Also called Emphysema or Chronic Airflow Obstruction. Also see Chemtrails and Parasites.LungEncyclopedia Entry for COPD :COPD - control drugs. Anticholinergic inhalers include: Aclidinium (Tudorza Pressair) Glycopyrronium (Seebri Neohaler) Ipratropium (Atrovent) Tiotropium (Spiriva) Umeclidinium (Incruse Ellipta) Use your anticholinergic inhalers every day, even if you do not have symptoms.Beta-agonist inhalers include: Arformoterol (Brovana) Formoterol (Foradil; Perforomist) Indacaterol (Arcapta Neohaler) Salmeterol (Serevent) Olodaterol (Striverdi Respimat) DO NOT use a spacer with beta-agonist inhalers.Inhaled corticosteroids include: Beclomethasone (Qvar) Fluticasone (Flovent) Ciclesonide (Alvesco) Mometasone (Asmanex) Budesonide ( Pulmicort) Flunisolide (Aerobid) After you use these drugs, rinse your mouth with water, gargle, and spit.Combination medicines combine two drugs and are inhaled. They include: Albuterol and ipratropium (Combivent Respimat; Duoneb) Budesonide and formoterol (Symbicort) Fluticasone and salmeterol (Advair) Fluticasone and vilanterol (Breo Ellipta) Formoterol and mometasone (Dulera) Tiotropium and olodaterol (Stiolto Respimat) Umeclidinium and vilanterol (Anoro Ellipta) Glycopyrrolate and formoterol (Bevespi Aerosphere) Indacaterol and glycopyrrolate (Utibron Neohaler) Fluticasone and umeclidinium and vilanterol (Trelegy Ellipta).Roflumilast (Daliresp) is a tablet that is swallowed.Azithromycin is a tablet that is swallowed.Chronic obstructive pulmonary disease - control drugs; Bronchodilators - COPD - control drugs; Beta agonist inhaler - COPD - control drugs; Anticholinergic inhaler - COPD - control drugs; Long-acting inhaler - COPD - control drugs; Corticosteroid inhaler - COPD - control drugs.Anderson B, Brown H, Bruhl E, et al. Institute for Clinical Systems Improvement website. Health care guideline: diagnosis and management of chronic obstructive pulmonary disease (COPD). 10th edition. www.icsi.org/_asset/yw83gh/COPD.pdf. Updated January 2016. Accessed February 28, 2018. Han MK, Lazarus SC. COPD: clinical diagnosis and management.Encyclopedia Entry for COPD :COPD - how to use a nebulizer. With a nebulizer, you will sit with your machine and use a mouthpiece. Medicine goes into your lungs as you take slow, deep breaths for 10 to 15 minutes. Nebulizers can deliver medicine with less effort than inhalers. You and your doctor can decide if a nebulizer is the best way to get the medicine you need. The choice of device may be based on whether you find a nebulizer easier to use and what type of medicine you take. Most nebulizers use air compressors. Some use sound vibrations. These are called 'ultrasonic nebulizers.' They are quieter, but they cost more. Follow these steps to set up and use your nebulizer: Connect the hose to the air compressor. Fill the medicine cup with your prescription. To avoid spills, close the medicine cup tightly and always hold the mouthpiece straight up and down. Attach the other end of the hose to the mouthpiece and medicine cup. Turn on the nebulizer machine. Place the mouthpiece in your mouth. Keep your lips firm around the mouthpiece so that all of the medicine goes into your lungs. Breathe through your mouth until all the medicine is used. This usually takes 10 to 15 minutes. Some people use a nose clip to help them breathe only through their mouth. Turn off the machine when you are done.You will need to clean your nebulizer to prevent bacteria from growing in it, since bacteria can cause a lung infection. It takes some time to clean your nebulizer and keep it working properly. Be sure to unplug the machine before cleaning. After each use: Wash the medicine cup and mouthpiece with warm running water. Let them air dry on clean paper towels. Later, hook up the nebulizer and run air through the machine for 20 seconds to make sure all of the parts are dry. Take apart and store the machine in a covered area until the next use. Once per day, you may add a mild dish soap to the cleaning routine above. Once or twice each week: You may add a soaking step to the cleaning routine above. Soak the cup and mouthpiece in 1 part distilled white vinegar, 2 parts warm water solution. You may clean the outside of your machine with a warm, damp cloth as necessary. Never wash the hose or tubing. You will also need to change the filter. The instructions that come with your nebulizer will tell you when you should change the filter.Most nebulizers are small, so they are easy to