How Accurate Is a Pulse Oximeter?

A pulse oximeter uses a light source that shines through your fingertip. By measuring the amount of light that passes through your fingertip, the device can estimate how much oxygen is being carried by your red blood cells. This procedure has become such a common part of physical exams that it has been called a fifth vital sign, along with temperature, pulse, respiratory rate, and blood pressure.

Pulse oximeters that are used in a doctor’s office or health care facility are regulated and tested by the FDA. This type of pulse oximeter can also be prescribed by a doctor for home use. An example would be a patient who has lung disease and needs to check oxygen levels frequently. To be approved by the FDA, these devices are checked against oxygen saturation measured by an ABG.  They must be accurate to within two to three percent of an ABG.

Pulse oximeters are also available for home use without a prescription, but these are not regulated by the FDA. Smart phone apps for pulse oximetry are a recent addition. These devices are not intended for medical evaluation. They are intended for general wellness or as a way for athletes or pilots to check their oxygen level.

During the recent COVID-19 epidemic, many people purchased over-the-counter pulse oximeters to check their oxygen saturation because it became commonly known that a low oxygen saturation could be a sign of a COVID infection. The FDA became alarmed about the use of OTC devices and issued a safety communication to doctors and consumers. The FDA warned that OTC pulse oximeters might not be accurate, especially in certain people. These devices might not be accurate in people with dark skin, cold skin, thick skin, or poor circulation. They might also be affected by nail polish, dirty nails, or artificial fingernails.

Do You Need a Pulse Oximeter Reading Chart?

Pulse oximeters are easy to read, so no additional chart is needed. If your oxygen saturation is below 92%, you should contact your doctor. ©Marvin Samuel Tolentino Pineda | Getty Images

Although you will find pulse oximeter charts on the internet, you really don’t need a chart. Pulse oximeters are easy to read. They give you your pulse and oxygen saturation right on the device. You just have to remember a few numbers. A normal oxygen saturation is 95 to 100 percent. If your oxygen saturation drops below 92 percent, you should contact your health care provider. If it falls below 88, you should get immediate medical attention.

Remember that pulse oximetry is only an estimate of oxygen saturation. A health care provider will look for other signs and symptoms of low oxygen saturation based on pulse oximetry and may do an ABG. Low oxygen saturation may occur in these conditions:

• COVID or other infections of the lungs, like pneumonia
• A blood clot that travels to the lung
• After surgical anesthesia
• With some medications that suppress breathing (like opioid drugs)
• Long term lung conditions like COPD, asthma, or lung cancer
• Heart disease
• Sleep apnea

How to Use a Pulse Oximeter at Home

Unless you have a condition that requires you to keep track of your oxygen saturation, you don’t need a home pulse oximeter. If you want to try one of these devices, keep in mind that OTC devices are not always reliable. When using an OTC device, it is also important to know the signs and symptoms of low oxygen saturation, which may include:

• A blue tint to the lips, face, or fingernails, called cyanosis
• Difficulty breathing or shortness of breath on exertion
• An unexplained and persistent cough
• Cheat pain or tightness
• A racing pulse

If you use one of these devices, follow the directions that come with the device. Before you put it on your finger and remove any nail polish or artificial nails. Make sure your hand is warm, relaxed, and positioned below the level of your heart. Be still until the reading shows up on the device. If you are in good health, it is unlikely that you will have any drop on oxygen saturation without other signs or symptoms. Pay more attention to trends over time than a single reading. If in doubt, contact your health care provider.

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What Does Cleansing Your Lungs Do?

Lung cleansing products claim to treat inflammation, reduce cough, reduce congestion, and even help you stop smoking or help to cleanse your lungs after you stop smoking. According to the website LungSupportSupplements.com, licorice, lobelia, and grindelia are key herbs used in supplements. Other herbal ingredients may include wild cherry bark, turmeric, marshmallow root, mullein leaf, and many others.

Other lung cleansing ingredients may be vitamins, especially vitamin D. There have been a few studies showing vitamin D may reduce lung inflammation, but these studies were small and not very convincing. Today, the NIH Office of Supplements says the only role for vitamin D as a health supplement is for bone health. As far as any other vitamins, none have been shown to improve lung health as a lung detox supplement, and NIH says the best way to get vitamins is through your diet, not from supplements.

The ALA says the claims of lung detox or cleansing products are unproven and some products may be dangerous. For example, vaping or inhaling essential oils can be damaging to your lungs. A final warning on all these products is that they are not regulated by the FDA. That means they may have ingredients not stated on the label, and they may have side effects or interfere with the medications you take.

