The Symptoms and Causes of COPD

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that makes it hard to move air in and out of the lungs. Chronic bronchitis and emphysema are two of the most common conditions that contribute to COPD. These two typically occur together and can vary in severity among COPD patients.

COPD is a progressive disease, which means lung damage can worsen over time. While there is no cure, treatment and healthy lifestyle changes can help manage symptoms and slow disease progression.

The goal of treatment is to ease symptoms and improve quality of life. For eligible patients, home health can be an important resource to support better health for people with COPD.

What are the Symptoms of COPD?

COPD symptoms can appear mild at first and can even be mistaken for a cold. However, there are signs that may point to having COPD.

Early Symptoms

Early symptoms of COPD include:

• Occasional shortness of breath when active.
• Trouble taking a deep breath.
• A cough that doesn’t go away.
• Wheezing or chest tightness.
• Having more colds than usual or more serious lung infections.
• Needing to clear throat often, especially when waking up.

You may start to find that daily tasks become harder, such as walking upstairs, gardening or bringing groceries inside. If there is no obvious cause for the symptoms and they are progressing, it’s time to see your doctor.

Worsening Symptoms

Symptoms will continue to get worse over time, and may lead to serious lung damage, especially if you’re a smoker. Later stage symptoms may include:

• Fatigue or extreme tiredness most of the day.
• Blue lips or fingernails.
• Losing weight without trying.
• Swollen feet, ankles, or legs.

COPD Flare-Up Symptoms

There may be times when COPD symptoms suddenly worsen. These are called exacerbations or flare-ups, which may happen a few times a year, and last for a couple of days or even weeks. Flare-ups may be triggered by breathing in smoke, pollen, chemicals or cold air from bad air quality, or even a cold or the flu. Flare-up symptoms can include:

• More trouble than usual breathing.
• Wheezy or noisy breathing.
• Coughing more than usual.
• Noticing a difference in color, thickness or amount of phlegm you cough up.
• More tired than usual or having difficulty sleeping while lying flat.

If you notice symptoms becoming more severe than usual, especially increased shortness of breath, coughing or changes in mucus color or amount, contact your healthcare provider promptly.

What Causes COPD?

COPD occurs more often for those who are 40 years of age or older. Those who have a history of smoking, inhaling second-hand smoke and other fumes or chemicals and dust found in many work settings are at higher risk. Genetics can also play a role even if you’ve never smoked or been exposed to toxic fumes.

Smoking

Although not everyone who smokes will get COPD, your risk is greater the longer you smoke and the more tobacco products you use. Smoking is the number one cause of COPD, whether you’re a current or former smoker. ¹ By quitting smoking, you can slow the progression of COPD and make treatments more effective. After only a few weeks of not smoking, your breathing, coughing and clogged sinuses can improve.

Harmful Pollutants

COPD can also be caused by breathing in harmful pollutants, such as dust, fumes or chemicals. This often occurs in the workplace setting but can also occur at home. Try to avoid ammonia, asbestos, carbon monoxide, dust and fumes when at work, and dust smoke, cleaners, spray products, mold and bacteria when at home. Keep in mind the following for removing harmful products from your home:

• Do not use plug-in air fresheners.
• Find more natural, less toxic cleaners.
• Change filters in dryers, refrigerators, furnaces and heating vents often.
• Avoid using fireplaces and wood stoves.
• Avoid using sponges or replace them often.

Genetics

Alpha-1 antitrypsin deficiency is a disease known to cause COPD. ² Alpha-1 causes a much lower level of blood protein called alpha-1-antitrypsin. This protein protects the lungs from irritation caused by breathing in toxins. Alpha-1 is a genetic disorder and is passed down from parents to children. A simple blood test can detect if you have alpha-1, and there is a specific treatment plan that can slow the progress of COPD for those with the disease.

Living with COPD

Living with COPD can be a challenge. With the right treatment plan and support, many people with COPD can continue to enjoy meaningful daily activities. By maintaining a good diet, the right care and patience, you can learn to manage the symptoms of the disease.

Managing a COPD Flare

Managing a COPD flare (acute exacerbation) involves recognizing worsening symptoms early, such as increased shortness of breath, more frequent coughing, increased sputum production, or a change in sputum color. Notify your healthcare provider as soon as you notice changes in your symptoms. Your healthcare provider may recommend treatment that includes:

• Using prescribed rescue inhalers or nebulized bronchodilators to open the airways
• Taking corticosteroids as directed to reduce inflammation
• Using antibiotics when a bacterial infection is suspected or confirmed

Your care team may also provide you with a COPD action plan, so you know what steps to take and when to seek prompt medical attention for severe symptoms, a drop in oxygen levels, or an increased difficulty with breathing. Early, proactive treatment while staying hydrated, resting and monitoring oxygen levels can help reduce complications, improve recovery and prevent hospitalization.

