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

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

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

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

How to Use This Quit Smoking Guide

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

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

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

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

Here are some ways you can use this guide:

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

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

Frequently Asked Questions About Quitting Smoking

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What if I Gain Weight After I Quit?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Quit-smoking Programs and Resources

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

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

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

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

Text and App-Based Mobile Quit-Smoking Programs

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

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

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

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

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

Online Quit-Smoking Programs and Support Groups

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

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

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

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

Quit-Smoking Phone Hotlines

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

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

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

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

Quit-Smoking Counseling

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

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

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

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

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

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

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

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

Here are some quit-smoking counseling resources to consider:

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

Counseling for Other Psychiatric Problems

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

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

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

Online Educational Resources

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

Here are some links to some of the most useful

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

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

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

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

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

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

Why are People with COPD Prone to Airway Infections?

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

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

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

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

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

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

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

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

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

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

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

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

When Does Someone With COPD Need to Take Antibiotics?

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

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

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

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

How Do Antibiotics Work?

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

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

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

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

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

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

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

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

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

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

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

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

How Antibiotics are Used to Treat COPD

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

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

Treating Bacterial Respiratory Infections

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

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

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

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

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

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

Treating COPD Exacerbations

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

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

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

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

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

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

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

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

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

Preventing Exacerbations: Prophylactic Antibiotics

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

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

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

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

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

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

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

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

Benefits and Risks of Antibiotics to Treat COPD

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

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

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

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

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

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

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

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

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

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

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

COPD & Inflammation: An Inflammatory Disease

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

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

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

Lung and Airway Inflammation

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

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

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

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

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

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

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

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

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

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

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

Systemic Inflammation

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

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

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

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

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

Inhaled Steroids Versus Systemic Steroids: A Major Difference

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

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

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

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

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

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

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

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

Inhaled Steroid Medications: For Daily COPD Maintenance and Exacerbation Prevention

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

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

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

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

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

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

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

Using Inhaled Steroids to Treat COPD

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

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

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

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

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

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

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

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

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

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

How Inhaled Steroid Medications Work

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

COPD Progression: The Unfortunate Reality of Living With COPD

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

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

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

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

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

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

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

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

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

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

Why Does COPD Progress?

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

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

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

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

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

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

Can You Predict COPD Progression?

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

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

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

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

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

Can You Slow Down COPD Progression?

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

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

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

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

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

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

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

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

Minor Symptom Flare-Ups

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

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

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

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

COPD Exacerbations

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

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

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

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

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

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

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

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

COPD Progression

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

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

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

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

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

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

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

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

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

You're Spending More Time at the Hospital

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

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

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

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

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

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

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

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

Mask-wearing is uncomfortable for just about everyone, but people with COPD and other breathing disorders have more reason than most to complain. Having a serious respiratory disease can legitimately make breathing through a face mask more difficult, even though face coverings are not actually dangerous for people with COPD (as most doctors agree).

Unfortunately, masks have become an unavoidable feature of daily life in many places, as they are a central part of the public health efforts to control the spread of COVID-19. This has left many people with COPD wondering how to cope with the discomfort of mask-wearing and, in some cases, even looking for exceptions or alternative solutions to wearing a mask.

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That's why we created this guide to address the logistics of masking for people with COPD. In it, you'll find a variety of practical strategies you can use to not only make wearing a mask more tolerable so you can enjoy outings and other activities without feeling breathless and fatigued.

Throughout this guide you'll find tips for coping with a variety of situations, including those that tend to be especially challenging for people with COPD (e.g. hot weather, prolonged masked outings, and using supplemental oxygen while wearing a mask). We'll also dissect the pros and cons of different kinds of masks, and how to choose one that is both effective and easy to breathe in with COPD.

Face Masks & COPD: What Every COPD Patient Should Know

We know that many people with respiratory diseases like COPD have questions and concerns about how wearing a mask affects their health and their breathing. Here are a few of the most common ones that you might have heard before or worried about yourself:

• Is it safe for people with chronic respiratory diseases like COPD to wear a mask?
• Can wearing a mask impair your breathing or reduce how much oxygen you get when you breathe?
• Can people with COPD and other serious respiratory disease get exempted from having to wear a mask?