Antioxidants are the other common ingredient in lung detox products, especially the antioxidant vitamin D. Antioxidants have been studied much more than herbal supplements. These substances are abundant in fruits and vegetables and they may help your immune system deal with inflammation and infection, or reduce your risk of inflammatory diseases. However, the same benefits have not been shown with antioxidant supplements. Because antioxidants from foods affect the body differently than from supplements, antioxidant supplements are not recommended by NIH.

Can You Do Anything for Lung Health?

You can, but there is nothing new or exciting about the ways to do it. The best thing about your lungs is that they are very good at cleaning themselves. Your lungs will naturally repair themselves and move mucous and toxins up into your airway where you can cough them out.  Studies show that even the lungs of heavy smokers will look the same as the lungs of nonsmokers after 20 years of not smoking.

For best lung health, the ALA recommends:

• Not smoking and avoiding secondhand smoke
• Not vaping
• Eating a diet high in fruits and vegetables for antioxidants
• Getting regular aerobic exercise
• Maintaining a healthy weight
• Avoiding outdoor and indoor air pollutants

According to the United States Environmental Protection Agency (EPA), air pollution can be dangerous to everyone at very high levels. If you have a lung disease, even lower levels can be dangerous. You can check your local air quality at this EPA website.

Indoor air pollution from sources like cooking, cleaning, secondhand smoke, and aerosol spray chemicals can also damage your lungs. The EPA recommends using a portable air purifier or placing an air filter in your furnace, central heating, or and air-conditioning system. ALA adds using a high-quality vacuum cleaner frequently in your home.

You can protect your lungs naturally, and you don’t have to pay for a lung cleansing or lung detox product. Your lungs will do a fine job of cleaning themselves, as long as you follow the ALA tips for lung health.

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Benefits of Indoor Plants

Humans need oxygen to breathe. Plants need CO2. Although CO2 can be toxic to humans, it is like oxygen for plants. Humans give plants CO2 and plants give humans oxygen, which is a mutually beneficial, called a symbiotic relationship.

You probably don’t need more oxygen in your house, and house air does not have enough CO2 to be dangerous, unless there is another source of CO2 like a space heater. But, house plants have another more important function that you can benefit from. They are a low-cost air purification system. Several studies show that indoor plants enhance air quality.

Phytoremediation: How House Plants Clean the Air

The process of plants filtering the air is called phytoremediation. Studies show that when house plants take in CO2 from the air, they also remove indoor VOCs. Air pollution can occur in your house and it can cause lots of problems, like allergies, headaches, infections, and asthma attacks. VOCs can come from smoking, paints, adhesives, plastics, cleaning solutions, and a whole host of other indoor products. Indoor air pollution can be worse than outdoor pollution if you live in a tightly made, modern house, especially since most people spend most of their time indoors.

Phytoremediation can remove cancer-causing VOCs like benzene, trichlorethylenes, formaldehyde, and toluene. It can also remove particulate matter like indoor allergens. Other organic compounds that can be harmful and can be removed by plants include nitrates, sulfates, ammonia, and ozone. Plants can remove airborne microbes like fungi and bacteria. One study found that plants could reduce airborne microbes by 50 percent. Finally, since plants keep indoor humidity at 40 to 60 percent, they can reduce the transmission of airborne viral droplets like flu or COVID-19. These viruses survive in the air and travel farther in low humidity.

How Many Plants Do You Need to Improve Air Quality?

The National Aeronautics and Space Agency (NASA) has been studying indoor plants as a natural filtration system and source of oxygen for space travel and indoor space stations. According to NASA’s research, 15 or more house plants would significantly improve air quality in a living space of 1,800 square feet. The best plants for air quality have lots of leaves, have at least an 8-inch diameter, and grow quickly.

Best House Plants for Oxygen and Air Quality

The snake plant is one of the most common indoor house plants, and it has pretty impressive air purifying capabilities!

All plants add oxygen and improve air quality, but some have been studied and found to be best. The highest oxygen producing plants with the highest ability to filter the air include:

• Peace Lily
• Aloe Vera
• Weeping fig
• Areca Palm
• Chrysanthemum
• Gerbera daisy

Snake Plant: Oxygen at Night

One of the plants that NASA found beneficial as part of its clean air study is the snake plant, also called mother-in-law’s tongue. Out of five VOCs tested, this plant removed four. Another benefit for NASA is that this plant does not need direct sunlight and it gives off oxygen at night.

