your oxygen tank too high or not following dosage instructions) or from doctor error (e.g. prescribing too high an oxygen concentration or too long a duration for therapy). To reduce this risk, most doctors start COPD patients on lower oxygen doses and increase them gradually as needed, while also carefully monitoring patients for signs of hypercapnea and other adverse effects.

That's why it's important to use your supplemental oxygen correctly and treat it with the same care and diligence that you would treat any other type of medication. That means always making sure you get your oxygen dosage right and follow your doctor's instructions for oxygen use exactly.

Luckily, serious adverse effects from home oxygen therapy are pretty rare, though the risk increases with higher oxygen concentrations and longer duration of use. However, there are some other more common—and much more mild—side-effects that can occur even if you use your oxygen 100 percent correctly.

Here are some of the more common side effects of using supplemental oxygen:

• Skin irritation
• Ear pain
• Nose bleeds
• Dry mouth, nose, and throat
• Dizziness
• Reduced sense of taste
• Reduced sense of smell

Many of these side effects (e.g. dryness and abraision) are essentially discomforts caused by the oxygen equipment itself or how the oxygen is administered to your lungs rather than the oxygen medicine itself.

You Can Make Oxygen Therapy More Comfortable

Unfortunately, many people experience discomfort when using supplemental oxygen, particularly after wearing the equipment for long periods of time (as many oxygen patients must do). This is one of the main reasons why some patients aren't consistent about using their oxygen therapy or simply don't use their oxygen as much as they should.

Some of these ailments are caused by pressure and skin chaffing where equipment (such as over-the-ear straps and tubing, nasal cannulas, or oxygen masks) touches the skin, particularly around the mouth, nose, and ears. Many patients also complain about the longer length of tubing that hangs down from their mask or nasal cannula, which can restrict movement and easily get snagged or pull on the ears.

Another common source of discomfort is the air that comes from the oxygen supply, which tends to flow faster and be less humid than breathing ambient air. Over time, this constant flow of dry air can dry out your lips, mouth, nose and throat, which can lead to nosebleeds and split lips.

While this all might sound very discouraging, there's no need to despair! You don't have to suffer without relief, because there are many different techniques you can use to reduce and mitigate all of these common discomforts and more.

For example, you can modify your oxygen delivery equipment to reduce ear pain and irritation by adding padding under the tubing on your ears. You can reduce skin chaffing by covering problem areas of tubing with fabric wraps or fabric tape.

You can prevent extension tubing snagging and keep it out of the way by clipping it to your back or running it under your clothes. You can also get specialized equipment designed specifically for better comfort, including nasal cannulae made from softer plastic tubing that's gentler on the skin.

To reduce nose and throat dryness, you can use a humidifier bottle to add moisture to the air coming from your oxygen delivery device. You can also use a variety of (non-petroleum) topical ointments, lip balms, and creams to treat dry skin on and around your lips, mouth, and nose.

While these techniques might not eliminate all your discomfort completely, they can make oxygen therapy much more comfortable and much more tolerable to use. These are also just a few of many possible solutions that you could experiment with and adapt to your personal needs.

For even more practical tips and suggestions, check out our comprehensive guide about how to make oxygen therapy more comfortable, which includes more detailed information about specialized oxygen products and comfort-improving techniques.

It Can Help to Clear Some Extra Space at Home

Home oxygen therapy requires a lot of equipment, and that equipment takes up space—and a lot of it. We're not just talking storage space (even though you'll need that too), but also space for you to move around with your equipment freely.

Using oxygen at home requires a good deal of lugging equipment and tubing around, and you don't want to feel restricted or at risk of getting tangled up everywhere you go. Because of this you might need more wide-open space in your home than you needed before after beginning home oxygen therapy.

To get the extra space you need, you might need to clear out some clutter, re-arrange your furniture, or even re-think the overall setup of your home. Try to do this with consideration for how you personally use and move through the space, looking for ways you can make it easier to navigate your home without running into obstacles that could crowd you, trip you up, or snag on your oxygen tubes.

