Breathing exercises are an important part of COPD treatment, and experts recommend doing them regularly to keep your breathing muscles strong. They can also help you recover some of the breathing strength and function you lose after an illness or exacerbation weakens your lungs.



Unfortunately, practicing these techniques every day can be tedious, and it's easy to fall behind. It doesn't help that the benefits are usually subtle, and that they tend to happen so gradually that you might not notice them at all.


However, breathing exercises do help, which is why you can find special tools, known as incentive spirometers, to help you do them better. These devices are designed measure your breaths and give help you hone your breathing technique


Incentive spirometers give you real-time feedback as you breathe, allowing you to see and track your results in a way that's just not possible with unstructured breathing exercises. This can help motivate you to practice and strive for better results, whether you use it as part of your regular COPD treatment regimen or means to recover from a COPD exacerbation.


If you are interested in learning more about incentive spirometers and how they can help your lungs, then this post is for you. In the following sections, we'll explain everything you need to know about incentive spirometers and COPD, including what they are, how they work, and how to use them by following a simple step-by-step guide.


What is An Incentive Spirometer?








An incentive spirometer is a simple measurement and feedback device that can help you improve your breathing strength and ability over time. It does this by helping you practice taking long, slow, deep breaths (known in medical jargon as sustained maximal inspirations), and training you how to sustain those deep breaths for longer.


It's essentially a kind of lung exercise and recovery aid for people who struggle to breathe properly. That includes people suffering from lung injuries caused by surgery or pneumonia, and people with chronic lung diseases like asthma and COPD.


What an incentive spirometer essentially does is measure the speed and volume of the air that you inhale. It also has a simple visual mechanism that shows you exactly how quickly and deeply you are breathing in real time while you use it.


Using an incentive spirometer every day can help you strengthen your breathing muscles and improve how well your lungs function. It can increase lung capacity, reduce shortness of breath, and generally make it easier to breathe.


Incentive spirometers are particularly helpful for those who are recovering from a short-term illness like a lung infection or COPD exacerbation. These conditions often cause temporary lung function loss that can be recovered with treatment and time.


However, incentive spirometers do not necessarily work for everyone, and it's important to talk to your doctor if you are considering using one. Whether or not an incentive spirometer is right for you might depend on a variety of factors, including your specific respiratory condition, the severity of your symptoms, and the likelihood that your lung function can improve.


How Does an Incentive Spirometer Work?


There is more than one kind of incentive spirometer, but each type works in a very similar way. To help you get a better general idea of how they work, let's take a look at one of the most common incentive spirometer designs.


This type of incentive spirometer is a hand-held device made up of a handle and a mouthpiece attached to two differently-sized, clear plastic tubes. The large tube measures the volume of air you breathe in, while the smaller tube measures the air speed.









Each tube contains a movable plastic piece, called a “float,” that slides up and down as you breathe. Different spirometers have different types of floats; some look like balls, some look like small cylinders, and some have a flat, puck-like shape.


When you you inhale through the incentive spirometer, it creates an air current that blows the floats in each tube upward. How much they move depends on how fast and how deeply you inhale.


The purpose of these floats is to give you valuable visual feedback about your deep breathing technique so you can see your results and improvements. This helps you learn how to control your breathing better, and can also serve as incentive to practice and work toward better results. 


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For the larger tube, your goal is to push the puck up as high as possible by taking in deeper breaths. The markings on the side of the tube indicate how much air (in volume) you inhale.


If you or your doctor wants to set a specific volume goal, you can do this by marking a specific point along this volume measurement tube. Then, you can use that point as a benchmark to measure your progress and to motivate you to push the float up to or beyond that personal goal.


The float in the smaller tube works differently; instead of trying to push it up as high as it will go, your goal is to keep the float within a certain middle range. You can do this by controlling the speed and steadiness of your breath: the faster you breathe in, the higher the float will go.




What are the Benefits of Using an Incentive Spirometer?


If you have COPD, then using an incentive spirometer has many of the same benefits as regular COPD breathing techniques and other inspiratory muscle training exercises. However, incentive spirometers specifically focus on honing deep breathing skills, which are particularly helpful for combating shallow breathing patterns that worsen shortness of breath.


When you practice with an incentive spirometer, you are essentially training your lungs to take longer and deeper breaths. This helps to increase your lung capacity—or how much air you can breathe in to your lungs at one time—which helps your lungs work more efficiently.








Practicing with an incentive spirometer also helps you exercise specific muscles in your abdomen and chest that you use to breathe. Making these muscles stronger not only makes it easier to breathe, but can also reduce chest muscle tightness, chest pain, and fatigue.


This is an important benefit for people with COPD, who experience shortness of breath at least in part due to respiratory muscle fatigue. Tired breathing muscles can trigger quick, shallow breathing which technically requires less effort, but is also less effective at getting you the oxygen you need.


Using an incentive spirometer can help you correct this breathing pattern by helping you build up the strength and skill you need to breathe more deeply instead. It also allows you to see your improvements over time and measure your progress toward personal breathing goals.


Unfortunately, while we know that incentive spirometers work, there have not been very many studies done on incentive spirometers and COPD in particular. Fortunately, what little research that has been done shows very promising results.


One study, for example, looked at the effects of incentive spirometers on patients with mild to severe COPD. It found that participants who used incentive spirometers experienced both an increase in exercise capacity and a decrease in shortness of breath.





Another study using the Respivol incentive spirometer also found a variety of positive results for people with COPD. Those who used the device regularly for 3-6 months showed a significant increase in certain lung function measures (maximal inspiratory pressure and maximal expiratory pressure), as well as reduced shortness of breath, increased exercise tolerance, and even an increase in quality of life.


However, it's important to realize that there is no known treatment, including incentive spirometers, that can reverse any of the permanent lung damage caused by COPD. They can, however, help you breathe more efficiently, and potentially even return back to baseline after temporary lung function loss caused by an illness or exacerbation.




Where to Get an Incentive Spirometer




If your doctor recommends or approves you to use an incentive spirometer, you have a few different choices of where to get one. In some cases, you can purchase one directly from your doctor, but that can be pricier than buying one yourself.


The easiest place to purchase an incentive spirometer on your own is to go to a medical supply store, either in person or online. You might also be able to find one at your local pharmacy or in the medical section of a general store like Walmart.


If you will be buying your incentive spirometer yourself, you might still want to ask your doctor to give you a prescription for the device. You can buy them over the counter, but you will need a prescription if you want it to go through your insurance and if you want to pay for it with your FSA or HSA account.


Luckily, incentive spirometers are surprisingly inexpensive, costing less than most fast food meals. You can buy them in most places for between $6 and $20, depending on the type and brand you buy.


How to Use Your Incentive Spirometer





As we mentioned before, incentive spirometers are not all the same and come in a variety of sizes and shapes. Because of this, there is no single set of instructions for how to use an incentive spirometer that will work perfectly with every type.