Before you load up on house plants make sure they are safe if you have small children or pets. For example, you might want to avoid the snake plant.  If children eat parts of this plant, it can cause mild nausea and temporary mouth numbness. Poisoning is more severe in cats and dogs. It can cause severe vomiting and diarrhea in these animals.

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What Does Air Quality Mean and What Is Unhealthy Air Quality?

Every day, the EPA issues AQI numbers for areas all around the country. This number tells you if your air quality is good, moderate, unhealthy, or bad. AQI numbers start at 0 and can go up to 500. The higher the number, the worse the air pollution. AQI numbers rarely go above 200 in the United States. These are the numbers and what they mean:

• AQI of 0 to 50 is good air quality, and safe for everyone. The color code on an AQI chart is green.
• AQI of 51 to 100 is moderate air quality. AQI of 100 is the limit of air quality considered to be satisfactory for most people. People who are very sensitive to air pollution may have symptoms from this level of pollution. The color code is yellow.
• AQI of 101 to 150 is unhealthy air quality for sensitive groups, such as people with asthma or other lung conditions. People without these conditions usually do not have symptoms. The color code is orange.
• AQI of 151 to 200 is very unhealthy for sensitive people. They may experience severe respiratory symptoms. People without lung problems may also experience symptoms. The color code is red.
• AQI of 201 to 300 is very unhealthy for everyone and a health alert is issued. The color code is purple.
• AQI over 301 is hazardous for everyone and a health warning emergency is issued. The color code is maroon.

Respiratory Symptoms From Unhealthy Air Quality

These symptoms can include cough, throat irritation, shortness of breath, chest tightness, wheezing, or chest pain or burning. It may be painful to take deep breaths. Lung conditions like COPD or asthma may suddenly get worse. Hospital admission for respiratory disease typically goes up during a time of poor air quality. People who are at risk of respiratory issues during a period of poor air quality include children and adults with asthma, people over age 65, and people with long-term health conditions like diabetes and heart disease.

What to Do When Air Quality Is Unsafe for You

If you or someone in your family is at risk from air pollution, you should check the daily AQI numbers in your area. You can find your AQI numbers in your local newspaper or on your local news station. National media companies like CNN, The Weather Channel, and USA Today publish AQI numbers and warnings for all areas of the country. You can also find your AQI at the EIP website airnow.gov.

If your state or local environmental protection department participates in a program called EnviroFlash, you can receive air pollution alerts or warnings. These warnings are especially important for unexpected air pollution from fires.

If the air quality is unsafe for you:

• Limit outdoor air exposure.
• If you need to be outside, avoid times of higher high air pollution, late afternoon and evening.
• Stay away from highway traffic areas.
• Avoid moderate exertion outdoors, which includes activities like brisk walking, light jogging, physical work, and or running sports.

Indoor air pollution could come from the poor quality air outside, so make sure to stay on top of replacing air filters around the home.

Do Air Purifiers Work for Air Pollution?

AQI only measures outdoor air pollution. If you are at risk from poor air quality, the EPA recommends an indoor air purifier. Indoor air pollution may come from outdoor air it may come from indoor air pollution sources like cooking, cleaning, or secondhand smoke. The EPA says that using a portable air purifier or upgrading the air filter in your furnace, central heating, or air-conditioning system can help to improve indoor air quality.

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Stages of COPD have been used to predict survival in the past, but doctors have learned that survival depends on many factors. [1,4,5] Improved treatment for COPD is now available even for advanced stages. Treatment can control symptoms, slow progression, and allow people to live longer more active lives at any stage. [2,3,5]

The Four Stages of COPD

Stages of COPD used to be based on lung tests like spirometry and other pulmonary function tests. These tests measure your lung capacity. According to the COPD Foundation, pulmonary function testing is no longer considered a one-size-fits all way to stage or predict COPD. [1] Lung function tests alone can’t predict how COPD will progress over time. [1,4]

Other things that affect the stage and progression of COPD include your genes, your body weight, how short of breath you get with activities, even how far you can walk in six minutes. Other diseases you live with may also have a big impact on survival. These include diseases like heart disease, diabetes, depression, and anxiety. [1,4]

The COPD Foundation describes the stages as a guide to help you and your doctor find the best treatment, not as a way to predict survival. [1] These are the stages and their symptoms: [5]

Stage 1, Mild COPD

Symptoms of stage 1 COPD include a persistent cough and shortness of breath on exertion. The coughing could bring up mucus, or just be dry. This is when lung damage begins, but can easily be missed because the symptoms remain mild.