You should also be thoughtful about where you run your oxygen tubing, especially anywhere it lies across the floor. Do your best to keep your extension tubing from running across main walkways and other places where it could cause you or someone else to trip.

Finding the best arrangement might take some trial and error, but it's worth taking the time to get it right. After all, a living space that's cramped or difficult to navigate is not only frustrating (and affects your quality of life), but it's also a potential safety hazard.

You'll Need to Work With a Medical Supply Company to Get Your Oxygen & Supplies

Getting a prescription for supplemental oxygen is just the first step to starting oxygen therapy; the next step is to actually get the oxygen and the rest of your oxygen delivery equipment. Unfortunately, you can't get what you need simply by visiting a regular pharmacy like you can with most other prescriptions.

The good news is that you can get all your oxygen and equipment delivered straight to your home, but the bad news is that you'll likely need to arrange that delivery yourself. This can be a bit tricky, since it requires working with your insurance company (or medicare provider) to find an eligible medical supply company that offers what you need.

Keep in mind that different medical supply companies often have different prices andd different selections of equipment. Before choosing a supplier, make sure you know exactly what kinds of products they have, including what oxygen supply devices they offer (e.g. home oxygen concentrators or portable oxygen tanks) and other oxygen delivery equipment (e.g. types of plastic tubing, oxygen masks, nasal cannulae, humidifier bottles, etc.).

If you're not sure exactly what you need or what to look for, that's okay; your doctor should help you begin the process and prepare a detailed order (PDF link) for you to give to your insurance company and oxygen supplier. Your doctor can also walk you through the different equipment you will need and why you need them; for example, if you need high-flow or high-concentration oxygen, you might need to use an oxygen mask rather than a nasal cannula.

Most oxygen supply companies rent their oxygen equipment for 36-month (3-year) periods, at which point you can continue renting the equipment (for up to two more years) or switch to another supplier. During that 3-5 years, the company agrees to supply you with an adequate amount of oxygen, along with all other necessary supplies, and perform any required maintenance that your oxygen equipment needs during that period.

It's important to keep track of when your rental agreement starts and when you need to renew your contract (or find a new oxygen supply company), that way you can take care of it before the rental period expires. Being pro-active will help ensure that you don't have any gap or delay in your oxygen supply.

For more information and instructions for how to order your oxygen supplies, check out the following links:

• This article from Verywell Health tells you how to order oxygen through Medicare.
• This guide for choosing and ordering oxygen supplies (PDF link) from The LAM Foundation and COPD Foundation, which includes a helpful breakdown of the benefits and risks of 3-year versus 5-year contracts.
• Information about Medicare coverage for oxygen equipment from medicare.gov.
• This guide from our Respiratory Resource Center explains what you need to know about health insurance and oxygen equipment.

Keeping Your Equipment Clean and Maintained is Key

Unfortunately, your oxygen equipment won't stay in good shape all on its own. You'll need to perform some degree of regular cleaning and maintenance to keep your equipment working, clean, and safe.

First, you'll need to sanitize your oxygen mask, nasal cannula, and connector tubing regularly—at least once per week. You can do this by washing the equipment in warm, soapy water (to get off any mucus or grime), dunking it into a vinegar solution (to kill bacteria), and then setting it out to dry.

You should also clean your equipment (and possibly even replace your mask or nasal cannula) anytime you get sick with any kind of respiratory virus or infection. Failing to do so—or simply not cleaning your equipment often enough—allows dangerous viruses and bacteria to multiply and potentially get you sick.

You will also need to replace your nasal cannula or oxygen mask with a new one on a regular basis, usually about every two weeks. You will also need to replace your extension tubing about every 3-6 months, though you should always follow the instructions for the specific equipment you use.