transport. You may carry your nebulizer in your carry-on luggage when traveling by plane. Keep your nebulizer covered and packed in a safe place. Pack your medicines in a cool, dry place when traveling.Call your doctor if you are having trouble using your nebulizer. You should also call if you have any of these problems while using your nebulizer: Anxiety Feeling that your heart is racing or pounding (palpitations) Shortness of breath Feeling very excited These may be signs that you are getting too much medicine.Chronic obstructive pulmonary disease - nebulizer.Celli BR, Zuwallack RL. Pulmonary rehabilitation.Encyclopedia Entry for COPD :COPD - managing stress and your mood. When you have COPD, caring for your emotional health is just as important as taking care of your physical health. Learning how to deal with stress and anxiety and seeking care for depression can help you manage COPD and feel better in general.Having COPD can affect your mood and emotions for several reasons: You cannot do all the things you used to do. You may need to do things much slower than you used to. You may often feel tired. You may have a hard time sleeping. You may feel ashamed or blame yourself for having COPD. You may be more isolated from others because it is harder to get out to do things. Breathing problems can be stressful and scary. All of these factors can make you feel stressed, anxious, or depressed.Having COPD can change how you feel about yourself. And how you feel about yourself can affect COPD symptoms and how well you care for yourself. People with COPD who are depressed may have more COPD flare-ups and may have to go to the hospital more often. Depression saps your energy and motivation. When you are depressed, you may be less likely to: Eat well and exercise. Take your medicines as directed. Follow your treatment plan. Get enough rest. Or, you may get too much rest. Stress is a known COPD trigger. When you feel stressed and anxious, you may breathe faster, which can make you feel short of breath. When it is harder to breathe, you feel more anxious, and the cycle continues, leading you to feel even worse.There are things you can and should do to protect your emotional health. While you cannot get rid of all the stress in your life, you can learn how to manage it. These suggestions may help you relieve stress and stay positive. Identify the people, places, and situations that cause stress. Knowing what causes you stress can help you avoid or manage it. Try to avoid things that make you anxious. For example, DO NOT spend time with people who stress you out. Instead, seek out people who nurture and support you. Go shopping during quieter times when there's less traffic and fewer people around. Practice relaxation exercises. Deep breathing, visualization, letting go of negative thoughts, and muscle relaxation exercises are all simple ways to release tension and reduce stress. DO NOT take on too much. Take care of yourself by letting go and learning to say no. For example, perhaps you typically host 25 people for Thanksgiving dinner. Cut it back to 8. Or better yet, ask someone else to host. If you work, talk with your boss about ways to manage your workload so you do not feel overwhelmed. Stay involved. DO NOT isolate yourself. Make time every week to spend time with friends or attend social events. Practice positive daily health habits. Get up and get dressed every morning. Move your body every day. Exercise is one of the best stress busters and mood boosters around. Eat a healthy diet and get enough sleep every night. Talk it out. Share your feelings with trusted family or friends. Or talk with a clergy member. DO NOT keep things bottled up inside. Follow your treatment plan. When your COPD is well-managed, you will have more energy for the things you enjoy. DO NOT delay. Get help for depression. Feeling angry, upset, sad, or anxious at times is understandable. Having COPD changes your life, and it can be hard to accept a new way of living. However, depression is more than occasional sadness or frustration. Symptoms of depression include: Low mood most of the time Frequent irritability Not enjoying your usual activities Trouble sleeping, or sleeping too much A big change in appetite, often with weight gain or loss Increased tiredness and lack of energy Feelings of worthlessness, self-hate, and guilt Trouble concentrating Feeling hopeless or helpless Repeated thoughts of death or suicide If you have symptoms of depression that last for 