Stage 2, Moderate COPD

Symptoms of stage 2 COPD include cough and shortness of breath, which may occur during routine activity. The cough may be worse in the morning and bring up more mucus. These coughing fits and discomfort can begin to disturb sleep and cause daily fatigue.

Stage 3, Severe COPD

As stage 3 COPD sets in, stage 2 symptoms will worsen along with frequent upper respiratory infections, tightness in the chest, and difficulty getting a deep breath. Daily life begins to change, as this disease impacts the quality of life. In addition to the lung symptoms, swelling of feet, ankles, and legs may occur.

Stage 4, Very Severe COPD

In stage 4, all of the COPD symptoms will continue to worsen along with constant wheezing, loss of weight, and loss of appetite. Increased heart rate and blood pressure, delirium, and a barrel-shaped chest also occur.

Treatments Prolong Life and Improve Quality of Life

The chief culprit of COPD is smoking. Getting help to quit should be your primary health goal.

For stage I COPD, the most effective treatment and the best way to prolong survival is to stop smoking. Without this step, no other treatments can prevent COPD from getting worse. [2] There are many medication options for all stages of COPD. Examples include inhalers that open your lungs and decrease inflammation, oral medications that improve breathing, and antibiotics to fight off infections. [2,3,5]

Other therapies include oxygen, pulmonary rehabilitation programs, and surgery. Oxygen therapy along, with not smoking, definitely improves survival. [4] Pulmonary rehab programs include education, exercise, nutrition advice, breathing exercises, and counseling. Surgical advances for COPD include procedures that remove damaged lung tissue to make room for healthy lung tissue, called lung volume reduction. A lung transplant is now an option for some people. [2,3,5]

Lifestyle Changes for Living Better with COPD

You will learn breathing techniques and breathing exercises to help you breathe better in pulmonary rehab. You can use these regularly at home. Other ways to manage COPD at home include: [2,3,5]

• Controlled coughing to clear mucous
• Drinking plenty of fluids
• Avoiding secondhand smoke and air pollution
• Staying as fit as you can with physical activity and exercise
• Eating a balanced diet with enough calories to maintain your weight
• Getting your vaccinations

COPD is a serious disease and it does tend to get worse over time. Although there is no cure, COPD can be treated. Stages of COPD are important for choosing the best therapies, but the stage of COPD is not the last word on survival. With advanced treatment and lifestyle changes any stage of COPD can be treated.

SOURCES

1. COPD Foundation, Stages of COPD, https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Stages-of-COPD.aspx
2. Mayo Clinic, COPD, https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679
3. NYU Langone Health, COPD, https://nyulangone.org/conditions/chronic-obstructive-pulmonary-disease-in-adults/support
4. BMJ Best Practice, COPD, Prognosis, https://bestpractice.bmj.com/topics/en-us/7/prognosis
5. MedicineNet, What is COPD? https://www.medicinenet.com/what_are_the_four_stages_of_copd/article.htm

The post What to Know About Chronic Obstructive Pulmonary Disease: Stages, Outlook and Treatment appeared first on University Health News.

People with COPD signs and symptoms tend to decrease their physical activity as shortness of breath makes exertion more and more difficult. If your COPD prognosis is poor, you also may think you need to cut down on physical activity. However, decreased activity can start a vicious cycle of progressive deconditioning. This leads to a worsening of COPD symptoms and more breathlessness. COPD rehabilitation is aimed at breaking that cycle.

COPD Rehabilitation: Program Basics

COPD rehabilitation is more than an exercise program, although exercise is the most important component. According to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), pulmonary rehabilitation is tailored to the needs of individual patients, and is designed to optimize physical and social performance and autonomy.

A portable spirometer, called an “incentive” spirometer, challenges and recruits reluctant alveolae.

The AACPR lists the following core components for a COPD rehabilitation program:

• Exercise training and other therapeutic exercise (aerobic, strength, and flexibility training)
• Education and skills training (such as breathing retraining)
• Secretion clearance techniques
• Prevention and management of COPD exacerbations
• Control of irritants and allergens
• Instruction in proper use and safety of oxygen systems
• Nutritional assessment and intervention if necessary (Find out how a COPD diet might help you in our article on COPD home remedies.)
• Psychosocial assessment, support, panic control, and professional intervention, if necessary
• Help with smoking cessation if currently smoking
• Education about medication use
• Implementation of a home treatment program follow-up

COPD patients at all stages can benefit from a COPD rehabilitation program—in fact, one study found that patients in the earlier stages of COPD derived greater benefits than those in the later stages.