You may also need to perform other cleaning and maintenance tasks, such as wiping down the outside of your equipment, replacing a home oxygen concentrator's filter, or checking oxygen tanks regularly for damage or leaks. Make sure you know what kind of maintenance you're responsible for and what kind of maintenance your oxygen supplier provides.

For more detailed information and instructions for taking care of your oxygen equipment, check out our how-to guide on Oxygen Equipment Cleaning and Maintenance.

You Need to Be Prepared for Emergencies

When you're dependent on supplemental oxygen to breathe and stay healthy, it's very important to make sure you always have access to your oxygen. That requires planning for emergencies like power outages and other situations that could affect your ability to use oxygen.

First, you should always keep an extra supply of backup oxygen in your home just in case you can't use your primary supply for some reason (e.g. if it's empty or malfunctioning). While you should never run out of oxygen in a normal situation, you should always be prepared for natural disasters and other emergency situations that could delay the delivery of your oxygen supplies.

If you use an oxygen concentrator that relies on power to work, you'll specifically need a backup supply that doesn't need electricity, such as a liquid or compressed-gas oxygen tank. That way, if there's ever a power outage, you'll always have a source of oxygen hold you over until the power comes back on.

You should also notify your electricity utility company once you begin oxygen therapy, especially if you have an oxygen concentrator plugged in at home. This gives you the opportunity to get on a priority service register, which can make you eligible for certain safety benefits like giving your home priority when restoring power after an outage; however, whether or not you can get any extra benefits depends entirely on your particular power company, so make sure to ask your local utility what they offer to be sure.

For a more detailed guide on how to prepare for emergencies when you rely on oxygen therapy, check out the Comprehensive guide to emergency preparedness for people with lung diseases from the American Thoracic Society

You Can Still Go Out & Stay Active on Oxygen

Not everyone with COPD is an ex-smoker or smoker,. There are a lot of other factors that cause COPD. While, It is no secret that cigarettes cause a lot of respiratory issues and other bodily harm, and smoking does lead to Chronic Obstructive Pulmonary Disease (COPD) many of the 16 million Americans who have been diagnosed with COPD have never smoked in their lifetime.

So what else causes COPD and how can we continue to treat this chronic disease for smoker and nonsmokers effectively?

In this blog we cover:

• What COPD is
• How COPD and smoking is related
• How nonsmokers develop COPD

What is COPD?

Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive lung diseases.

The most common of these diseases are emphysema which slowly destroys air sacs in your lungs, and interferes with outward air flow and chronic bronchitis which causes inflammation and narrows the bronchial tubes allowing excess mucus to build up. Many people with COPD have both of these conditions, and when it is severe enough, they require supplemental oxygen therapy. To treat cases of COPD, people will opt to use portable oxygen concentrators. 

It’s estimated that about 30 million people in the United States have COPD, while an estimated 14 million are unaware that they have it. If your COPD goes untreated, it can lead to a faster progression of disease, heart problems, and worsening respiratory infections. 

COPD and Smoking 

Smoking is one of the main causes of COPD, however it is not the only reason people develop this disease. 

In today’s day and age, smoking has a negative connotation, and it is widely known that smoking is bad for your health and the ones around you. This scientific fact has only come to light and into popularity in relatively recent years. 

There was a time when many of us were alive where smoking was a normal everyday thing that most adults participated in, and the negative effects smoking presented to the smoker and those subjected to secondhand smoke were less known and much less talked about.

Now there are a lot more alternatives for smoking for people who want to quit, there are scientific studies proving the harmful aspects smoking has on your body, there are advertisements and movements to help inform people, and smoking is not allowed indoors and even in private outdoor spaces in most areas. 

The overall language surrounding smoking has changed dramatically, and a lot of the time there is little sympathy for smokers. 