So before we jump right into the “survival strategies” portion of this guide, we'd like to take a moment to address these and other common questions that people have about masking & COPD. If you'd like to skip ahead, you can click the following links to go straight to the sections on Choosing a Mask for COPD or Tips & Tricks for Making a Mask More Bearable.

Is it Safe to Wear a Mask if You Have COPD?

Despite the fact that wearing a mask can cause a great deal of discomfort, it's important to know that they're not actually dangerous for your health. In fact, some of the largest COPD & lung disease organizations in the US have gone out of their way to reassure patients that wearing a face covering is not only safe, but also important for people with COPD and other chronic lung diseases.

Organizations endorsing the safety of masking for COPD patients include:

• The COPD Foundation
• The American Lung Association
• The American Thoracic Society
• The American College of Chest Physician

It's important to note that the list above is far from comprehensive; a large number of healthcare networks and medical organizations across the country have endorsed masking as a means to reduce virus transmission.

Can Wearing a Mask Impair Breathing?

Since the advent of mask mandates, many people—especially people with respiratory diseases—have been concerned that wearing a face mask might impair their ability to breathe. Some have even claimed that wearing a mask can reduce blood oxygen levels or cause too much carbon dioxide to get absorbed into the blood.

The good news is that these concerns are unfounded; studies consistently show that face masks don't impair breathing—and that holds true for healthy adults, older adults, and people with chronic lung diseases (including COPD).

That's because both oxygen and carbon dioxide can pass through masks very easily; the molecules are many times smaller than the respiratory droplets that masks are meant to block. This means that breathing in a mask won't cause carbon dioxide to get trapped inside it, nor will it block oxygen from getting in.

This is confirmed by multiple studies that measured healthy participants' blood oxygen and carbon dioxide saturation while wearing a mask. These studies find that wearing a mask affects blood levels of carbon dioxide and oxygen minimally, if at all (even during exercise), and report a near-zero risk of any significant breathing impairment for the general population.

Studies on people with COPD, including those with severe lung impairment, show similar results. One study, for instance, found that COPD patients wearing masks experienced no significant decrease in oxygen levels (and no significant increase in carbon dioxide levels) both at rest and during physical activity.

One exception to this is N95 masks. Though they are very effective at preventing virus transmission, N95 masks create a lot more airflow resistance than a typical cloth or surgical mask.

Of course, this isn't a concern for the vast majority of people since N96 masks are meant for healthcare workers and are not recommended for general public use. As we discussed above, a regular cloth or surgical mask will not impair your breathing even if you have COPD or another serious respiratory disease.

If you'd like to learn more about research on mask safety and efficacy, check out this comprehensive analysis from the Scientific Advisory Group (PDF link).

Why is Wearing a Mask So Uncomfortable for People with COPD?

As we discussed in the section above, many studies have confirmed that masks do not actually impair your breathing. But that doesn't explain why wearing a mask can make you feel like it's harder to breathe.

To understand why that is, you have to know a few things about the mechanics of breathing; namely, that breathlessness is a sensation that can be triggered by a variety of different factors, some of which have nothing to do with how much oxygen you're getting or how well you can breathe.

One of these factors is airflow resistance, which affects how much effort it takes to pull air into your lungs when you breathe. Slight changes in airflow resistance (e.g. from breathing through a mask) can trigger feelings of anxiety and breathlessness even if nothing is actually impairing your ability to breathe.

This is a normal physiological reaction to airflow resistance that—in and of itself—isn't a cause for serious concern. It's essentially your body's way of alerting you in case you're actually suffocating; it just tends to be very sensitive, which can lead to false alarms.

So while it's important to pay close attention to your symptoms when you have COPD, it's also important to remember that shortness of breath is just a feeling and that it can have a totally benign cause. So even if the airflow resistance from wearing a mask might make you feel uncomfortable and breathless, you can confidently reassure yourself that it doesn't pose an actual risk to your health.

Can You Be Exempted from Mask Requirements if you Have COPD?

The short answer to this is a conditional yes; the CDC has acknowledged that people with disabilities that make it difficult to breathe in a mask (which could include some people who are disabled because of their COPD) may be exempted from wearing a mask. However, this isn't a blanket excuse for all COPD patients to forego mask-wearing; it just means that some COPD patients in some situations should get exemptions—not that all people with COPD should choose to not wear masks.