Although those with less advanced COPD had better results, those with severe COPD signs and symptoms also had improved ability to exercise, and less shortness of breath. This research suggests that when it comes to COPD rehabilitation, the earlier the better. However, all of the patients were helped by the program. Other studies have found that rehabilitation benefits are generally sustained for up to 18 months after the program ends, especially if the exercise training is maintained.

There are many COPD rehabilitation programs around the country. Your doctor can most likely refer you to one—alternately, the American Association for Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org) has a searchable online directory of rehabilitation programs. Health insurance may or may not cover COPD rehabilitation—you’ll need to check with your insurance carrier.

Medicare coverage of COPD rehabilitation can vary from state to state, so check with your doctor or provider to obtain the guidelines in your state.

See also these University Health News posts:

• “Lung Diseases and COPD Facts: Understanding the Breathing Process“
• “Lifestyle Changes Among the Keys to COPD Treatment“
• “Is There Such a Thing as a COPD Diet?“

Originally published in May 2016 and updated.

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Low COPD oxygen levels may also cause fatigue, memory loss, headaches in the morning, depression, and confusion. Over time, chronically low oxygen levels also can cause heart failure and impact COPD life expectancy. This makes COPD oxygen therapy a major treatment approach for stage 4 COPD.

Do You Need COPD Oxygen Therapy?

To determine whether a person with COPD has hypoxemia, a physician will perform either an arterial blood gas test or pulse oximetry, both of which measure the amount of oxygen in the blood.

With oxygen therapy, COPD hypoxemia levels may not be as poor, but oxygen therapy usually is given only to patients with very severe (stage 4) COPD. In Stage 4 COPD, airflow is severely limited and the amount of air that can be blown out in one second (called the FEV1 ratio) is less than 30 percent of what would be expected for someone without lung disease. For these people, long-term use of supplemental oxygen for more than 15 hours each day can extend COPD life expectancy and improve the quality of life.

COPD oxygen therapy also may reduce shortness of breath during exertion, which makes it easier to perform activities of daily living. Oxygen therapy also may improve mental functioning, reduce depression, and aid the heart.

Using COPD Oxygen Therapy for Hypoxemia

Supplemental oxygen may be used continuously (24 hours) or periodically, such as only during exercise or overnight. The primary goal of using supplemental oxygen is to ensure adequate delivery of oxygen to preserve the function of vital organs.

Normal atmospheric air is about 21 percent oxygen, but the amount of oxygen you breathe into your lungs can be increased with additional pure oxygen that you inhale with each breath. Your doctor will prescribe a specific amount of supplemental oxygen, and provide instructions on when and how long it should be used, as well as which delivery method will be used. There are three methods for delivering oxygen—with each system, the oxygen is breathed in through a mask or a nasal tube (cannula).

• Compressed oxygen gas: Compressed oxygen gas is contained in tanks or cylinders of varying sizes. Large stationary tanks are used inside the home, while smaller, more portable tanks can be used on brief forays outside the home (they usually have enough oxygen to last a few hours).
• Liquid oxygen: When oxygen gas is cooled, it produces a liquid form of oxygen. When the liquid is warmed, it turns back into a gas that can be inhaled. Like compressed oxygen gas, liquid oxygen systems include a large tank for use in the home. The system also includes a small portable canister for use outside the home (this canister is filled with liquid oxygen from the indoor tank). One disadvantage of liquid oxygen systems is the tendency for the liquid to evaporate over time.
• Oxygen concentrator: An oxygen concentrator is an electric device that takes air from the room and separates the oxygen from other gases. The oxygen is then available to be inhaled through a mask or nasal cannula. This system does not require that tanks of liquid or gaseous oxygen be continuously refilled. The supply of oxygen is unlimited and the device is small enough to be moved from room to room—however, it is not portable enough to be taken outside, and it requires electricity to operate.

Traveling with COPD Oxygen Therapy

If you need to travel by air and you use COPD oxygen therapy, you will need to notify the airline well in advance in order to arrange for use of oxygen during the flight. Also keep in mind that even if you don’t require COPD oxygen therapy at home, you may need supplemental oxygen while flying. This is because the air pressure inside an airplane cabin is lower than it is on the ground, especially when the airplane is taking off and landing.