While smoking is a very harsh addiction, there are a lot of tools including therapy that can help you quit. It is much easier said than done, and we do have a few resources on our website that can help smokers nick the habit: 

There’s nothing worse than waking up in the morning to symptoms like fatigue, stiffness, chest pain, or grogginess. However, this is a reality that many Americans face, especially those with pulmonary illnesses like COPD, pulmonary fibrosis, and asthma.

According to Dispatch Health, fatigue is the second most common symptom of COPD behind dyspnea (shortness of breath). This study found that the amount of COPD patients with clinically significant fatigue is around 50%, in contrast to 10% in elderly people without COPD.

Although there are many factors that contribute to tiredness, fatigue, and grogginess in COPD patients, the most significant cause is decreased lung function. According to WebMD, it can take up to 10 times as much energy for someone with COPD to breathe as it does for their healthy counterparts.

As you can imagine, over time, this can become quite exhausting. Additionally, if labored breathing leads to reduced oxygen levels in the blood (hypoxemia), this can lead to further fatigue.

While we could sit here and rattle off all of the causes of fatigue in COPD patients, you’re probably a lot more interested in the solutions. That’s why, in this post, we’re going to be discussing some of the proven ways for COPD patients to improve their energy levels.

Whether you have mild, moderate, or severe COPD, these tips will help you take back control and start feeling more motivated in your daily life. As always, if you have any questions for us, please leave them in the comments below or speak with an oxygen concentrator representative.

Quit Smoking Immediately

Cigarette smoking is the leading cause of lung disease in the world. A burning cigarette emits more the 7,000 chemicals, and when they enter the body, they quickly damage the air passages, air sacs (alveoli), and your lungs’ natural immune functions. 

Years of smoking almost inevitably leads to some of the most common lung diseases including chronic obstructive pulmonary disease, lung cancer, and more. But lung damage is not the only thing that you have to worry about when you light up a cigarette. The way smoking affects the brain is of equal concern.

One of the most concerning chemicals found in cigarette smoke is nicotine. You probably know this as the chemical that makes cigarettes “addictive”. While this is true, it has far worse effects on the body than this. Like coffee, nicotine is a stimulant. Smoking a cigarette or two will give you a sort of “high” where you feel like you have a lot of energy and alertness. 

However, when the effects of nicotine begin to wear off, you’ll start to experience a crash and eventual withdrawals, causing you to start the whole process over again. Over time, this can mess with your body’s natural sleep-wake cycle causing you to lose sleep at night.

Another way that smoking can lead to reduced energy levels in COPD patients is through the development of mood disorders. We talk about mental health a lot here at LPT Medical because, no matter how physically healthy you are, you can’t be happy if your mental health isn’t in check. 

Studies have found that, contrary to popular belief, cigarette smoking leads to increased anxiety, and smokers are more likely to develop depression and other mental illnesses than their non-smoking counterparts. According to Hopkins Medicine, about 75% of people with depression have trouble getting to sleep at night.

Manage Your Diet Carefully

If there’s one thing that everyone should be taught from a young age, it’s the importance of a healthy, well-balanced diet. While you can go through all of the foods you eat and pick out the “unhealthy” from the “healthy”, it makes more sense to think of what your individualized needs are and then tailor your diet to that. 

For example, COPD patients often have trouble maintaining their weight because they have a higher energy expenditure than healthy people due to their reduced lung function. This means that COPD patients oftentimes need to increase their protein intake. Loss of muscle mass (muscle atrophy) not only leads to fatigue but can also lead to osteoporosis and other bone disorders.  

Another thing you should do is replace simple carbohydrates in your diet (glucose, fructose, and sucrose) with complex carbohydrates (whole grains, vegetables, and fruits). The problem with simple carbs is that they are broken down and digested very quickly by the body. 

This leads to a quick spike in blood glucose and thus immediate energy. However, consuming simple carbs also means that you will experience a “crash” later on, which will leave you feeling exhausted and unmotivated. According to the Lung Institute, carbohydrates produce the most carbon dioxide in the body in relation to the amount of oxygen that’s used to break it down while fat produces the least. 