It's also important to note that, while text and video instructions can certainly help, nothing can substitute for a doctor's expertise. To ensure you use your incentive spirometer correctly, you should ask your doctor to demonstrate how to use it, and then practice in front of her so she can evaluate your technique.


Bearing these things in mind, let's take a closer look at how to use the basic dual-tube spirometer we described in a previous section. This is one of the most common incentive spirometer designs that you will find in most medical supply stores, from the brands Medline, Teleflex, SPIRO-BALL, and Respivol.


Before using your incentive spirometer, make sure to position your body upright in a position that makes it easier to breathe. Ideally, you should sit up straight in a chair or on the edge of your bed.


Avoid wearing tight clothes, belts, or anything else that could restrict your ability to breathe. You might also want to clear out your airways before you begin by practicing controlled coughing or other mucus clearance techniques.








Steps to Use an Incentive Spirometer:
While sitting in a relaxed, comfortable position, hold your incentive spirometer upright in front of you.
Seal your lips around the mouthpiece.
Inhale as slowly and deeply as possible, then hold your breath for as long as you can (at least 3-5 seconds).
While breathing in, watch the float in the smaller tube, and try to keep it within the marked range (this measures your breathing speed).
You can change the position of this float by adjusting how quickly you inhale.
Increasing the speed of your breath will move the float higher, while slowing it down will cause the float to fall down lower.
While breathing in, watch the float in the larger tube and try to push it as high as possible (this measures the volume of your breath).
Note which measurement mark the float reaches at it's highest point.
The deeper breath you take, the higher the float will go.
If your spirometer has a movable indicator on the outside of the tube, you can use this to mark the maximum height.
Record this measurement for future reference and to help you keep track of your progress.
Take a few moments to rest.
Repeat these steps for another 10 to 15 breaths in order to complete one full incentive spirometer session.


If at any point you start to feel dizzy or lightheaded, you should stop and take a break to breathe normally for awhile. Once you feel better, you can continue using your incentive spirometer again.


To see these steps in action, check out this video demonstration:



Continuing to Practice




Incentive spirometers are not a one-time or occasional treatment; they only work if you use them often over an extended period of time. How long that time is depends on your particular health condition and your reason for using the incentive spirometer.


If you are using an incentive spirometer for normal COPD maintenance, then your doctor may advise you to use it long-term or indefinitely. If you are using an incentive spirometer to help your lungs recover from an exacerbation, then you might be able to stop using your incentive spirometer after several weeks or months.


Either way, you will need to use your incentive spirometer every day in order for the treatment to be effective. Your doctor will tell you often you should use it during the day based on your health and treatment goals.


In a hospital setting, doctors often recommend using an incentive spirometer very frequently; usually once every 1-2 hours for patients recovering from serious lung infections and surgeries. However, this can differ from person to person, which is why you should always follow your doctor's specific advice.


It's also a good idea to keep records of your incentive spirometry results for you and your doctor to discuss and evaluate later. Simply write down your highest volume measurement you get from each incentive spirometer session, and then you'll be able to track any changes that happen over time.


Most importantly, don't give up on your incentive spirometer if you don't notice results right away. Real improvement takes time, so it's important to practice, persevere, keep working toward your personal incentive spirometry goals.




Conclusion
Managing COPD and lung function decline is tough, but there is a wide variety of tools and treatments available to help. Tools like incentive spirometers can help you keep up with certain aspects of treatment—like breathing exercises—by providing a simple and satisfying way to practice every day.


Incentive spirometry is safe, inexpensive, and has the potential to provide a variety of breathing and exercise benefits for people with COPD. It's easy to get the hang of and, if you stick with it long enough, it can make a noticeable difference in your symptoms.


If you or someone you love suffers from COPD, consider asking your doctor if she believes that an incentive spirometer would be a helpful addition to their home treatment regimen. While not every person will see significant improvements after using an incentive spirometer, many do, and it's well worth considering giving it a try.

COPD and other respiratory diseases often come with health complications, both big and small. One of the more serious complications of COPD is acute respiratory failure, a medical emergency that occurs when you experience a sudden and serious drop in lung function.

Acute respiratory failure can be deadly, and getting immediate treatment can mean the difference between life and death. Because of this, it's vital for every person with COPD, and other chronic respiratory conditions, to be able to recognize and understand respiratory failure.

That's why, in this post, we're going to explain what respiratory failure is and how COPD can put you at risk. We'll also show you how to identify the symptoms of respiratory failure, what to do if it happens, and what you can do to minimize your risk for developing this life-threatening condition.

What Exactly is Respiratory Failure?

Respiratory failure happens when your lungs are no longer able to function well enough to meet your body's needs. This causes an imbalance of oxygen and/or carbon dioxide in your blood that can severely affect your ability to breathe.

To better understand how this happens, let's consider what healthy lungs are supposed to do: First, the air sacs (called alveoli) in your lungs absorb oxygen from the air you breathe in and transfer it to your bloodstream. Then, your heart pumps that oxygen to all the nooks and crannies of your body, where it's used as fuel for all kinds of vital functions.

When your body uses up that oxygen, it creates a waste product—carbon dioxide—that goes back into your bloodstream to get pumped back up to your lungs. Then, your lungs perform their second important duty; they take the carbon dioxide out of your bloodstream and get rid of it when you exhale.

This whole process is known as “gas exchange”, and healthy lungs can do this quickly and efficiently, even faster than your body needs. This ability is known as “respiratory capacity,” and having extra capacity allows your lungs to keep up even when you need more oxygen than usual (e.g. when you exercise) or when your lung function is reduced (e.g. when you get sick).

In the case of respiratory failure, however the opposite is true: your respiratory function gets lowered to the point that your lungs can no longer exchange gases fast enough to keep up with your body's needs. Essentially, this means that your lungs either can't absorb enough oxygen fast enough, can't get rid of carbon dioxide fast enough, or possibly even both.

As a result, one of three things happens:

• Your blood oxygen levels fall to dangerous levels, a condition known as hypoxemia
• Carbon dioxide builds up to dangerously high levels in your blood, a condition called hypercapnea.
• In some cases, both hypoxemia and hypercapnea can happen simultaneously.

If the hypoxemia or hypercapnea become severe enough, it is diagnosed as either acute or chronic respiratory failure. We'll go into more detail about the differences between the two in the next sections below.

Respiratory failure is often caused by COPD and other chronic respiratory disorders. However, it can also be caused by other serious health conditions, including pneumonia, drug overdoses, and other diseases or injuries that affect the nerves and muscles you use to breathe.

Causes of Respiratory Failure:

• Lung Conditions:
• COPD
• Cystic fibrosis
• Pulmonary embolism
• Pneumonia

• Nerve and Muscle Conditions:
• ALS
• Muscular dystrophy
• Stroke

• Spine Conditions:
• Scoliosis
• Spinal cord injuries

• Chest injuries
• Overdosing on drugs or alcohol
• Acute lung injuries from inhaling dangerous amounts of harmful fumes or smoke (e.g. breathing smoke in a house fire)

Acute vs. Chronic Respiratory Failure

There are two main types of respiratory failure: acute and chronic. Acute respiratory is severe and sudden, which chronic respiratory failure is a long-term health condition that develops gradually over time.