In fact, doctors strongly urge all COPD patients to wear a mask if they are able to, since people with COPD are more vulnerable than most to severe complications and death from COVID-19. As researchers wrote in an article published in the European Respiratory Journal, “Relieving respiratory patients from the obligation to wear masks could be highly deleterious for them, since by definition those patients with respiratory conditions who cannot tolerate face masks are at higher risk of severe COVID-19.”

Other medical professionals agree that everyone should wear a mask, regardless of medical condition, since masks have “no effect on respiratory mechanics.” As one doctor put it, “I believe that most people need education on proper use rather than exemption,” including fragile respiratory patients.

If you have COPD, you should be taking every reasonable precaution you can manage to avoid getting sick, including wearing a mask in situations where you're at risk of being exposed to other people's germs. This is especially important if not yet been fully vaccinated, or if you belong to a group for which the vaccine is known to be less effective (e.g. if you are an immunocompromised person or over the age of 65).

You should also keep an eye on your local and national health recommendations, which provide up-to-date guidance on masking and other COVID-prevention measures for both vaccinated and non-vaccinated individuals.

Unless your doctor advises against it or you absolutely cannot tolerate it because of your respiratory symptoms, the benefits of masking are likely to far outweigh any discomfort you might feel. However, that's not to say that the discomfort of wearing a mask is trivial; we don't want to downplay how absolutely miserable it can be.

That's why we're going to spend the rest of this post exploring a variety of different strategies you can use to minimize that discomfort and be able to wear a mask without feeling breathless or fatigued.

Choosing the Right Mask for COPD

The most important factor in mask-wearing comfort is the face covering itself. While this might seem like a no-brainer, finding a mask that fits right, works right, and doesn't create too much resistance when you breathe can be a difficult task.

Unfortunately, a lot of people wear uncomfortable masks that they don't like because they don't realize there are better options out there. But if you take some time to research (and even try out) different types of face coverings, you might be surprised at how much more comfortable the “right” mask can be.

Here are some of the main criteria you should consider when choosing a mask:

Mask Layers

Most face coverings are made up of multiple layers of fabric sewn together, a characteristic often referred to as the material's “ply.” A “three-ply” mask, for example, has three layers of fabric, while a “one-ply” mask has only one.

The number of layers your mask has will effect not only how well it filters out germs but also how comfortable it is to breathe in. The CDC recommends wearing a mask made of at least 2-ply fabric, which is a good middle ground between masks that are less effective (1-ply) and masks that create a lot of resistance when you breathe (e.g. 3-ply and up).

Mask Fit

How a mask fits on your face affects not only how comfortable it is to wear, but also how well it works at protecting you from germs. Unfortunately, many people wear masks incorrectly, increasing their risk of being exposed to other people's germs.

A well-fitting mask is one that fits snugly—but not too tightly—with all the edges sitting flat against your face. A mask that's too loose won't filter air correctly, while a mask that's too tight can be uncomfortable to wear for long periods of time.

Ideally, your mask should also have nose wire to help the mask fit around the curve of your nose without leaving gaps. The goal is to make sure you don't leave any space between the mask and your face that will allow unfiltered air to slip through.

You can help a loose-fitting surgical mask fit better by wearing a cloth mask over the top to hold it snug against your face. However, this method creates extra airflow resistance that might make it too uncomfortable for people with COPD and other respiratory diseases.

If you have a mask that fits too loose, you can always tie a knot in the ear loops to shorten them in a pinch. You can also get masks that that tie around the back of your head, which not only makes them conveniently size-adjustable but also reduces ear soreness (a common complaint about masks that cling to your ears).

Material & Mask Type

The material your mask is made of helps determine not only how effective it is, but also how comfortable it is to wear and breathe in. There are many different types of mask materials, but the types of masks recommended by the CDC for public use generally fall into one of two main types: cloth masks and surgical masks.

Reusable Cloth masks

Cloth masks are face coverings made from one or more pieces of woven fabric sewn together. The type of fabric varies, though most are made from cotton, polyester, and other fabrics commonly used in clothing.

Studies show that different types of cloth masks vary in how well they filter out germs (or, to be more precise, respiratory droplets that carry germs). However, this has less to do with what kind of fabric the mask is made of than how tightly woven that fabric is.

Fabric that's too light (e.g. mesh or see-through) doesn't make a very good filter, while fabric that is too dense can create too much resistance when you breathe. Unfortunately, finding a cloth mask that's both comfortable and effective is always balancing act: you want a mask that's dense enough to block as many droplets as possible while still being light enough to allow air to pass easily through.