Low air pressure decreases the amount of oxygen in the air. People without lung disease can adapt to the changes in air pressure, but for a person with severe COPD, even a small change in air pressure may cause an exacerbation of symptoms.

Always discuss air travel plans with your doctor. Lung function tests will likely be needed to determine whether supplemental oxygen is required, and your doctor will also need to provide a letter for the airline. During the flight, the oxygen will be provided by the airline (there will likely be a fee for this service), since passengers are not allowed to bring their own oxygen canisters on board an airplane.

Information about which airlines permit the use of oxygen on flights, along with their policies, is available from the Airline Oxygen Council of America (www.airlineoxygencouncil.org).

For further reading on COPD, see these University Health News posts:

• “Is There a COPD Cure? Here’s the Answer“
• “GOLD COPD Guidelines for Lung Disease Treatment“
• “Is There Such a Thing as a COPD Diet?“
• “How to Prevent Smoking Diseases—and Add Years to Your Life“

Originally published in May 2016 and updated.

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Sadly, however, smoking still kills about half a million Americans annually, and it isn’t just the obvious smoking diseases (like lung cancer) that account for these deaths. In fact, more illnesses than you might imagine can be termed “smoking diseases,” and your vulnerability to them varies depending on your age.

Smoking Diseases and Age

More younger Americans smoke—about 16 percent, compared with about 8 percent of adults age 65 and older—but older adults are at particular risk for smoking diseases because they typically have smoked for longer (an average of 40 years). Most smoking diseases strike during older age, and older smokers with a long history of tobacco use face significantly increased health risks as they continue to grow older.

Studies have demonstrated that smokers underestimate their risks of developing smoking diseases, and a few studies have found that smokers age 65 and older have even lower risk perceptions than younger smokers. The disparity in risk perception, experts believe, is due at least in part to the fact that smoking was viewed as acceptable a generation ago.

But it isn’t all negative—studies also suggest that older smokers may be slightly more successful at quitting than younger adults.

How Smoking Diseases Take Hold

Smoking harms the body because inhaled smoke contains many inflammatory substances—such as tar, and dangerous metals (including arsenic and lead)—that damage the body’s cells to the extent they may become cancerous. Smoking increases the risk of at least 14 cancers, including cancer of the breast, lung, larynx, esophagus, mouth, throat, bladder, pancreas, kidney, liver, stomach, bowel, cervix, and ovaries.

Smoke contains carbon monoxide, which displaces oxygen in the blood, and nicotine, which constricts the blood vessels, raising your blood pressure (a major risk factor for stroke), and forcing your heart to work harder to pump blood around your body. It lowers HDL (“good”) cholesterol, which is vital for transporting cholesterol to the liver to be processed for excretion, and elevates LDL (“bad”) cholesterol, which can build up on the walls of your arteries, narrowing and potentially blocking them, and impeding blood flow in the process.

These negative effects on your cardiovascular system mean that heart disease, diabetes, and kidney disease can be categorized as smoking diseases.

Smoking damages not just the lungs, but is implicated in a variety of diseases, from ulcers to arthritis to coronary artery disease.

Smoking Diseases: The Stats

The results of smoking can be seen in the statistics:

• Cigarette smoking, the leading preventable cause of disease and death in the U.S., is linked to 20 percent of all deaths and at least 30 percent of all cancer deaths.
• Of these, most deaths that can be linked to smoking diseases occur among people age 65 and older.
• Men in this age group who smoke are twice as likely to die from a stroke; women smokers are about one and a half times as likely to die from a stroke than their nonsmoking counterparts.
• The risk of dying from a heart attack is 60 percent higher for smokers.
• Smokers are more than twice as likely as nonsmokers to develop dementia of any kind, including Alzheimer’s disease.
• Smokers also have two to three times the risk of developing cataracts, a leading cause of blindness and visual loss.
• And of course, COPD signs and symptoms fall into the category of smoking diseases. If you have COPD signs and symptoms, your COPD life expectancy will increase if you quit smoking.

Why Is It So Hard to Quit Smoking?

About 70 percent of smokers say they want to quit, and about 40 percent try to quit each year. Only 4 to 7 percent, however, succeed without help, even though they’re aware of their risk for smoking diseases. This is partly because the nicotine contained in cigarettes is addictive, and partly because there is a strong psychological aspect to smoking, since it often is associated with social activities.

Cigarette smoking: It’s a dangerous habit that raises one’s risk factor for throat cancer, according to research.