Chronic Respiratory Failure

The symptoms of chronic respiratory failure are, essentially, the main symptoms of moderate to severe COPD. Many people with COPD have chronic respiratory failure, and many people develop it in the later stages of the disease.

In fact, managing chronic respiratory failure is a major aspect of late-stage COPD treatment. You can live with chronic respiratory failure for years and usually manage it at home with the help of medications and your COPD treatment team.

Symptoms of Chronic Respiratory Failure

• Difficulty breathing
• Frequent shortness of breath, especially during physical activity
• Coughing up mucus
• Wheezing
• Headache
• Rapid breathing
• Fatigue
• Anxiety
• Confusion
• Bluish skin color, especially in the fingertips or lips

Acute Respiratory Failure

On the other hand, acute respiratory failure is a life-threatening medical emergency that requires immediate treatment. It can happen quickly, without much warning, and is most often caused by illness and COPD exacerbations.

Acute respiratory failure can be either hypoxemic (caused by low blood oxygen levels) or hypercapnic (caused by high blood carbon dioxide levels).

According to medical criteria, acute hypoxemic respiratory failure occurs:

• If the partial pressure of oxygen in your blood drops below 60 mmHg (91% blood oxygen saturation), OR
• If the partial pressure of oxygen in your blood drops 10mmHg or more below your usual baseline oxygen saturation.

Acute hypercapnic respiratory failure occurs:

• If the partial pressure of carbon dioxide in your blood rises above 50 mmHg, OR
• If the partial pressure of carbon dioxide in your blood rises by 10 mmHg or more above your baseline.

Acute respiratory failure often happens suddenly and begins with irregular breathing patterns like severe difficulty breathing and rapid, shallow breaths. You might also notice other symptoms in the hours and minutes before major breathing problems start, such as anxiety, fatigue, sweating, confusion, or a fast, racing heartbeat.

Symptoms of Acute Respiratory Failure:

• If caused by high carbon dioxide levels (hypercapnic respiratory failure):
• Rapid breathing
• Confusion

• If caused by low oxygen levels (hypoxemic respiratory failure):
• An inability to breathe
• Rapid and shallow breathing
• Bluish skin color, especially in the fingertips or lips
• Loss of consciousness
• Irregular heartbeat
• Racing heartbeat
• Profuse sweating
• Anxiety and restlessness
• Tiredness and fatigue

In this post, we're going to focus on acute respiratory failure, as it is one of the leading causes of death for people with COPD. In the following sections, we'll explain more about the relationship between COPD and acute respiratory failure, including how to prevent it and how to know if you are at risk.

How Does COPD Cause Respiratory Failure?

As we explained before, acute respiratory failure is caused by an imbalance of gasses in your blood, which happens when your lung's normal function gets severely and suddenly disrupted. Now, we'll take a closer look at how exactly COPD causes respiratory failure.

Essentially, COPD puts you at risk because it reduces your baseline lung function and makes your lungs more vulnerable to infection and inflammation. The lower your lung capacity, the more vulnerable your lungs are to minor respiratory ailments, which can tip the balance of gas exchange to trigger acute respiratory failure.

It works like this: lungs affected by COPD exchange gases more slowly and inefficiently than healthy lungs. This happens because the air sacs responsible for facilitating gas exchange in the lungs get damaged and destroyed by COPD.

In addition to this, the airways that carry air to and from the lungs become narrowed, inflamed, and blocked up by mucus. This makes it more difficult to both inhale enough air and to exhale air from the lungs completely. It also makes it easier for viruses and infections to multiply in your lungs and airways.

Over time, this airway obstruction can lead to lung hyper-inflation, which happens when you can't push all of the air out of your lungs when you exhale. The leftover air stays trapped inside your lungs and prevents them from collapsing completely, which eventually causes your lung tissues to stretch out and expand.

This, in turn, makes it even more difficult to breathe and exhale completely, causing more and more air to become trapped in your lungs. This puts extra strain on the muscles you use to breathe, leading to respiratory muscle fatigue and potentially respiratory muscle failure, which is another potential trigger for acute respiratory failure.

These are some of the main reasons why COPD raises your risk for hypercapnea, hypoxemia, and both acute and chronic respiratory failure. The further disease progresses, the harder it becomes for your lungs to exchange gases fast enough to satisfy your body's needs.

Eventually, the lungs become so strained that they can't keep up at times when your body needs more oxygen than usual, which is why physical activity can make you feel short of breath if you have COPD. This also means that anything that reduces your lungs ability to function—even minor things like illness or inflammation—can make it impossible for your lungs to keep up.

When this happens, it causes imbalances in the gasses in your blood, leading to hypoxemia, hypercapnea, or both. If this happens slowly and gradually, then it leads to chronic respiratory failure, which can be treated at home with medications like bronchodilators, supplemental oxygen, and other COPD treatments.

On the other hand, acute respiratory failure happens when you experience a sudden drop in respiratory function, which is an immediate, life-threatening emergency. Acute respiratory failure is more likely to happen to people who already have chronic respiratory failure, a condition known as acute-on-chronic respiratory failure.

Acute respiratory failure is usually triggered by something that puts extra strain on your lungs, such as a COPD exacerbation. Acute respiratory failure can also be caused by environmental irritants that cause lung inflammation, like air pollution and smoke, while some cases of respiratory failure have no obvious or traceable cause.

Both acute and chronic respiratory failure can significantly increase your risk of dying from COPD. In fact, research shows that acute-on-chronic respiratory failure is the number one cause of mortality in people with COPD, accounting for about 38% of all deaths.

How Do You Know if You're At Risk for Respiratory Failure?

Respiratory failure is a well-known complication of COPD, but not every person with the disease will experience it. There are a variety of factors that influence your risk for respiratory failure, including the severity of your disease.

For example, the risk is higher if you have certain medical problems, such as heart disease or asthma, in addition to COPD. Behaviors like smoking and excessive drinking can also elevate your risk.

Another risk is using supplemental oxygen incorrectly, whether through misuse of the medication or getting the wrong prescription. In rare cases, this can disrupt gas exchange severely enough to cause acute respiratory failure.

Most cases of respiratory failure, however, are triggered by COPD exacerbations. Exacerbations are essentially major symptom flare-ups that last for days or weeks at a time, causing temporary or permanent lung function decline.

Exacerbations are most likely to happen when you get sick with a respiratory illness—like pneumonia, a common cold, or the flu. If not brought under control quickly, exacerbations can limit your lung function so severely that it causes acute respiratory failure.

Other factors that may increase your risk for respiratory failure:

• Smoking
• Excessive drinking
• Breathing respiratory irritants like air pollution, noxious chemical fumes, and smoke
• Lung hyperinflation
• Malnutrition

What Should You Do if You Have Acute Respiratory Failure?

Acute respiratory failure is an extremely serious condition, and it can be deadly if you don't get immediate medical care. If you notice the signs of acute respiratory failure in yourself or someone else, you should call 911 or get someone else to drive you to the emergency room right away.