Here are additional recommendations from the CDC regarding cloth mask materials:

• The mask should be made from a washable material (so it's easy to clean between uses)
• The mask should not be see-through (if you hold it up to a bright light source, the fabric should be woven tightly enough to block the light from shining through)
• The mask should not have holes, gaps, valves, or any other opening in the fabric that would allow air to go in or out without being filtered through the mask material first

Another important characteristic to consider when choosing a cloth mask is the “feel” of the mask material against your face. You want a mask made from a flexible, soft, high-thread-count fabric that doesn't cause any itching or irritation on your skin.

You might need to try out a few different types of masks before you find a design and material that works for you. You can also look for recommendations online by searching for “breathable” masks and reading reviews written by other people with respiratory diseases.

Disposable Surgical Masks

Surgical masks are made up of a special type non-woven fabric made from plastic (often polypropylene). This type of fabric makes a good face covering because it is acts as a decent filter while still letting air through relatively easily when you breathe.

Because of this, many people find surgical masks easier to breathe in compared to the relatively-heavy fabric required for cloth masks to be effective. Surgical masks also tend to be somewhat moisture-resistant, which helps them not get damp as quickly from the moisture in your breath.

There are several different types of surgical masks rated for different medical purposes as well as generic, non-medical “surgical masks” you can find at many stores. For the general purpose of protecting yourself when you're around other people and out in public, minimum protection surgical masks & most generic versions should work just fine.

You should, however, make sure that whatever surgical mask you choose is made from at least 2-ply fabric and has a nose wire at the top. Like all masks, your surgical mask should fit snug and comfortably on your face without leaving any gaps for unfiltered air to get through.

Cloth Masks vs Surgical Masks: Which One Should You Use?

Cloth masks and surgical masks are both approved by the CDC, so which type you choose to use is ultimately up to you. Both have their own benefits and drawbacks, and some might be better suited to certain people or situations.

One of the biggest benefits of cloth masks is that they are re-usable, which makes them very cost effective over time. However, washing cloth masks can be very inconvenient, especially when you need a fresh one every day.

Surgical masks, on the other hand, are single-use, which is very convenient; they're very low-maintenance and all you have to do is thrown them away after use. However, this also means that you have to keep buying new ones, which can get expensive and create a lot of extra waste.

It's also worth mentioning that some studies indicate that cloth masks don't work quite as well as surgical masks at filtering out the respiratory droplets that carry germs. However, even if they are somewhat less effective, experts agree that multi-layer cloth masks still offer a worthwhile amount of protection and remain an important tool in combating the spread of disease.

Many people use a combination of cloth and surgical masks, both separately and/or at the same time. For example, you might want to wear a cloth mask over a surgical mask for extra protection, or keep a box of surgical masks around just in case there's a time that you can't find a clean cloth mask to wear.

Tips & Tricks to Make Wearing a Mask More Bearable if You Have COPD

Now that we've covered the basics of how to choose a breathable mask, we'd like to share some additional tips that can make wearing that mask even more comfortable if you have COPD. In the following sections, you'll find more than a dozen practical strategies that can help take the edge off mask-wearing and help you avoid feeling anxious or breathless when you have to wear a mask.

Take Time to Rest

It's not fun to feel tired and short of breath when you go out to do something fun, which is why avoiding over-exertion is a common concern for many people with COPD. Unfortunately, for those who struggle with mask-wearing, it can be even harder to manage breathlessness and other COPD symptoms while wearing a mask.

Pay close attention to how you feel when you're out and about so you can catch the breathlessness early and take the time you need to rest. If you're out with other people, don't be afraid to excuse yourself for a few minutes or let them know when you need to slow down or take a break.

Take Mask Breaks

Many people with COPD and other respiratory diseases struggle wi

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

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

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

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

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

Using Oxygen Can Create a Serious Fire Risk

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Supplemental Oxygen Has Side-Effects and Risks

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

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

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

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

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

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

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

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

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

You Can Make Oxygen Therapy More Comfortable

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

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

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

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

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

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

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

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

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

It Can Help to Clear Some Extra Space at Home

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keeping Your Equipment Clean and Maintained is Key

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

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

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

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

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

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

You Need to Be Prepared for Emergencies

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

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

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

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

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

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