So eating too many carbs as a COPD patient can lead to increased breathlessness and fatigue.

One last modification you can do to your diet to have more energy throughout the day is to eat more frequently. While you’ve probably been told before that “snacking” is a bad thing, it can be incredibly beneficial if you do it the correct way. 

Many store-bought snacks like granola bars, candy bars, or yogurt are filled with sugar and other additives but if you create your own snacks, you can be sure that they’re healthy and won’t sap your energy. For example, a piece of fruit, some veggies, and hummus, or unsalted nuts will provide you with lots of energy to make it through the day. 

One of the best benefits of healthy snacking is that you won’t be so hungry once mealtime comes around, meaning you’ll eat less and won’t feel so bloated and exhausted afterward. 

Stay Hydrated

As a whole, the human body is around 60% water, the lungs are about 83% water, and the brain is 73% water. Water plays a pivotal role in some of the most basic functions of the body including circulation, digestion, and temperature regulation. And according to Healthline, being dehydrated can make you feel tired even when you’re fully rested. 

This is likely due to low blood pressure that results from having insufficient water intake. While there are many drinks you could consume to stay hydrated, water is always the best choice. The Lung Institute recommends that COPD patients drink between 64 to 96 ounces par day. 

In addition to drinking enough water, it’s important to avoid things like sugary, caffeinated, or alcoholic beverages. Although sugar and caffeine are great for a quick pick-me-up, they are not a good long-term solution to your fatigue and sleepiness. 

Alcohol, on the other hand, is a central nervous system depressant that causes feelings of sleepiness and relaxation. Overconsumption of alcohol has been shown to delay the onset of sleep and many people even experience sleep disruptions or poor quality of sleep. 

Get Tested for Vitamin D Deficiency

Vitamins and minerals play a vital role in the body’s function. They are considered “essential nutrients” because they have hundreds of functions from assisting in bone development to boosting your immune system. Unfortunately, many COPD patients are deficient in vitamin D which is responsible for regulating bone health and energy levels in the body.

Vitamin D assists mitochondria to use oxygen in the healthy function of muscles and various other parts of the body. In other words, when you are vitamin D deficient you’re at a higher risk for osteoporosis and low energy levels.

There are several reasons why COPD patients might be vitamin D deficient. Firstly, our primary source of vitamin D is the sun because our bodies naturally produce vitamin D when we’re exposed to sunlight. 

However, many COPD patients are not as active as they used to be before being diagnosed and may avoid going outside when it’s sunny because of the risk of respiratory exacerbation or heat exhaustion. Another reason COPD patients may be vitamin D deficient is their diet has changed. 

Fatty fish, egg yolks, and vitamin D fortified foods are some of the best sources of vitamin D. 

If you have reason to believe that you are vitamin D deficient, it’s best to consult with your doctor to discuss your symptoms. Typically, vitamin deficiencies are diagnosed through a type of blood test called 25-hydroxyvitamin D or 25(OH)D for short. Your vitamin D levels are measured in nanomoles/liter (nmol/L) or nanograms/milliliter (ng/mL):

• Deficient: under 30 nmol/L
• Potentially deficient: 30-50 nmol/L
• Normal: 50-125 nmol/L
• Higher than normal: over 125 nmol/L
  
  

Take Oxygen as It’s Prescribed

Supplemental oxygen is a type of medical therapy designed for people with impaired lung function. In the case of emphysema, the tiny air sacs in the lungs called alveoli become damaged and swollen. Since the alveoli are responsible for transferring oxygen to the blood and carbon dioxide back into the lungs, this disease results in low blood oxygen levels. 

Emphysema patients need to use oxygen as it was prescribed by their doctor in order to maintain the appropriate level of oxygen in their blood.