It's also a good idea to prepare for this type of situation ahead of time, since COPD symptoms can quickly become dangerous without a lot of warning. You should always keep a stash of important information and documents on hand in a place where yo can quickly grab them in an emergency.

This stash should include the addresses and phone numbers of the nearest hospitals, your doctors' contact info, and your emergency contact's info, as well as important medical records and a list of all the medications you take. Having these things available will not only ensure that you can get to the hospital fast, but it will also help doctors treat you more quickly and effectively once you arrive.

How Acute Respiratory Failure is Treated

If you go to the hospital with acute respiratory failure, the first thing that medical personnel will do is try to stabilize your breathing and ensure that your body gets enough oxygen. This usually includes administering supplemental oxygen through an oxygen mask, BiPAP machine, or mechanical ventilation.

If you need mechanical ventilation, that requires your doctor to insert a plastic tube through your mouth or nose and down into your windpipe. This tube is then attached to a breathing machine that delivers oxygen directly to your lungs to keep you stable until you can breathe again on your own.

Your doctor will then confirm the diagnosis of acute respiratory failure by measuring the levels of oxygen and/or carbon dioxide in your blood. This can be done with a simple finger pulse oximeter, or by taking a blood sample for an arterial blood gas test.

If the cause of respiratory failure is an illness or infection, your doctor will treat the underlying cause. Your doctor may also give you a variety of medications—such as steroids, antibiotics, and bronchodilators—to reduce lung inflammation and make it easier to breathe.

How to Prevent Acute Respiratory Failure

Respiratory failure is not always preventable, but there are certain things you can do to lower your risk. The next sections include a variety of practical tips to help you avoid the most common causes of respiratory failure, including exacerbations and improper supplemental oxygen use.

Avoid Exacerbations and Getting Sick

COPD exacerbations are responsible for the majority of cases of acute respiratory failure in people with COPD. Because of this, taking steps to avoid exacerbations is one of the most effective things you can do to reduce your risk for respiratory failure.

Fortunately, exacerbations are often avoidable if you follow your COPD treatment plan and do everything you're supposed to do to avoid getting sick. That includes practicing proper hygiene, getting vaccinated against pneumonia and the flu, and doing all the other things your doctor tells you to do to keep your symptoms under control.

The more illnesses and exacerbations you can prevent, the fewer chances you'll have to develop serious COPD complications like acute respiratory failure. It can also help you avoid permanent lung function loss, which can happen during severe exacerbations.

To learn more about how to prevent COPD exacerbations, read our comprehensive guide on the topic here. In the meantime, here are some helpful tips to start with.

Basic Steps to Avoid COPD Exacerbations

• Take your medications on time every day.
• Keep up with vaccinations, including yearly influenza shots and the adult Pneumonia vaccine.
• Use mucus clearance techniques to get rid of excess mucus in your lungs and airways (which can trap bacteria and cause infections).
• Always practice proper hygiene in public places (e.g. wash your hands often, avoid dirty surfaces, and avoid transferring pathogens from your hands to your nose, mouth, and eyes).
• Avoid irritants and triggers that make your COPD symptoms worse, including allergens, dust, mold, smoke, and air pollution.

Treat Exacerbations Promptly

Not all exacerbations are avoidable, even if you do your best to stay healthy. In fact, research shows that people with COPD have about one exacerbation every year on average, which increases to two every year for people with severe COPD.

Fortunately, exacerbations are not an all-or-nothing thing; some exacerbations are life-threatening, while others are mild enough to to treat at home. The trick is to catch them early and to take the proper steps to keep it under control.

Exacerbations are easiest to treat in the beginning, right when you first notice your symptoms flaring up. It's much easier to prevent the symptoms from getting worse than it is to reduce them once they're already worsened.

Here are some of the early signs of a COPD exacerbation that you should learn to recognize:

• An increase in the severity of your usual COPD symptoms, including:
• Worse coughing
• Coughing up more sputum than usual
• A change in color of your mucus or sputum
• Worsened shortness of breath
• Increased wheezing or rattling in your chest when you breathe
• Needing to use your rescue inhaler more than usual

• New symptoms, including:
• Irregular or uneven breathing
• Morning headache
• Difficulty sleeping
• Difficulty eating
• Fever

So what should you do if you feel the beginnings of an exacerbation coming on? Well, it depends on your individual COPD treatment plan and the severity of your disease.

The first thing you should do is look at your COPD action plan, which should tell you exactly what actions and medications to take when you notice your symptoms flaring up. This often includes things like reducing your physical activity, taking extra inhaler doses, or starting a preventative antibiotic or steroid regimen.

Your action plan should also tell you when you should call your doctor for extra help and treatment. For example, it might instruct you to call if your symptoms don't improve within a few days, or it might recommend calling as soon as your symptoms start to get worse.

When in doubt, don't hesitate to ask your doctor for advice or to clarify the instructions in your COPD action plan. If you don't have a COPD action plan or aren't sure whether or not you have one, you should schedule time to speak to your doctor about it ASAP.

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A COPD action plan is a vital tool that every person with the disease should have; it tells you how to treat your COPD in a variety of different circumstances and how to recognize medical emergencies like the signs of respiratory failure. That's why it's vital to work with your doctor to come up with a COPD action plan that's easy to follow and understand.

Here are some links to helpful guides and information about COPD action plans:

• Printable COPD action plan (PDF link) that you can work through with your doctor or use as an example for reference
• Another printable COPD action plan (PDF link) from Lung Foundation Australia
• Our practical guide to COPD action plans with detailed information about to use your COPD action plan to meet your health and lifestyle goals

Monitor Your Symptoms

Nicotine withdrawal is one of the most difficult challenges you will have to overcome when you first quit smoking. In fact, it's one of the main reasons that smokers tend to relapse in the first few days and weeks after quitting.

However, as long as you plan ahead, you can minimize your withdrawal symptoms and increase your chances of making it through those critical first weeks.

In this post, we're going to tell you all about nicotine withdrawal and what kinds of symptoms you can expect when you stop smoking. Then, we'll introduce you to some tools to help you cope with tobacco cravings, including strategic plans for distraction and quit-smoking medications that are scientifically proven to make it easier to quit.

In the final sections, we'll go over each type of quit-smoking medication one-by-one, including all the different forms of nicotine replacement therapy and non-nicotine medications like Chantix and Zyban. We'll go over their strengths, weaknesses, side-effects, and how to use each medication properly so you can better weigh your options and choose the ones that are best for you.

What is Nicotine Withdrawal?

Nicotine is one of the main reasons that smoking is so addictive, and it's also one of the biggest reasons that quitting smoking is so hard. Nicotine dependence is so powerful that most smokers start to get nicotine withdrawal symptoms just a few hours after their last smoke.

Soon after you quit smoking, nicotine withdrawal can cause a variety of physical and mental symptoms that make you feel worse for awhile. However, these symptoms are only temporary, and will disappear in a few weeks after your body adjusts to the change.