When you try to quit, you’ll suffer from physical and mental withdrawal symptoms that can include headaches, fatigue, and tightness in the chest as well as irritability, depression, and difficulty concentrating. You also might find that your social life suffers as you try to avoid situations in which you might be tempted to smoke.

Withdrawal symptoms can last several weeks, but will lessen every day that you remain smoke-free. If you doubt your willpower, consider using medications—research has shown they can double the chances of success. Your doctor can prescribe drugs that reduce the nicotine craving and you also can opt for nicotine replacement gum, nasal spray, or patches.

How to Quit Smoking

Medicare covers smoking and tobacco use cessation counseling for beneficiaries who have smoking-related illnesses such as a COPD diagnosis, or who are taking medications that are affected by tobacco use. Medicare’s prescription drug benefit also covers smoking cessation treatments prescribed by a physician (over-the-counter treatments, such as nicotine patches or gum, are not covered).

Boost your odds of quitting smoking and help yourself avoid smoking diseases by:

• Setting a quit date and talking to your doctor about medications that may help you.
• Throwing cigarettes, lighters, and ashtrays into the garbage.
• Avoiding situations that may trigger an urge to smoke, and planning in other habits or activities you can engage in instead.
• Stocking up on other things to put in your mouth rather than cigarettes, such as peppermints, carrot sticks, toothpicks, and cinnamon sticks.
• Writing down your reasons for wanting to quit smoking (a list of smoking diseases is a good incentive), and pinning the list where you can see it as a constant reminder.

Originally published in 2016, this post is regularly updated.

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Almost every person with COPD will be prescribed a short-acting bronchodilator (either a beta-agonist, an anticholinergic, or a combination of both) to use as needed to relieve shortness of breath, coughing, wheezing, and other symptoms. Some people also will need long-acting bronchodilators and/or an anti-inflammatory drug. Your doctor will work with you to figure out the right drugs and combinations of drugs to relieve your symptoms, and you also should get immunized against influenza and pneumonia.

One thing you should avoid using is over-the-counter cough medications, such as guaifenesin (Robitussin, Mucinex), since there is little evidence to show that these are helpful for people with COPD. Although coughing can be bothersome, it has the important function of helping to clear mucus. This means that suppressing a cough may increase the risk of lung infection.

Mild COPD Treatment

For a person with mild COPD who has occasional symptoms, a short-acting bronchodilator alone may be sufficient to manage the condition. Two short-acting bronchodilators—a beta-agonist plus an anticholinergic—also may be prescribed. To simplify this regimen, a combination of a short-acting beta-agonist plus a short-acting anticholinergic is available in a single inhaler. If more symptoms develop over time, additional medications will likely be necessary.

Moderate-to-Severe COPD Treatment

For people with moderate-to-severe COPD who tend to experience symptoms more frequently, one or more long-acting bronchodilators will be added to the regimen. These drugs will be taken regularly every 12 or 24 hours. If acute episodes of breathlessness or coughing occur while taking these medications, a short-acting bronchodilator such as albuterol can be used to quell the episodes.

Inhaled corticosteroids are recommended for people with moderate-to- severe COPD who do not get sufficient relief from bronchodilators alone, or who experience frequent exacerbations of symptoms. Inhaled corticosteroids have been shown to reduce flare-ups. However, some studies have found that using inhaled corticosteroids, with or without a bronchodilator, increases the risk of developing pneumonia. Nevertheless, because inhaled corticosteroids may decrease the risk of dying, they often are added when bronchodilators alone are insufficient. Hopefully further research will clarify the role of inhaled steroids in COPD. Patients should discuss any concerns they have with their physician.

For people prescribed long-term use of both a long-acting bronchodilator and a corticosteroid, combinations of both in a single inhaler are available.

Severe COPD Treatment

For patients with more severe COPD, combinations of two long-acting bronchodilators are generally used. These often are combined in a single inhaler.

Immunizations

For people with obstructive airway diseases, flu or pneumonia can be very serious and even life threatening. Fortunately, vaccines are available to protect against influenza and some forms of pneumonia. It is extremely important that everyone with obstructive airway disease follow the recommended vaccination schedule, or their doctor’s advice.

Flu Vaccine

People with COPD or other lung problems should receive an influenza vaccination once a year. The ideal time to get a flu shot is in October or November, as flu season runs from November to March.

Pneumococcal Vaccine

The pneumococcal vaccine protects against the bacteria that is the most common cause of pneumonia, Streptococcus pneumoniae. There are now two forms of pneumococcal vaccine, the Pneumovax and the Prevnar 13. It is recommended that all adults over age 65 receive a pneumococcal vaccination. Unlike the flu shot, which must be given every year in the fall, pneumococcal vaccination provides protection for at least five years. It can be given at any time of the year.