When someone with emphysema has low blood oxygen levels for an extended period of time, this can result in hypoxia or low oxygen levels in the body’s tissues. This can cause complications like headaches, confusion, fatigue, and even organ failure. 

On the other hand, increasing your oxygen intake to an amount higher than what your doctor prescribed can be equally harmful. Oxygen toxicity is what happens when you ingest too much oxygen. It can result in symptoms like difficulty breathing, chest pain, dizziness, fatigue, and nausea.

One of the best ways to ensure that you have access to a reliable supply of oxygen wherever you go is to choose the right oxygen device. While oxygen tanks have been used by COPD patients for decades, they are not the best option for the majority of people. Portable oxygen concentrators tend to be a much better choice because they don’t need to be refilled like oxygen tanks do, and they’re also much lighter and smaller. 

What this means is that you won’t have to stop what you’re doing constantly to find a place to refill your oxygen device. Concentrators run on batteries, so you only have to carry what you need.  

One of the greatest features of newer portable oxygen concentrators like the ARYA Airvito, Inogen One G5 and Caire FreeStyle Comfort is their auto-adjusting flow rates.

If you’re using the device while you’re sleeping, the concentrator will adjust its oxygen output based on your breathing rate and breathing depth ensuring that you always get the optimal amount of oxygen. 

This will prevent you from receiving too little or too much oxygen while you sleep resulting in fewer interruptions and more restful sleep. And finally, if you’re taking oxygen as it was prescribed but you still feel out of breath or fatigued, be sure to consult your doctor before increasing your flow setting.  

Exercise Consistently

Exercise is important for everyone, regardless of their age and health condition. However, a healthy exercise routine looks different for everyone. For example, if you’re in early-stage COPD and your symptoms are very mild, you might want to try a high-intensity exercise routine. Conversely, if you’re in stage three or four COPD, you may need to resort to moderate exercise.

The important thing is that you’re consistent with your exercise routine and you don’t resort to long periods of sedentary behavior. This will keep your body’s circulation in check and ensure that you don’t overexercise.

According to WebMD, studies show that exercise is a great way to improve energy levels, even in people with chronic diseases that are associated with fatigue. By exercising, you’re improving your cardiovascular health and strengthening your lungs and muscles meaning your body, as a whole, will be more efficient and you won’t get exhausted from simple things like carrying the groceries or walking to the mailbox. 

Believe it or not, the stronger your muscles are, the less oxygen they need in order to function properly. If you want to start exercising but don’t know where to begin, ask your doctor about pulmonary rehabilitation. This is a course where you will learn the proper way to exercise with your disease.

Another way that consistent exercise boosts your energy is by helping you get restful sleep. If you feel restless and anxious when you go to bed, you’re not alone. According to SleepHealth.org, 70% of Americans report getting insufficient sleep at least once a month, and 11% report feeling this way every night. 

Sleep disorders are a major issue in the United States, especially amongst people with COPD and other chronic diseases. 

Conclusion

Studies have shown that fatigue is one of the most commonly reported symptoms of COPD. These patients spend a significant amount of energy just getting a full breath and alterations to their diet can leave them without the nutrients they need to feel alert and full of energy. 

If you or your loved one has COPD and is experiencing fatigue, restlessness, or sleepiness, try some of the tips above or consult your doctor who can help you get to the root cause of the issue. Most people are surprised to find that these symptoms can be treated naturally and without having to drastically change their daily routine.

In the meantime, if you’re in the market for an easy-to-use, reliable, and affordable oxygen generator, look no further than LPT Medical. We have a wide variety of units available including but not limited to stationary oxygen concentrators, continuous flow portable oxygen concentrators, and pulse dose portable oxygen concentrators. 

We also sell a range of different accessories to help you make the most of your new concentrator such as backpacks, extra battery packs, external charges, oxygen tubing, and much more. If you have any questions, just give us a call or email us and ask to speak with an oxygen concentrator specialist.