2 weeks or more, call your doctor. You do not have to live with these feelings. Treatment can help you feel better.Call 911, a suicide hot line, or go to the nearest emergency room if you have thoughts of harming yourself or others. Call your doctor if: You hear voices that are not there. You cry often for no apparent reason. Your depression has affected your work, school, or family life for longer than 2 weeks. You have 3 or more symptoms of depression. You think one of your current medicines may be making you feel depressed. DO NOT change or stop taking any medicines without talking to your doctor. You think you should cut back on drinking, or a family member or friend has asked you to cut back. You feel guilty about the amount of alcohol you drink, or you drink alcohol first thing in the morning. You should also call your doctor if your COPD symptoms get worse, despite following your treatment plan.Chronic obstructive pulmonary disease - emotions; Stress - COPD; Depression - COPD.Celli BR, Zuwallack RL. Pulmonary rehabilitation.Encyclopedia Entry for COPD :COPD - quick-relief drugs. Quick-relief beta-agonists help you breathe better by relaxing the muscles of your airways. They are short-acting, which means they stay in your system only for a short time. Some people take them just before exercising. Ask your doctor if you should do this. If you need to use these drugs more than 3 times a week, or if you use more than one canister a month, your COPD probably is not under control. You should call your doctor.Quick-relief beta-agonists inhalers include: Albuterol (ProAir HFA; Proventil HFA; Ventolin HFA) Levalbuterol (Xopenex HFA) Albuterol and ipratropium (Combivent) Most of the time, these medicines are used as metered dose inhalers (MDI) with a spacer. Sometimes, especially if you have a flare-up, they are used with a nebulizer. Side effects might include: Anxiety. Tremor. Restlessness. Headache. Fast or irregular heartbeats. Call your doctor right away if you have this side effect. Some of these medicines also exist in pills, but the side effects are a lot more significant, so they are very rarely used that way.Oral steroids (also called corticosteroids) are medicines you take by mouth, as pills, capsules, or liquids. They are not quick-relief medicines, but are often given for 7 to 14 days when your symptoms flare-up. Sometimes you might have to take them for longer. Oral steroids include: Methylprednisolone Prednisone Prednisolone.COPD - quick-relief drugs; Chronic obstructive pulmonary disease - control drugs; Chronic obstructive airways disease - quick-relief drugs; Chronic obstructive lung disease - quick-relief drugs; Chronic bronchitis - quick-relief drugs; Emphysema - quick-relief drugs; Bronchitis - chronic - quick-relief drugs; Chronic respiratory failure - quick-relief drugs; Bronchodilators - COPD - quick-relief drugs; COPD - short-acting beta agonist inhaler.Anderson B, Brown H, Bruhl E, et al. Institute for Clinical Systems Improvement website. Health care guideline: diagnosis and management of chronic obstructive pulmonary disease (COPD). 10th edition. www.icsi.org/_asset/yw83gh/COPD.pdf. Updated January 2016. Accessed February 28, 2018. Han MK, Lazarus SC. COPD: clinical diagnosis and management.Encyclopedia Entry for COPD :COPD - what to ask your doctor. What will make my COPD worse? How can I prevent things that can make my COPD worse? How can I prevent getting a lung infection? How can I get help quitting smoking? Will fumes, dust, or having pets make my COPD worse? What are some signs that my breathing is getting worse and I should call the doctor? What should I do when I feel I am not breathing well enough? Am I taking my COPD medicines the right way? What medicines should I be taking every day (called controller drugs)? What should I do if I miss a day or a dose? Which medicines should I take when I am short of breath (called rescue drugs)? Is it ok to use these drugs every day? What are the side effects of my medicines? For what side effects should I call the doctor? How will I know when my inhalers are getting empty? Am I using my inhaler the right way? Should I be using a spacer? What shots or vaccinations do I need? Are there changes in my diet that will help my COPD? What do I need to do when I am planning to travel? Will I need oxygen on the airplane? How about at the airport? What medicines should I bring? How do I get prescription refills? Who should I call if I get worse? What are some exercises I can do to keep my muscles strong, even if I cannot walk around very much? How can I save some of my energy around the house? Should I consider pulmonary rehabilitation?.What to ask your doctor about COPD; Emphysema - what to ask your doctor; Chronic bronchitis - what to ask your doctor; Chronic obstructive pulmonary disease - what to ask your doctor.Anderson B, Brown H, Bruhl E, et al. Diagnosis and management of chronic obstructive pulmonary disease (COPD). 