Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) causes severe shortness of breath, which can result from chronic bronchitis, emphysema, or both. Chronic bronchitis is defined as a constant cough and excessive mucus production that lasts for at least three months for more than two consecutive years. Emphysema is characterized by damage to the lungs, which causes them to lose their elasticity, forming pockets of dead air called bullae.

Chronic bronchitis and emphysema are generally caused by prolonged use of tobacco. Long time cigarette smoking can deplete levels of an enzyme called alpha-1 anti-trypsin. Normal levels of alpha-1 anti-trypsin help protect the lungs from damage. There is a less common form of emphysema that can occur in non-smokers. It is caused by an inherited deficiency of this enzyme (see Risk Factors).

Signs and Symptoms


Smoking is the number one cause of COPD. It can also be caused by exposure to pollutants or toxic chemicals. One rare form is inherited (see Risk Factors).

Risk Factors


Your health care provider will listen to your chest for wheezes and decreased breath sounds (due to inflation of your lungs). Your doctor will also look for signs of increased work involved in breathing like flaring of your nostrils and contraction of the muscles between your ribs. Your respiratory rate (number of breaths per minute) may be elevated.

A chest X ray will probably be ordered which will likely reveal over-expanded (hyperinflated) areas in the lungs. A CT scan may be ordered to check the severity of your COPD. A probe placed on your finger or ear (called a pulse oximeter) may be used to check the level of oxygen in your blood. A sample of blood taken from an artery (called an arterial blood gas) may show low levels of oxygen and high levels of carbon dioxide, particularly during the late stages of disease. Lung function tests show decreased rates of airflow while you are exhaling and over-expanded lungs.

Preventive Care

Treatment Approach

Not smoking is the key to preventing COPD or to stop it from getting worse. Drug treatment varies depending on the severity of the disease. Your health care provider may talk with you about lifestyle changes you can make to help relieve the symptoms of COPD. These include exercising and eating a healthy diet. Support groups or therapy (see Mind/Body Medicine) can help make it easier to live with the condition.


Quitting smoking is crucial. Other lifestyle measures you can take include dietary changes and exercise as described below.

Some evidence suggests that poor nutrition, particularly deficiencies in antioxidants and certain minerals including vitamins A, C, and E, potassium, magnesium, selenium, and zinc is associated with having COPD and, possibly, with worsened lung function. Such nutrients can be obtained from an adequate daily intake of fresh fruits and vegetables, nuts, and whole grains.

Exercise helps some people with COPD. By strengthening your legs and arms and improving endurance, you may reduce breathlessness somewhat. Walking, for example, is a good exercise to build endurance. Talk to your doctor and/or respiratory therapist about how to build up slowly and safely. Attending a comprehensive pulmonary rehabilitation is the best way to learn exercise and safe breathing techniques (see below).

There are breathing exercises (for example, a pursed lip technique, breathing from the diaphragm, or using a spirometer [breathing device] twice a day) that may help improve lung function. Talk to your doctor about working with a respiratory therapist in order to learn such exercises. It is important, when learning breathing techniques, to work with an appropriately trained professional because the techniques are not good for everyone with COPD. Attending pulmonary rehabilitation is the best way to learn exercise and breathing techniques.


Surgery and Other Procedures

When flare-ups are severe, requiring hospitalization, use of oxygen and nebulized lung treatments may be necessary. Occasionally, mechanical ventilation on a respirator is needed during the hospital course. At late stages of the disease, many people with COPD need continuous oxygen at home.

Lung transplant is sometimes performed for severe cases of COPD.

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. Be sure to talk to your physician about any supplements you are taking or considering taking.

Although not studied in people with COPD specifically, bromelain (a mixture of protein-digesting enzymes found in pineapples [Ananas comosus]) can help reduce cough and diminish mucus production from a respiratory infection. In theory, therefore, it may be able to do the same if you have chronic bronchitis.

Magnesium deficiency may be associated with an increased risk of developing emphysema and other lung diseases. Sometimes, intravenous magnesium (that is, magnesium delivered through a vein) is part of the treatment for a COPD flare-up in the hospital. The doctor will determine if this is necessary or appropriate.

It is not known whether eating foods rich in magnesium or taking magnesium supplements will reduce your chances of developing emphysema. Such foods, however, including legumes, whole grains, and green leafy vegetables, should be a regular part of a healthy diet anyway.

Some clinicians recommend checking your magnesium level (a simple blood test) if you have COPD and taking magnesium supplements if your levels are low.

N-acetylecysteine (NAC)
A review of scientific studies found that NAC may help dissolve mucus and improve symptoms associated with chronic bronchitis and emphysema. Smokers may also benefit from NAC supplementation. Studies on large groups of people have found that NAC appears to have cancer prevention properties in people who are at risk for lung cancer (like chronic smokers who are also at risk for COPD).

Omega-3 Fatty Acids
Some experts believe that dietary and supplemental forms of omega-3 fatty acids, including alpha-linolenic acid (ALA) found in walnuts and flaxseeds, may prove helpful as part of your treatment for COPD. Scientific research is needed.

Vitamin C
According to some clinicians, taking vitamin C supplements is "safe and reasonable" if you have COPD, especially if you continue to smoke. Research to date is limited, however, and more studies are needed to know if this is truly helpful if you have COPD. In the interim, it is worthwhile to obtain adequate amounts of vitamin C by eating plenty of fresh fruit. In fact, just increasing the amount of fruit you eat by one or two servings per week may help improve lung function.

Other supplements that have gained popularity for COPD, but need further study before comment can be made regarding their value include:


The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine. Also, be sure to talk to your physician about any herbs that you are taking or considering taking.

Herbs that an herbal specialist might recommend based on clinical experience, particularly during a flare-up of your chronic bronchitis include:


Preliminary studies suggest that acupuncture may help relieve shortness of breath in those with COPD. More research is needed to know for certain if this is an effective use of acupuncture.

Similarly, acupressure (a technique much like acupuncture but pressure from the practitioners thumb or fingers is used instead of needles) may be a worthwhile addition to attending a pulmonary rehabilitation program where one learns breathing techniques and exercises to feel less short of breath. Again, more research in this area would be helpful.

If you are trying to quit smoking, acupuncture is an excellent treatment approach for this purpose.

Mind/Body Medicine

Other Considerations

If you have COPD, you are prone to respiratory infections. Your health care provider will most likely tell you to get a flu shot every year and a pneumococcal vaccine once in your lifetime.

Prognosis and Complications

COPD is considered a chronic illness. Whatever damage there is to your lungs will not improve. If you stop smoking, the damage is likely to not get worse. If you continue to smoke, however, your lungs and lung function will continue to deteriorate.

Potential complications of COPD include:


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