The pneumococcal vaccine is advised for all people with COPD age 65 and older. It also may be given to people with COPD who are younger than age 65 and have severe or very severe disease (FEV1 less than 40 percent of predicted), and recommended for people with asthma who are younger than age 65.

Treating COPD Exacerbations

The most common cause of an exacerbation is a lung infection that may increase mucus production. In these cases, antibiotics may be used. Before prescribing an antibiotic, the doctor may send a sample of the sputum for analysis to determine whether the infection is bacterial or viral, since antibiotics are only effective against bacteria. Studies have shown that a short course (five days) of antibiotics is just as effective as taking antibiotics for longer than five days.

In 2017, the American Thoracic Society and European Respiratory Society issued joined guidelines on the management of COPD exacerbations. Their recommendations included:

• For ambulatory patients with an exacerbation of COPD, a short course of oral corticosteroids plus antibiotics.
• For patients hospitalized with an exacerbation, oral corticosteroids rather than intravenous corticosteroids, if possible.
• For patients hospitalized with an exacerbation causing respiratory failure, noninvasive mechanical ventilation.
• After being discharged for an exacerbation, pulmonary rehabilitation should begin within three weeks. It should not be started during hospitalization.

A recent study found that engaging in any amount of regular exercise following hospitalization for a COPD exacerbation actually reduces the risk of dying.

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A diet that is rich in fiber (from whole grains, whole fruits, vegetables, beans, brown rice, and nuts), and low in red meat, refined grains, and sugar may help keep the lungs healthy and reduce the chances of getting COPD for both smokers and nonsmokers. However, it is unknown whether changing fiber intake improves lung function in patients who already have COPD.

COPD most often affects people age 40 and older who have smoked a pack of cigarettes per day for 10 or more years. Pipe and cigar smoking also can decrease lung function and increase the chance of COPD, even in people who have never smoked cigarettes—so can smoking water pipes or marijuana.

Smokers who have a family history of COPD are at particularly high risk. For some people, exposure to secondhand smoke can cause respiratory symptoms and possibly COPD. Exposure to secondhand smoke in childhood appears to increase the risk for developing COPD in adulthood. In a 2016 study, middle-aged people whose mothers were heavy smokers (more than 20 cigarettes a day) were more than twice as likely to have lung impairment indicative of COPD than people whose mothers had not smoked.

People who quit smoking are still at increased risk of eventually being diagnosed with COPD. However, stopping smoking significantly reduces the chances of getting COPD, as well as other lung and heart diseases, and smokers with COPD who stop smoking slow the progression of their COPD. Smoking also increases the risk for lung cancer, but this risk declines when a person stops smoking, and continues to decline the longer they go without smoking.

The Risk of COPD for Marijuana and E-Cigarette Smokers

In recent years, there has been interest in understanding the possible lung effects of marijuana smoke inhalation, due to its increased use recreationally and medicinally. To date, there have been no conclusive studies. It seems unlikely that we will know for many years, given that the permanent effects of smoke inhalation take time to manifest. There is, however, some concern that marijuana smoking may increase the risk of cancer as well as COPD.

E-cigarettes were introduced in the United States in 2006 as a supposedly safe alternative to tobacco cigarettes. Despite the lack of long-term research, some studies suggest these products may not be as benign as first thought. E-cigarettes typically contain nicotine, a flavoring, and a solvent. The nicotine encourages addiction, while the flavoring is for appeal. As of 2017, a whopping 7,700 flavors of vaping liquid were available. Although these flavorings are widely used in the food industry and are safe to eat, their safety when inhaled is unknown. Additionally, some vaping liquids contain impurities such as anabasine, which is principally used as an insecticide.

More studies are underway to assess whether e-cigarettes and other electronic nicotine delivery systems (ENDS) help with smoking cessation. To date, the results of randomized, controlled clinical trials is mixed. As far as safety goes, studies have linked the use of ENDS to changes in airflow that precede COPD, daytime cough, phlegm production, headache, dry mouth, vertigo, and nausea.

The U.S. Food & Drug Administration (FDA) regulates the manufacture, packaging, labeling, advertising, sale, and distribution of ENDS. All ENDS products must carry a warning that the product contains nicotine, and that nicotine is addictive. They are not required to say what other chemicals are contained in the product.

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