10th ed. Updated January 2016. www.icsi.org/_asset/yw83gh/COPD.pdf. Accessed December 21, 2016. Macnee W, Vestbo J, Agusti A. COPD: pathogenesis and natural history.Encyclopedia Entry for COPD :COPD and other health problems. Having other health problems can affect your symptoms and treatments. You may need to visit your doctor more often. You also may need to have more tests or treatments. Having COPD is a lot to manage. But try to stay positive. You can protect your health by understanding why you are at risk for certain conditions and learning how to prevent them.If you have COPD, you are more likely to have: Repeat infections, such as pneumonia. COPD increases your risk of complications from colds and the flu. It increases your risk of needing to be hospitalized due to lung infection. High blood pressure in the lungs. COPD may cause high blood pressure in the arteries that bring blood to your lungs. This is called pulmonary hypertension. Heart disease. COPD increases your risk of heart attack , heart failure , chest pain, irregular heartbeat , and blood clots. Diabetes. Having COPD increases this risk. Also, some COPD medicines can cause high blood sugar. Osteoporosis (weak bones). People with COPD often have low levels of vitamin D, are inactive, and smoke. These factors increase your risk of bone loss and weak bones. Certain COPD medicines also may cause bone loss. Depression and anxiety. It is common for people with COPD to feel depressed or anxious. Being breathless can cause anxiety. Plus, having symptoms slows you down so you can't do as much as you used to. Heartburn and gastroesophageal reflux disease ( GERD ). GERD and heartburn can lead to more COPD symptoms and flare-ups. Lung cancer. Continuing to smoke increases this risk. Many factors play a role in why people with COPD often have other health problems. Smoking is one of the biggest culprits. Smoking is a risk factor for most of the problems above. COPD usually develops in middle age. And people tend to have more health problems as they age. COPD makes it hard to breathe, which can make it hard to get enough exercise. Being inactive can lead to bone and muscle loss and increase your risk for other health problems. Certain COPD medicines can increase your risk of other conditions such as bone loss, heart conditions, diabetes, and high blood pressure.Work closely with your doctor to keep COPD and other medical problems under control. Taking the following steps can also help protect your health: Take medicines and treatments as directed. If you smoke, quit. Also avoid secondhand smoke. Avoiding smoke is the best way to slow down damage to your lungs. Ask your doctor about stop-smoking programs and other options, such as nicotine replacement therapy and tobacco cessation medicines. Discuss the risks and side effects of your medicines with your doctor. There may be better options available or things you can do to reduce or offset the harms. Tell your doctor if you notice any side effects. Have a yearly flu vaccine and a pneumonia vaccine to help guard against infections. Wash your hands often. Stay away from people with colds or other infections. Stay as active as possible. Try short walks and light weight training. Talk with your doctor about ways to get exercise. Eat a healthy diet rich in lean proteins, fish, whole grains, fruits, and vegetables. Eating several small healthy meals a day can give you the nutrients you need without feeling bloated. An overfull belly can make it hard to breathe. Talk with your doctor if you feel sad, helpless, or worried. There are programs and medicines that can help you feel more positive and hopeful. Remember that you are not alone. Your doctor will work with you to help you stay as healthy and active as possible.You should call your doctor when: You have new signs or symptoms that concern you. You are having trouble managing one or more of your health conditions. You have concerns about your health problems and treatments. You feel hopeless, sad, or