Nicotine withdrawal is essentially your body's reaction to no longer getting a steady supply of nicotine from smoke. Heavy smokers tend to have worse withdrawal symptoms than light smokers, and specific symptoms can vary widely from person to person.

Physical Symptoms of Withdrawal:

• Dry mouth
• Headaches
• Nausea
• Fatigue
• Sweating
• Coughing
• Digestive issues
• Increased appetite
• Difficulty staying asleep
• Weight gain

Psychological Symptoms of Withdrawal:

• Strong nicotine cravings
• Irritability
• Anxiety
• Poor mood and mood swings
• Feeling jittery or restless
• Difficulty concentrating

Nicotine withdrawal symptoms usually start within 24 hours of your last cigarette and reach their peak in about three days. While those first days can be very difficult, once you make it through, you'll be more likely to succeed in staying smoke-free.

Your withdrawal symptoms should begin to get better after just a few days, improving little by little over the course of several weeks. By the time you make it one whole month without smoking, chances are that most of your symptoms will have already disappeared.

However, everyone experiences withdrawal differently, so don't be surprised if your symptoms are different from other smokers' or follow a different timeline. For example, many ex-smokers find that their nicotine cravings stick around for longer than the other symptoms.

Fortunately, your withdrawal symptoms will go away eventually, as long as you continue to abstain from smoking. In fact, you'll find that they'll quickly be replaced with a variety of positive mood and health benefits.

But until the withdrawal wears off, you'll need some strategies for coping with the initial negative symptoms. In the next sections, we'll show you some helpful strategies and tools (including quit-smoking medications) you can use to make it through.

Make a Distraction Plan

It's much easier to ignore cravings and temptations when you have something—anything—else to focus on. That's why you should plan some activities you can use to keep yourself busy on the first day you quit and beyond.

Fun activities like hobbies, movies, and social activities with friends are a good place to start. Physical activities like walking and biking are also a great way to take your mind off your worries, and they give you the added satisfaction of doing something positive for your health.

Practicing self-care at home is another healthy way to take your mind off smoking; this includes relaxing activities like taking a bath, writing in a journal, and practicing mindfulness meditation. However, you should also find things to do outside of your home that get you away from your normal routine.

Just about anything you like to do can be an effective distraction from the desire to smoke, as long you actually remember to to do it. Unfortunately, it's easy to forget all the things you planned to do in the moments you need them the most.

Your mind isn't always is the best place to think up distractions when you're already in the middle of a tobacco craving. So, instead of leaving it up to your brain when it's busy grappling with the temptation to smoke, you should put your plan down in writing somewhere you can reference it on the fly.

First, take some time to really think about activities you like to do that could work as potential distractions from smoking. Then, take the time to write them down on paper, or type them into a document on your phone.

Just make sure you keep your plan in a place that you can access it easily whenever a sudden craving hits. That way, you'll always have a handy list of strategies to choose from, even when your brain has trouble remembering the details of your quit-smoking plan on its own.

You might want to make a few separate lists of specific distractions you can use in different settings and situations. For example, you might want a list of activities you can do at home, a list of things you can do outside the house, and a list of quick and simple strategies you can use when you're on-the-go or just don't have a lot of time.

Here are a few ideas to get you started.

Home-Based Distractions:

• Call or text a friend
• Try cooking or baking a new recipe
• Write in a journal
• Read a book or magazine
• Watch a movie or favorite TV show
• Organize a cluttered area of your home
• Finally do that deep cleaning project you've been putting off
• Prep some ingredients for a delicious home-cooked meal
• Color in a coloring book (there are plenty of adult coloring books to choose from that have much more detail than coloring books made for children)

Getting-Out-of-the-House Distractions:

• Take a quick walk (around the block, on a trail, etc.)
• Go out for coffee by yourself or with a friend
• Visit a local museum, park, library, or other public place
• Volunteer at an animal shelter or another organization
• Join a club (e.g. a sports club, a book club, or a knitting club)

Quick & Simple Distractions to Use On-the-Fly:

• Drink a glass of water or eat a quick snack
• Listen to a song that makes you feel good
• Play a quick game on your phone (e.g. a relaxing matching or puzzle game)
• Watch a short video online
• Find a quiet place to relax, breathe, or meditate for a moment
• Focus on your breaths and practice deep breathing exercises

Quit-Smoking Medications

Using a quit-smoking medication can significantly increase your chances of quitting and staying smoke-free after you quit. They can help you control cravings, reduce withdrawal symptoms, and even help prevent weight gain after you stop smoking.

There are two main types of quit-smoking medications: Nicotine replacement therapies and non-nicotine medications like Chantix and Zyban.

Nicotine Replacement Therapies

Nicotine replacement therapies are the most popular and most frequently recommended types of quit-smoking medications. They come in a variety of different forms, including patches, gum, pills, lozenges, and more; many of them are available over-the-counter, but some of them require a doctor's prescription.

Nicotine replacement medications are all designed to give you a specific dose of nicotine in a form that's much safer than inhaling it through smoke. When you use them throughout the day, they help stave off nicotine withdrawal, reducing both symptoms and tobacco cravings.

A large number of studies have shown that nicotine replacement therapies can significantly boost your chances of being able to stop smoking for good. In fact, the medications are so effective that many doctors and experts say that they should be an integral part of just about every smoker's plan to quit.

The exceptions to this are people with certain health conditions, such as heart disease and diabetes, and women who are pregnant or breastfeeding. If you have an existing health problem, make sure you talk to your doctor before starting any type of quit-smoking medication.

Here are some of the main benefits of using a nicotine replacement therapy to help you quit:

• Increases your chance of quitting smoking successfully by 50 to 70 percent
• Reduces tobacco cravings
• Prevents symptoms of nicotine withdrawal
• Reduces weight gain after quitting (however, you may gain weight after you stop using the nicotine replacement therapy)

Nicotine replacement therapy can have some negative side effects, too, and they can vary based on the type of medication you use. Some of the most common negative symptoms are nausea, stomach problems, a racing heartbeat, and difficulty sleeping.

It is also possible to overdose on nicotine when you use nicotine replacement therapy, even though it is rare. That's why you should always follow the instructions on the medication and never take more than the maximum dose.

Which type of nicotine replacement therapy works best for you will depend on your personal lifestyle and preferences. For example, you might find that certain forms of nicotine replacement medications are easier to use or fit better into your daily routine.

You should also consider using more than one type of nicotine replacement at the same time when you quit. Research shows that people who use a combination of nicotine replacement therapies are more likely to succeed in staying smoke-free than those who use just one.

However, it's still a good idea to talk to your doctor first, even if you plan to use an over-the-counter nicotine replacement therapy. He can help you explore your options, give you helpful advice about side-effects and dosage, and answer any questions or concerns you might have.

Most nicotine replacement medications come in a variety of different nicotine doses, and you can estimate how much nicotine you need based on how many cigarettes you're used to smoking every day. In general, heavier smokers need a higher dose of nicotine in order for the therapy to be effective.

