Few situations are more unsettling than not being able to breathe. Whether from a momentary injury that knocks the wind out of you, swimming underwater for too long or recovering after sprinting at full speed, anyone who has struggled to fill their lungs with oxygen knows how scary the feeling can be.

But sometimes people experience breathing troubles that are less acute yet longer lasting. Such issues may be associated with conditions like asthma, sleep apnea and cystic fibrosis.

Chronic obstructive pulmonary disease (COPD) is another of the most common breathing conditions, but it's also one of the most debilitating.

## What is COPD?

Chronic obstructive pulmonary disease, or COPD, is an ongoing group of lung conditions that include chronic bronchitis and emphysema. COPD is the result of damaged lung tissue, which leads to inflammation that irritates the airway and limits airflow. Because such damage usually worsens over time, "COPD mostly affects people who are 50 or older," says Dr. Shawn Aaron, senior scientist of the inflammation and chronic disease program at the Ottawa Hospital Research Institute in Canada.

Common symptoms of COPD include wheezing, chest tightness, a painful and persistent cough (with and without accompanying mucus) and fatigue. "Another of the most worrisome features of the disease can be periodic flare-ups - called exacerbations, which can greatly diminish your ability to breathe," explains Dr. Meilan King Han, pulmonary diseases specialist at University of Michigan Health. Due to the severity of such episodes, "some COPD patients can end up hospitalized," she says.

People with COPD are also more vulnerable to respiratory infections such as pneumonia, COVID-19 and tuberculosis. Related complications are why "COPD is a leading cause of death both in America and worldwide," says Dr. David Mannino, chief medical officer at the COPD Foundation in Florida.

At least 15 million adults have some form of COPD, per the U.S. Centers for Disease Control and Prevention, but Mannino says it could be twice that number because the condition is often misdiagnosed or undiagnosed.

### What Causes COPD?

The damaged lung tissue associated with COPD is most often caused by long-term exposure to irritants such as fumes, dust, chemicals or smoke. This is why "cigarette smoke is the main cause of COPD in high-income countries like the United States," says Mannino. "However, not everyone who smokes will develop COPD symptoms, and not all people with COPD have a history of smoking."

"Exposure to outdoor pollution or indoor cooking smoke and fumes is a major cause of COPD," says Aaron, especially in developing countries. He adds that some people also develop the condition because of poor early lung development related to premature birth.

Genetic factors, early-life respiratory infections and a history of asthma "can all also contribute to the development of COPD," says Han.

## How is COPD Treated?

Regardless of what's causing the condition, COPD is treatable. "The mainstays of therapy have historically been inhaled bronchodilators and inhaled steroids," says Han. Such medications can reduce breathlessness, improve stamina and lower one's risk of flare-ups, says Mannino.

He adds that non-pharmacologic therapies are also helpful in reducing symptoms and risk of flare-ups. "These include participating in pulmonary rehabilitation, using oxygen therapy as prescribed and adhering to vaccination guidelines," he says. And you can't overemphasize the importance of quitting smoking, adds Aaron.

"By adhering to medication recommendations, avoiding infection and irritating fumes, eating foods that support lung health and strengthening lung tissue by getting plenty of cardiovascular activity," says Mannino, "individuals with COPD can maintain a good quality of life."

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