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
Signs and Symptoms
Ongoing cough, often with phlegm that may be hard to "bring up"
Shortness of breath during exertion and, eventually, at rest
Excessive mucus production and impaired ability to eliminate mucus
Progressive difficulty exhaling
Recurrent respiratory infections
Decreased exercise tolerance, including walking upstairs or carrying
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
Smoking, especially if you have a history of smoking one pack per day
for 20 years or the equivalent (for example, 2 packs per day for 10 years)
Inherited deficiency of an enzyme called alpha-1 anti-trypsin that
normally helps protect the lungs from damage
Passive smoking (ongoing exposure to cigarette smoke from others)
Being over age 50
Work exposure to toxic chemicals such as silica or cadmium
Working around industrial smoke, excessive dust, or other air
pollutants (for example, miners, furnace workers, and grain farmers)
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.
If you already smoke, quit before there has been permanent damage to
If you have COPD, avoiding respiratory infections is very important.
Your doctor will recommend that you receive an influenza vaccine each year and
that you receive a pneumococcal vaccine once in your lifetime to protect you
from pneumonia. Caused by this particular organism.
Eating foods rich in antioxidants, magnesium and other minerals, and
omega-3 fatty acids (including fruits, vegetables, and fish) may help prevent
the development of COPD in the first place avoid worsening of your symptoms if
you already have this lung condition. See
Nutrition and Dietary Supplements
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
Bronchodilators (including ipratropium, albuterol, isoproterenol,
metaproterenol, pirbuterol, terbutaline, levalbuterol, salmeterol, and
formoterol)—increase airflow and help make it easier to
Theophylline - another type of bronchodilator
Corticosteroids—reduce inflammation; taken by
inhaler; when an attack is severe, your doctor may recommend oral or even
Antibiotics—used to treat COPD when symptoms
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.
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.
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
Herbs that an herbal specialist might recommend based on clinical experience,
particularly during a flare-up of your chronic bronchitis
globulus)- acts as an expectorant, which means
that it loosens phlegm in the respiratory passages, making it easier to cough up
mucus from your airways.
Garlic (Allium sativum)- may
help fight infection and has antioxidant properties (see earlier discussion
under Diet in section entitled Lifestyle as well as the section on Nutrition and
Licorice (Glycyrrhiza glabra) -- used by professional
herbalists to relieve respiratory ailments such as bronchitis; considered a
demulcent (soothing, coating agent); you should not use this herb if you have
high blood pressure.
Lobelia (Lobelia inflata) -- also called Indian tobacco,
lobelia has a long history of use by Native Americans as an herbal remedy for
respiratory ailments including bronchitis. It is considered an effective
expectorant, meaning that it helps clear mucus from the respiratory tract. It is
important to note, however, that lobelia is a potentially toxic herb. It is
considered relatively safe when used in very small doses (particularly
homeopathic doses) or in combination with other herbs that affect the
respiratory system. Lobelia use should only be considered with the guidance of a
qualified healthcare practitioner.
officinalis)— long history of use in
traditional healing systems for bronchitis.
Red Clover (Trifolium
pretense)- used traditionally for spasmodic
cough and bronchitis.
Saw Palmetto (Serenoa repens/Sabal serrulata) -- early
in the 20th century, saw palmetto was listed in the US Pharmacopoeia as an
effective remedy for bronchitis.
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.
The stress of having COPD is often helped by joining a support group
where members share common experiences and problems.
Yoga and tai chi are practices that use deep breathing techniques and
meditation; these practices may be helpful if you have COPD. Talk to your doctor
about safety for you.
Biofeedback is another method for helping to learn a more relaxed and,
therefore, more comfortable breathing pattern.
Music therapy can help relieve anxiety associated with COPD and,
possibly, shortness of breath.
Listening to relaxation tapes on a regular basis (for example, one or
two times per day) may help reduce anxiety and shortness of breath associated
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
Potential complications of COPD include:
Abnormally high pressure in the lungs called pulmonary hypertension
Enlargement of the heart and heart failure, leading to excessive fluid
and weight gain
Abnormal rhythms of the heart
Dependence on mechanical ventilation (a respirator) and/or oxygen
Pneumothorax (collapsing of part of the lung due to air leaking from
Pneumonia and other infections
Eventually, weight loss and wasting can occur
Behera D. Yoga therapy in chronic bronchitis. J Assoc Physicians
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
Communications; 1998:423, 468.
Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded
Commission E Monographs. Newton, MA: Integrative Medicine Communications;
2000:118-123, 139-148, 233-239, 244-248.
Bourjeily G, Rochester CL. Exercise training in chronic obstructive pulmonary
disease. Clin Chest Med. 2000;21(4):763-781.