anxious. You notice medicine side effects that bother you.Chronic obstructive pulmonary disease - comorbidities; COPD - comorbidities.Celli BR, Zuwallack RL. Pulmonary rehabilitation.Encyclopedia Entry for COPD :COPD flare-ups. Certain illnesses, colds, and lung infections from viruses or bacteria can lead to flare-ups. Other causes may include: Being around smoke or other pollutants Weather changes Doing too much activity Being run-down Feeling stressed or anxious You can often manage a flare-up right away with medicines and self-care. Work with your health care provider on an action plan for COPD exacerbations so that you know what to do. Get to know your usual symptoms, sleep patterns, and when you have good or bad days. This can help you learn the difference between your normal symptoms and signs of a COPD flare-up.Signs of a COPD flare-up last 2 days or more and are more intense than your usual symptoms. The symptoms get worse and just don't go away. If you have a full-blown exacerbation, you may need to go to the hospital. Common early signs include: Trouble catching your breath Noisy, wheezing breathing sounds Coughing, sometimes with more mucus than usual or a change in the color of your mucus Other possible signs of flare-up include: Not being able to take deep breaths Difficulty sleeping Morning headaches Abdominal pain Anxiety Difficulty speaking Swelling of the ankles or legs Gray or pale skin Blue or purple lips or nail tips Trouble speaking in full sentences.At the first sign of a flare-up: DO NOT panic. You may be able to keep symptoms from getting worse. Take medicines as directed for flare-ups. These may include quick-relief inhalers, steroids or antibiotics you take by mouth, anti-anxiety medicines, or medicine through a nebulizer. Take antibiotics as directed if your provider prescribes them. Use oxygen if prescribed. Use pursed lip breathing to save energy, slow your breathing, and help you relax. If your symptoms do not get better within 48 hours, or your symptoms keep getting worse, call your provider or go to the hospital.If you have COPD: Stop smoking and avoid secondhand smoke. Avoiding smoke is the best way to slow down damage to your lungs. Ask your provider about stop-smoking programs and other options, such as nicotine-replacement therapy. Take your medicines as directed. Ask your provider about pulmonary rehabilitation. This program includes exercise, breathing, and nutrition tips. See your provider 1 to 2 times per year for check-ups, or more often if directed. Use oxygen if your provider recommends it. Avoid colds and the flu, you should: Stay away from people with colds. Wash your hands often. Carry hand sanitizer for times when you cannot wash your hands. Get all of your recommended vaccines, including a flu shot every year. Avoid very cold air. Keep air pollutants, such as fireplace smoke and dust, out of your home. Live a healthy lifestyle: Stay as active as possible. Try short walks and light weight-training. Talk with your provider about ways to get exercise. Take frequent breaks throughout the day. Rest between daily activities to save your energy and give your lungs time to recover. Eat a healthy diet rich in lean proteins, fish, fruits, and vegetables. Eat several small meals a day. DO NOT drink liquids with meals. This will keep you from feeling too full. But, be sure to drink liquids at other times to keep from getting dehydrated.After following your COPD action plan, call your provider if your breathing is still: Getting harder Faster than before Shallow and you cannot get a deep breath Also call your provider if: You need to lean forward when sitting in order to breathe easily You are using muscles around your ribs to help you breathe You are having headaches more often You feel sleepy or confused You have a fever You are coughing up dark mucus Your lips, fingertips, or the skin around your fingernails is blue You have chest pain or discomfort You cannot speak in full sentences.COPD exacerbation; Chronic obstructive pulmonary disease exacerbation; Emphysema exacerbation; Chronic bronchitis exacerbation.Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society guideline. Chest. 2015;147(4):894-942. PMID: 25321320 www.ncbi.nlm.nih.gov/pubmed/25321320. Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and prevention of COPD: 2017 report. goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/. Accessed December 13, 2017. Han MK, Lazarus SC. COPD: clinical diagnosis and management.