Now lets take a look at the pros and cons of the different types of nicotine replacement medications.

Nicotine Patches

The nicotine patch is one of the most popular forms of nicotine therapy because it's so easy to use. All you have to do is put a sticky patch on your skin, and then you can forget about it for the rest of the day.

Nicotine patches work by releasing a slow, steady amount of nicotine that you absorb into your body through your skin. That way, you have a constant supply of nicotine throughout the day to help stave off cravings and withdrawal.

One patch lasts 24 hours, so you'll only need to use one patch every day. Because of this, however, you can't adjust the dose in response to sudden cravings; that's why many people pair the patch with another type of nicotine replacement therapy.

The patch is waterproof and resilient so it should stay stuck to your skin through showers and other normal daily activities. If it does come off, you can simply replace it with a new nicotine patch.

How to Use a Nicotine Patch:

• Place one nicotine patch on an area of dry, clean, and hairless skin (common places include the stomach, side, and upper arms).
• After 24 hours, replace with a new patch.
• You can continue using the patch for 8-12 weeks, or until your cravings and withdrawal symptoms subside (talk to your doctor if you think you need to use it longer).

Pros of Nicotine Patches

• Simple to use
• Last for 24 hours
• Can be used in combination with other nicotine replacement therapies
• Available over the counter

Cons of Nicotine Patches

• Can't adjust the dose
• Can cause skin irritation (especially if you have a skin condition such as eczema or psoriasis)
• Can cause side effects, including:
• Skin irritation and discomfort around and under the patch
• Skin tingling and itching around and under the patch
• Nausea
• Headaches
• Dizziness
• Racing heartbeat
• Muscle pain
• Difficulty sleeping

Nicotine Gum

Another option for nicotine replacement therapy is nicotine gum. This is simply a small piece of gum that releases nicotine as you chew it.

While nicotine gum is relatively easy to use, you have to chew it for an extended period of time using a stop-start technique. You start by chewing the gum until you feel a tingling sensation in your mouth, then you stop until the tingling subsides.

Then, you begin chewing again, stopping once you feel the tingling sensation once more. You have to continue repeating these steps for about thirty minutes in order to get the full nicotine dose.

This prolonged process is inconvenient for some people, but others find it satisfying to have something to do with their mouth and jaw. By engaging your mouth, like smoking does, it can satisfy oral fixation impulses and make cravings easier to resist.

How to Use Nicotine Gum:

• Avoid eating or drinking 15 minutes before using the gum (and while chewing it).
• Start by chewing one piece of gum every hour or two (you should use at least 9 pieces a day for the first 6 weeks).
• After 6 weeks, reduce the number of pieces you use per day by about half, using one piece every 2-4 hours.
• After 9 weeks, reduce your number of doses by half again, using one piece every 4 to 8 hours.
• Never swallow the gum.
• You should stop using the gum after about 12 weeks, or until your cravings and withdrawal symptoms subside (talk to your doctor if you think you need to use it longer).

Pros of Nicotine Gum

• Satisfies oral fixation by engaging your mouth and jaw
• Lower doses are available over the counter
• You can adjust the number of doses as needed to curb cravings and withdrawal symptoms

Cons of Nicotine Gum

• Must chew gum frequently throughout the day
• Must chew each piece of gum for an extended period of time
• Can leave a bad taste in your mouth
• Causes a tingling feeling in your mouth
• Can cause negative side effects, including:
• Mouth irritation
• Nausea
• Jaw pain
• Getting stuck to dental work
• Racing heartbeat

Nicotine Lozenges

A nicotine lozenge is a small tablet that releases nicotine as it dissolves slowly in your mouth. They are quick and simple to use, but you have to use them frequently throughout the day.

Nicotine lozenges usually only contain a small amount of nicotine (2 or 4 mg), and are often used in combination with other nicotine replacement therapies like the nicotine patch. You can also get mini nicotine lozenges that dissolve more quickly than regular-sized lozenges.

How to Use Nicotine Lozenges:

• Avoid eating or drinking 15 minutes before using the lozenge (and while the lozenge is in your mouth).
• Place the tablet between your cheek and your gums.
• Slowly suck on the tablet until it dissolves completely.
• For the first 6 weeks, use one lozenge every one or two hours.
• After 6 weeks, reduce your dosage frequency to one every 2-4 hours.
• After 9 weeks, reduce the number of doses again to one lozenge every 4-8 hours.
• Do not chew or swallow the tablet.
• Do not use more than 5 tablets per 6 hours or use more than 20 lozenges per day.
• You can continue using them for about 12 weeks (talk to your doctor if you think you need to use them longer).

Pros of Nicotine Lozenges

• Available over the counter
• Can adjust the frequency of your doses according to cravings and withdrawal symptoms
• Will not stick to fillings and dental appliances like nicotine gum can

Cons of Nicotine Lozenges

• Must use repeatedly throughout the day in order to be effective
• Can cause side effects, including:
• Coughing
• Heartburn
• Nausea
• Gas
• Hiccups
• Racing heartbeat
• Difficulty sleeping

Nicotine Nasal Sprays

Another type of nicotine replacement therapy comes in the form of a nasal spray. It works by squirting a nicotine-containing liquid directly into your nose, where you absorb it through your nasal lining.

With this method, nicotine absorbs into your bloodstream more quickly than most other forms of nicotine replacement therapy, including nicotine lozenges and gum. This makes it particularly useful for quickly countering sudden tobacco cravings.

How to Use a Nicotine Nasal Spray

• You will need to prepare (or prime) the spray before using a new spray bottle for the first time; to do this, simply spray the bottle several times into a sink or towel until you see a fine mist.
• To take one dose, tilt your head slightly backward and squirt one quick spray (without sniffing or inhaling) into both nostrils.
• If it begins to run out of your nose, keep your head tilted and sniff gently to keep the medication in your nostrils.
• In most cases, you should start out by using the nicotine spray once or twice per hour.
• You can continue using the nicotine nasal spray for 12-14 weeks (talk to your doctor if you think you need to use it for longer).

Pros of Nicotine Nasal Sprays:

• Works faster than most other nicotine replacement medications
• Can adjust dose frequency according to cravings and withdrawal symptoms

Cons of Nicotine Nasal Sprays:

• Only available by prescription
• Must use repeatedly throughout the day in order to be effective
• Not recommended for people with existing nasal or sinus problems
• Can trigger allergy-like symptoms (sneezing, coughing, watery eyes)
• Can cause other side effects, including:
• Nose and throat irritation
• Headache
• Racing heartbeat
• Nervousness

Nicotine Inhalers

Nicotine inhalers are small devices that you use to inhale nicotine into your mouth. This makes using a nicotine inhaler feel similar to smoking, which is a major part of its appeal.

Most nicotine inhalers look very different from the types of inhalers prescribed for health conditions like asthma. They generally have two parts: a mouthpiece and matching nicotine-containing cartridges.