Britton J, Pavord I, Richards K, Wisniewski A, Knox A, Lewis S. Dietary
magnesium, lung function, wheezing, and airway hyperactivity in a random adult
population sample. Lancet. 1994;
Britton JR, Pavord ID, Richards KA, et al. Dietary antioxidant vitamin intake
and lung function in the general population. Am J Respir Crit Care Med.
Cahalin LP, Braga M, Matsuo Y, Hernandez ED. Efficacy of diaphragmatic
breathing in persons with chronic obstructive pulmonary disease: a review of the
literature. J Caridopulm Rehabil. 2002;22(1):7-21.
Celli BR. Pulmonary rehabilitation in patients with COPD. Am J Respir Crit
Care Med. 1995;152:861-864.
Collins EG, Langbein WE, Fehr L, Maloney C. Breathing pattern retraining and
exercise in persons with chronic obstructive pulmonary disease. AACN Clin
Davis CL, Lewith GT, Broomfield J, Prescott P. A pilot project to assess the
methodological issues involved in evaluating acupuncture as a treatment for
disabling breathlessness. J Altern Complement Med. 2001;7(6):633-639.
Duke JA. The Green Pharmacy. Emmaus, Pa: Rodale Press; 1997:93-95,
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill;
Ferguson GT, Cherniack RM. Management of chronic obstructive pulmonary
disease. N Engl J Med. 1993;328:1017-1022.
Gift AG, Moore T, Soeken K. Relaxation to reduce dyspnea and anxiety in COPD
patients. Nurs Res. 1992;41(4):242-246.
Gigliotti F, Romagnoli I, Scano G. Breathing retraining and exercise
conditioning in patients with chronic obstructive pulmonary disease (COPD): a
physiological approach. Respir Med. 2003;97(3):197-204.
Guell R, Casan P, Belda J, et al. Long-term effects of outpatient
rehabilitiation of COPD: A randomized trial. Chest. 2000;117(4):976-983.
Jaber R. Respiratory and allergic diseases: from upper respiratory tract
infections to asthma. Prim Care. 2002;29(2):231-261.
Jobst KA. A critical analysis of acupuncture in pulmonary disease: efficacy
and safety of the acupuncture needle. J Altern Complement Med.
Jones A. Causes and effects of chronic obstructive pulmonary disease. Br J
Maa SH, Gauthier D, Turner M. Acupressure as an adjunct to a pulmonary
rehabilitation program. J Cardiopulm Rehabil. 1997;17(4):268-276.
Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol
Life Sci. 2001;58(9):1234-1245.
McBride S, Graydon J, Sidani S, Hall L. The therapeutic use of music for
dyspnea and anxiety in patients with COPD who live at home. J Holist
McKeever TM, Scrivener S, Broadfield E, Jones Z, Britton J, Lewis SA.
Prospective study of diet and decline in lung function in a general population.
Am J Respir Crit Care Med. 2001;165(9):1299-1303.
Newall C, Anderson L, Phillipson J. Herbal Medicines: A Guide for
Health-care Professionals. London: Pharmaceutical Press; 1996: 187-188.
Romieu I, Trenga C. Diet and obstructive lung diseases. Epidemiol Rev.
Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia,
PA: Hanley & Belfus, Inc; 2002:252-258, 259-261.
Schwartz J, Weiss ST. Dietary factors and their relation to respiratory
symptoms. The Second National Health and Nutrition Examination Survey. Am J
Schwartz J, Weiss ST. Relationship between dietary vitamin C intake and
pulmonary function in the First National Health and Nutrition Examination Survey
(NHANES I). Am J Clin Nutr. 1994;59(1):110-114.
Skorodin MS, Tenholder MF, Yetter B, et al. Magnesium sulfate in
exacerbations of chronic obstructive pulmonary disease. Arch Intern Med.
Smit HA. Chronic obstructive pulmonary disease, asthma and protective effects
of food intake: from hypothesis to evidence? Respir Res.
Stey C, Steurer J, Bachmann S, Medici TC, Tramer MR. The effect of oral
N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur
Respir J. 2000 Aug;16(2):253-262.
van Zandwijk N. N-acetylcysteine for lung cancer prevention. Chest.
Ziment I. History of the treatment of chronic bronchitis. Respiration.
Review Date: June 2003
Reviewed By: Participants in the review process include: Robert A. Anderson, MD, President
, American Board of Holistic Medicine, East Wenatchee, WA; Shiva Barton, ND,
Wellspace, Cambridge, MA; Jacqueline A. Hart, MD, Department of Internal
Medicine, Newton-Wellesley Hospital, Boston, Ma and Senior Medical Editor
A.D.A.M., Inc.; Paul Rogers, MD, Facility Medical Director, Bright Oaks
Pediatrics, Bel Air MD; Tom Wolfe, P.AHG, Smile Herb Shop, College Park,
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