Chronic obstructive pulmonary disease (COPD), a progressive illness that can cause wheezing, coughing, excess phlegm, shortness of breath, and chest tightness is an umbrella term for two, often overlapping conditions: emphysema, which is the result of  damage to the walls between many of the air sacs in the lungs, and chronic bronchitis, which is caused by repeated or constant irritation and inflammation in the lining of the airways. COPD primarily affects current or former smokers, but up to 30 percent of people with COPD never smoked.

In addition to smoking and secondhand smoke, exposure to air pollution, dust, chemicals, and smoke from home cooking or fireplaces can increase a person’s risk of developing this irreversible illness. People who are born with alpha-1 antitrypsin (AAT) deficiency have an elevated risk, and those with asthma often develop COPD as well.

Sex differences

COPD affects both men and women, but not in the same way. Dr. Jamie Garfield at Temple University explains that women are more likely to develop the disease, to have more severe symptoms, and to experience more flares. While COPD deaths are declining in men, they’re rising in women. Women with COPD report a lower ability to exercise and worse overall health-
related quality of life compared with men with the condition. Women with COPD were often lighter smokers than their male counterparts. This may be because women’s lungs and airways are often smaller than those of men, making cigarette smoking more dangerous. Secondhand smoke, wood fires, and even home cooking can increase the risk of COPD. Women may be exposed to more indoor air pollution from spending more time in the home, for example. And in many families, women do more household chores, such as cleaning, that can exacerbate COPD.

COPD doesn’t affect only breathing. About half of people with COPD also have osteoporosis, or weakening of the bones that can lead to fractures. Further, rates of anxiety and depression are elevated in people with COPD—especially women.


When it comes to treatment, the most important measure for both men and women is to quit smoking. From there, a doctor may recommend one or more of the following:

  • Medications to treat COPD symptoms include inhaled bronchodilators (which relax the muscles around your airways) and steroids (which reduce inflammation in the airways). There are evidence-based guidelines to help doctors choose the best medication for each patient’s specific disease and triggers. If your COPD is mild, you may need only a short-acting bronchodilator that lasts for about four to six hours. If your COPD is moderate or severe, you may need long-
    acting bronchodilators that last about 12 hours or more. If your COPD is severe, you may need a combination of bronchodilators and an inhaled steroid. If your oxygen levels are low, you may also use portable oxygen. You can receive oxygen therapy from tubes resting in your nose, a face mask, or a tube placed in your trachea. There is a great deal of evidence to help doctors choose the best medications for your particular symptoms, but you may run into hiccups with insurance coverage. “Often, we have an optimal agent and we have to modify that based on what the patient’s insurance will cover,” Dr. Garfield told Bottom Line Health.
  • Pulmonary rehabilitation teaches you how to manage your COPD symptoms by learning to breathe better, how to conserve energy, and how to eat and exercise in ways that improve your symptoms.
  • Prevention and treatment of lung infections. Certain vaccines, such as flu and pneumonia vaccines, are especially important for people with COPD.
  • Surgery. If more conservative measures don’t give you relief, your doctor may recommend surgery to remove air spaces that interfere with breathing (bullectomy), to remove damaged tissue (lung volume reduction surgery), to insert valves that keep air from re-entering a diseased part of the lung, or to replace a damaged lung with a healthy donor lung.

Reduce triggers

You may notice your symptoms get worse (or flare) because of certain triggers, such as pollution, smells, or cold air. Taking steps to reduce triggers can help you feel better.

Fight allergies. If you have allergies, consider taking allergy medicine or eliminating triggers. Replace carpets with hard flooring, keep pets out of the bedroom, and use mattress and pillow covers to keep dust mites out. Use air filters in your HVAC system to help clean the air, or use HEPA air filters.

Greener cleaning. Several chemicals that are commonly used in cleaning products, including ammonia, hydrogen peroxide, chlorine bleach, and alcohol, can irritate the bronchial passages and make it harder to breathe. To stay safer while cleaning, skip these ingredients, as well as aerosolized products and those with fragrance. Instead, opt for soap and water, baking soda, and vinegar. Air fresheners, scented soaps, perfume, candles, and incense can irritate your lungs, as well.

Watch out for wood smoke. Fireplaces, wood-burning stoves, and firepits all emit tint particles that can damage your lungs. Avoid secondhand smoke (from other smokers), too.

Cooking. If you use a gas stove, you can be exposed to elevated levels of nitrogen dioxide. Use either the above-stove fan or open a window and use a fan to blow air out that way instead. If you’re ready for a new stove, consider switching to electric.

Monitor air quality and stay indoors when the air quality is poor. Wear a scarf or mask to warm the air you breathe in cold weather.


Women with COPD may not be diagnosed until later in the disease, when treatment options are more limited. Dr. Garfield reports that she often sees women who were diagnosed with asthma, but not COPD, even when they had both conditions. If you suspect that you may have COPD, ask your doctor to perform a spirometry test, which measures how much air you exhale and how fast you do it. If your doctor is unable or unwilling to do this test, see a pulmonologist for a follow-up. It’s OK to question your doctor. Don’t be afraid to ask questions, expect clear answers, and, when needed, get a second opinion. 

The Time Is Now to Quit Smoking

Quitting smoking is one of the most important things you can do for your health. Try these tips to help.

1. Identify what motivates you to quit, and write it down. When you’re tempted to smoke, read it to remember your “why.”

2. Set a series of small, attainable skills to boost confidence.

3. Find alternate ways to manage stress. Look to nonsmokers for ideas.

4. Never give up. If you slip, try again.

5. Talk to your doctor about medications, gum, patches, and more to manage the discomfort of quitting as well as reduce cravings.

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