When you attach the cartridge to the mouthpiece and take a puff, it turns the nicotine into a vapor that you can suck into your mouth. Despite its name, however, you do not inhale the vapor all the way into your lungs; instead, you hold the vapor in your mouth for several seconds before blowing it out.

How to Use a Nicotine Inhaler:

• The number of doses you take each day, a

One of the main priorities in COPD treatment is keeping symptoms of the disease—such as breathlessness, coughing, and excess mucus—under control. However, this isn't always an easy thing to do, and COPD symptoms can get worse without much warning, even when you do everything right.

One of the biggest culprits of symptom flare-ups are COPD exacerbations, which are periods of elevated symptoms that can last for days, weeks, or more. In some cases, they can even lead to permanent lung damage and quicker lung function loss, which is why managing exacerbations is a vital aspect of treating COPD.

Because of this, many COPD treatment guides focus on how to prevent exacerbations, which is usually done through a combination of medication, lifestyle changes, and avoiding exacerbation triggers like illnesses and environmental irritants. However, it's also important to realize that exacerbations are not always avoidable; in fact, they are more or less an inevitable part of living with COPD.

As unfortunate as this is, it's anything but hopeless. COPD exacerbations are very treatable, and there are a variety of effective strategies and tools you can use to manage the symptoms of an exacerbation even after it has already begun.

That's why we created this practical guide about how to recover from a COPD exacerbation. In the sections below, we'll introduce you to a plethora of helpful tips and proven techniques you can use to manage exacerbations at home and get better as quickly as possible.

Whether you are experiencing an exacerbation now or you're preparing for when the next one comes, the information in this guide can help. When you learn how to be proactive about treating your COPD, you'll be better able to manage your symptoms and feel even empowered to take charge of even more aspects of your health and disease treatment.

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How to Get Over a COPD Exacerbation More Quickly

Catch it Early

If you want to limit the effects of an exacerbation and recover as quickly as possible, early detection is key. The sooner you notice the signs of an oncoming exacerbation, the sooner you can take action to bring your symptoms back under control.

In some cases, early detection and quick treatment can essentially “nip it in the bud” and prevent the exacerbation from getting significantly worse. It can also help prevent exacerbations triggered by respiratory illnesses like the cold or flu from escalating into a more serious infection like pneumonia.

In fact, research has shown that COPD patients who treat their exacerbations soon after they start recover more quickly than those who delay treatment. Patients who begin treatment promptly are also less likely to be hospitalized for the exacerbation and have a higher health-related quality of life.

Because of this, it's very important to monitor your COPD symptoms and how they change from day to day. The more familiar you are with your “baseline” symptoms, the more likely you are to notice when they start to get worse.

Here are some of the signs of a COPD Exacerbation:

• Increased shortness of breath
• Increased coughing or more sputum
• Increased fatigue
• Morning headaches
• Noisier breaths or wheezing sounds when you breathe
• Fever
• Symptoms of a cold or another respiratory illness
• Change in the color of your mucus or sputum
• Swollen ankles
• Confusion

These changes can happen suddenly without much warning, so you should always be on the lookout for flare-ups; even small up-tick in symptoms need to be carefully monitored for change. It's also important to know exactly what to do when an exacerbation strikes, as directed by your doctor and your COPD action plan.

Enact the Correct Steps in Your COPD Action Plan

We talk a lot about COPD action plans on this blog because they are just so important for managing the disease. Every person with COPD should have one of these individualized plans, which tells you precisely how to manage your COPD medications and treatments from day toy day.

While action plans are important for daily COPD management, they are perhaps even more useful for managing exacerbations. They tell you exactly what to do as soon as you notice your symptoms flare up, which gives you the opportunity to respond to a potential exacerbation quickly so you can start self-treatment at home.

The self-treatment directions in a COPD action plan often include things like reducing physical activity, taking a larger dose of medication, or starting a new medication. The exact instructions will vary from patient to patient, since they are designed to account for the severity of the disease and other individual needs.

At the start of an exacerbation, following the instructions in your COPD action plan can reduce your symptoms or prevent them from getting worse. In fact, research shows that COPD patients who follow an action plan recover from exacerbations more quickly, have fewer hospital visits, reduced shortness of breath, and a generally improved quality of life.

However, enacting your COPD action plan—while important—is not guaranteed to prevent an exacerbation from becoming more severe. It's important to talk to your doctor if your symptoms don't improve quickly, or if they continue to get worse.

Luckily, your action plan should also tell you when to notify your doctor of your symptoms, and how to know if you require more intensive medical care. When in doubt, don't hesitate to call your doctor and ask her for advice.

If you don't currently have a clear and complete COPD action plan, you should talk to your doctor about putting one together at your next visit. You could even ask your doctor to fill out this COPD action plan template (PDF link) or use it as a starting point for working out a more personalized plan.

The following sections include additional tips for using your COPD action plan to treat an exacerbation. For even more information on the topic, check out our previous guide on COPD action plans here.

Pay Close Attention to Which “Zone” You Are In

A COPD action plan isn't a singular set of instructions, but rather a collection of several sub-plans. Each of these sub-plans—which are often referred to as “zones”—corresponds to a different level of COPD symptom severity

Most action plans have 3 zones labeled by color: a green zone, a yellow zone, and red zone.

Here's an quick run-down of what each of these zones stand for:

• The Green Zone: This zone tells you how to treat your baseline symptoms, and it's the plan you'll follow on typical days.
• The Yellow Zone: This zone tells you what to do when your symptoms get worse, and usually directs you to take extra steps in addition to your usual treatment routine. Essentially, the yellow zone is your guide to managing the early signs of a COPD exacerbation.
• The Red Zone: This zone tells you what to do if you experience more severe symptoms; in many cases, this includes going to the hospital for professional medical care.

For each zone, your plan should have two important pieces of information. First, there should be clear descriptions of which types of COPD symptoms correspond to each particular zone. That way, all you have to do to determine which plan you should follow for the day is choose the zone with the description that most closely matches your current symptoms.

Second, each zone should includes a specific list of actions you need to take that day to manage your symptoms. These instructions may cover variety of different treatments and lifestyle factors, including diet, exercise, medications, and symptom management techniques.

However, you action plan can only help you if you know how to use it correctly, which is why it is so important to make sure that you thoroughly understand all the information it contains. Each part of your action plan is designed to help you manage a specific set of symptoms, and it will only be effective if you can accurately evaluate which zone to use each day.

Take Time to Rest

Getting plenty of exercise is a crucial part of managing COPD, and it's perfectly safe in most cases. However, when you're sick or coming down with an exacerbation, too much physical activity can make your symptoms worse.

Because of this, the “yellow zone” in many COPD action plans includes instructions to reduce or stop physical activity. Doing so allows your body to rest and prevents extra strain on your lungs, which are already more strained than usual because of the exacerbation.

It can be tempting to ignore this recommendation, especially if it means canceling plans or taking time off work. However, as frustrating as it might be, slowing down and taking it easy can help you recover more quickly so you can get back up on your feet ASAP.