When a COPD flare causes a significant decline in function, including reduced mobility or the need for skilled nursing or therapy services at home, home health can help eligible patients. Depending on the patient's needs and physician orders, the home health team may provide skilled nursing, physical therapy, occupational therapy or speech therapy services. Examples include:

• Skilled Nursing: Respiratory assessment, medication management and COPD self-management education.
• Physical Therapy: Strength, endurance, balance and mobility training.
• Occupational Therapy: Energy conservation techniques and safe completion of daily activities.
• Speech Therapy: Evaluation and treatment of swallowing or communication difficulties when appropriate.

For Medicare-covered home health services, patients generally must:

• Be under the care of a physician or authorized provider.
• Need intermittent skilled nursing care, physical therapy, speech therapy, or ongoing occupational therapy.
• Be considered homebound (leaving home requires considerable effort or assistance).
• Have a documented plan of care.

Eat Healthy Foods

When managing COPD conditions, an anti-inflammatory diet can help reduce inflammation in your body by supporting the balance of bacteria in your gut. Antioxidant-rich foods, such as dark-colored fruits and vegetables can protect your airways and heal some of the damage caused by inflammation. Here are some foods to consider when trying an anti-inflammatory diet:

• Variety of fruits and vegetables
• Whole grains such as oats, barley, whole grain wheat, buckwheat and quinoa
• Beans and lentils
• Nuts and seeds
• Fish and seafood
• Olive oil
• Antioxidants such as coffee, tea, garlic, ginger and other herbs and spices.

COPD can sometimes make it difficult to coordinate breathing and swallowing. This may increase the risk of food or liquids entering the airway instead of the stomach. If you notice coughing or choking while eating or drinking, frequent throat clearing during meals, increased shortness of breath when eating or repeated lung infections, talk with your healthcare provider. Tips that may help with food intake include:

• Eat several smaller meals during the day instead of three larger meals.
• Eat slowly. This will make it easier to breathe.
• If you are losing weight, talk to your care team about special drinks or additives that may help you get the nutrition you need.

Exercise Regularly

Although there is no cure for COPD, exercise can improve symptoms and overall health by promoting blood circulation and helping the heart send oxygen to the body. Exercise also strengthens the respiratory muscles, making breathing easier. If approved by your physician, the best types of physical exercise for those with COPD can include: 

• Stretching: Stretching is great for both warming up and cooling down after a workout, while relaxing and improving flexibility.
• Aerobic exercise: Aerobics allows the body to use oxygen more efficiently. Swimming, walking and cycling are all good examples, with a goal of 20-30 minutes of exercise three to four times a week. ³
• Resistance training: By strengthening muscles that help with breathing, resistance training uses resistance bands and weights, or you can use body weight if you don’t have access to weights.

People with COPD get tired more easily. Pacing activity throughout the day can help, as well as looking for ways to make tasks easier. Keep in mind these tips for breathing while exercising:

• Inhale before beginning the exercise and exhale through the most difficult part of the exercise.
• Take slow breaths and go at a manageable pace.
• Purse the lips while breathing out.

Before starting an exercise program, talk with your healthcare provider. A physical therapist can help develop a personalized exercise plan that is safe and effective based on your symptoms and activity tolerance.

Avoid Smoke and Air Pollution

Along with not smoking, avoiding places where others smoke is essential, as secondhand smoke can contribute to lung damage. Air pollution can also contribute to lung irritation and damage. Check local air quality forecasts before spending time outdoors. You should stay indoors if the air quality is poor.

The best way to improve air quality in your home is to improve ventilation. Consider opening your door and windows on good air quality days for a few minutes at a time. Air cleaners and filters can also improve indoor air quality.

Specialized Home Health Care for COPD

Although COPD has no cure, keeping track of symptoms alongside implementing lifestyle changes and daily habits, you can slow the progression of the disease and start to feel better. Home health can help you recover safely at home from COPD-related complications when they do occur, improving your overall health and helping to reduce your risk of returning to the hospital. At Amedisys, our COPD program for home health is specifically designed to address the challenges that COPD can create. Some of the goals of this program include:

• Managing COPD at home by helping you recognize when your symptoms get worse and know what steps to take
• Slowing the progression of COPD
• Improving your ability to stay active
• Preventing and treating COPD exacerbations (flare-ups)
• Helping you be as independent as possible
• Making sure your home is safe so you can stay as healthy as possible
• Improving your quality of life and overall health

Learn more about our COPD program and connect with us today.

*Use of this material does not create physician-patient relationship. The information included in this material is not intended to be a substitute for professional medical advice. This material may not include all information available on or related to the subject matter discussed herein. Consult your doctor or other professional healthcare providers with any questions regarding a medical condition or before starting or changing any treatment.

Melanie Morris, MBA, MSN, RN, COS-C is the Assistant Vice President of Care Delivery Management for Amedisys. In her 28 years as a nurse, she has enjoyed caring for many types of patients and is passionate about providing holistic care to patients in their homes, especially those with chronic conditions such as wounds.

Staci McGuire, DPT, MBA, serves as the Home Health Director of Clinical Strategy, Programs and Therapy Practice at Amedisys. With over 16 years of experience in various clinical roles within the organization, she is dedicated to empowering clinicians to provide exceptional care and achieve optimal patient outcomes by adhering to current best practices and standards of care.