Be Ready to Adjust Your Medications

There's a good chance that your COPD action plan will tell you to take extra medication when your symptoms flare up. It might, for example, tell you to take more of your usual medication (e.g. use your rescue inhaler more often) or it might tell you to start a new course of medication like steroids or antibiotics.

These medications can reduce both the length and severity of your exacerbation, but they're usually most effective if you start them early on. Because of this, you should make sure you have these extra medications on hand for when you need them.

For example, if your action plan says to begin a course of steroids when you feel an exacerbation coming on, ask your doctor for an extra supply to keep at home. That way, you can begin taking the medication immediately when you feel an exacerbation coming on, without having to make a trip to the pharmacy.

Know Your Treatments and What They are For

In order to self-treat an exacerbation and enact your COPD action plan, you need to have a thorough understanding of all your COPD medications. That includes the medications you take for daily COPD maintenance, as-needed inhalers, and medications specifically prescribed to treat COPD exacerbations.

You need to know more than just the name and dosage of your medicines; you should also know what each medication does and why you take it. After all, your overall health and your ability to recover from exacerbation depends on your ability to use them correctly.

The more you know about your medications, the better you will be able to manage your symptoms during an exacerbation, and the better you will be able to interpret the directions in your COPD action plan. It will also help you better communicate with your doctor about managing exacerbations and your COPD treatment plan in general.

Since you don't use them as often, you might not be as familiar with your exacerbation medicine as you are with your daily medications. That's why it's important to take the time to learn what they are and how they help.

Don't be afraid to use your doctor or pharmacist as a resource if you have any questions or concerns about any medicine you take. To help you get started, the following sections include a quick overview of each of the four main medications used to treat COPD exacerbations:

Quick-acting Bronchodilators

Quick-acting bronchodilators, also known as quick-relief or rescue inhalers, are as-needed medications that work almost immediately to open up your airways and make it easier to breathe. They are different from long-acting bronchodilators (also known as maintenance inhalers), which take much longer to work and need to be taken on a schedule every day.

During an exacerbation, you may need to use your rescue inhaler more often to keep your COPD symptoms under control. In fact, using your rescue inhaler more often is a common first sign of a COPD exacerbation.

Corticosteroids

Corticosteroids, sometimes simply called steroids, are medications that treat inflammation. They help you breathe better and reduce COPD symptoms by making your lungs less irritated and inflamed.

Because exacerbations worsen lung inflammation, corticosteroids are often prescribed to manage COPD flare-ups and exacerbations. Research shows that, in many cases, this treatment can reduce shortness of breath and even shorten the length of the exacerbation.

Antibiotics

Some exacerbations are caused by bacterial infections, which require antibiotics to cure. However, sometimes doctors prescribe antibiotics before an infection is known, in order to control bacteria in the lungs and prevent a more serious infection from taking hold.

These preventative antibiotic treatments can prevent a common cold or another illness from causing a secondary infection like pneumonia, which is a major risk during an exacerbation. In this way, antibiotics can help prevent an exacerbation from getting more severe and reduce the risk for serious complications.

Supplemental Oxygen Therapy

Supplemental oxygen is often used to treat low blood oxygen levels, known as hypoxemia, in people with COPD. People with chronic hypoxemia often need to use oxygen every day, but oxygen therapy is also used to treat temporary hypoxemia caused by COPD exacerbations.

Even if your blood oxygen levels are usually within a healthy range, exacerbations can impair your lung function to the point that they fall much lower than normal. If this happens, you might be have to use supplemental oxygen for a few days—or potentially longer—to ensure your body gets enough oxygen until you recover from the exacerbation.

Here are some additional guides to help you understand and manage your COPD medications:

• How to Take COPD Medications Correctly & Adhere to Your Treatment Plan
• 11 Tips for Saving Money on COPD Medications

Don't Delay Seeking Treatment

While self-treatment at home is enough to get over some exacerbations, it's not always possible to get better on your own. In many cases, COPD exacerbations require more extensive treatment from a doctor or an in-patient hospital stay.

Because of this, it's important to talk to your doctor if you have a flare-up that continues to get worse or doesn't start to get better after a few days. When in doubt, you can always reference your COPD action plan or call your doctor for advice.

What you shouldn't do is wait too long too get help, which could lead to much more severe symptoms and a longer recovery time. Delayed treatment can also increase your risk for permanent lung function loss, lung infections, and other complications.

During an exacerbation, you might also have a higher risk of experiencing life-threatening sympyoms that require emergency medical attention. If this happens, call 911 right away or get to an emergency room as soon as possible.

The following symptoms could be a sign that you need emergency medical care:

• Extremely severe breathlessness that doesn't go away with rest
• Breathlessness that leaves you unable to sleep or do light activity
• Unusual or severe chest pains
• Fever, shaking, or chills
• Confusion
• A bluish tint on your fingertips or lips
• Coughing up blood

To learn more about medical emergencies related to COPD, you can read our guide on the topic here.

Conclusion

If you have COPD, it's important to be prepared for handling the inevitable flare-ups and exacerbations when they come. That means knowing how to identify the signs of an exacerbation, enact a treatment plan, and knowing when it's time to get professional medical help.

With the right medications and a proper COPD action plan, you can self-treat the early stages of most exacerbations at home. Even if your symptoms end up getting worse, catching the exacerbation early and responding promptly can still limit how severe it becomes.

Even though exacerbations can be frightening and difficult to manage, remember that there are many ways to treat your symptoms and give yourself the best shot at quick recovery. By learning how to manage an exacerbation properly and taking a more active role in your health, you can take back a significant measure of control over your health and your COPD.

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

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

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

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

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

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

Respiratory Depressants: Medications that Make it Harder to Breathe

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

Some common symptoms of respiratory depression include:

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

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

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

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

The Dangers of Respiratory Depression for People with COPD

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

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

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

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

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

Central Nervous System Depressants: A Major Cause of Respiratory Depression

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

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

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

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

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

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

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

Can People with COPD Take Medications that Cause Respiratory Depression?

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

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

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

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

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

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

Types of Medications that Cause Respiratory Depression

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

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

Opoid Pain Relievers

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

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

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

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

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

Common Opoid Drugs and Brand Name Medications:

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

Sedative Antihistamines

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

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

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

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

Common Drugs and Medications Containing Sedative Antihistamines:

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

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

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

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

Cough & Cold Medications

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

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

Common Cough Medications that Can Act as CNS Depressants:

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

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

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

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

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

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

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

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

How to Recognize the Early Signs of COPD

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

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

Early Symptoms of COPD

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

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

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

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

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

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

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

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

Shortness of Breath

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

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

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

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

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

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

Excess Mucus

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

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

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

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

Other Breathing Difficulties

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

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

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

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

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

Chronic Cough

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

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

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

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

Fatigue

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

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

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

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

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

Your Symptoms Might Depend on What Kind of COPD You Have

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

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

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

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

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

Chronic Bronchitis

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

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

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

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

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

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

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

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

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

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

Emphysema

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How to Estimate Your Risk for COPD

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

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

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

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

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

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

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

Even if you end up developing COPD anyway,