Respiratory Health

Risk Factors

Common risk factors for COPD include:

• Smoking tobacco or exposure to tobacco smoke—as many as 8 out of 10 COPD-related deaths are associated with smoking.
• Air pollutants
• Genetic factors
• Respiratory infections

Symptoms

Symptoms of COPD include:

• Difficulty breathing
• Coughing/wheezing
• Excessive phlegm
• Difficulty taking a deep breath

COPD is diagnosed through spirometry testing. Spirometry testing is noninvasive and simple. It consists of blowing into a mouthpiece connected to a spirometer, a machine that determines the severity of air flow obstruction compared to people your age. Spirometry can determine if you have COPD and how severe it is.

COPD is a chronic disease—you will always have it, but you can help manage it through lifestyle changes including programs to learn to breathe better, medications, and, for some, oxygen therapy.

Get your COPD plan. Use this worksheet with your provider to track symptoms, treatment, and daily management.

COPD medications can decrease shortness of breath, help with coughing and wheezing, and prevent flare-ups that could be life threatening. Maintenance medications are used daily to help control your COPD and decrease the frequency of flare-ups. Rescue medications are taken when acutely experiencing symptoms. It’s important to check medication expiration dates, especially for rescue medications, as you may go a while between usages and expired medications can be less effective.

• Short-acting Beta Agonist: Relax your airway to help with shortness of breath and are used as needed for relief. These are often referred to as your "rescue inhaler." Some examples of short-acting beta-agonists are levalbuterol and albuterol.

• Long-acting Beta Agonist: These medications work in a similar way to the short-acting agents; however, they have a delayed onset of effect so they cannot be used for acute relief. These are used for maintenance treatment. Examples of long-acting beta-agonists are formoterol and salmeterol.

• Anticholinergics (antimuscarinics): Anticholinergics help to open airways and to reduce inflammation to make it easier to breathe. These inhalers are often referred to as a “controller” or “maintenance” inhalers. Some examples of anticholinergics are tiotropium, glycopyrrolate, and umeclidinium.

• Corticosteroids: Corticosteroids prevent or decrease airway inflammation that causes shortness of breath and wheezing. They are given orally, inhaled, and, in emergency situations, intravenously. Be sure to rinse your mouth after using an inhaled corticosteroid to avoid thrush, a fungus in your throat and mouth. Some examples of inhaled corticosteroids are fluticasone and budesonide.
  
  
  • Note: There are inhalers available with different combinations of these medications to help minimize the number of inhalations or puffs which need to be taken per day. Examples of these include Anoro Ellipta® which includes a long-acting beta-agonist and an anticholinergic or Advair® which includes a long-acting beta-agonist and a corticosteroid. Lastly there are triple therapy inhalers like Trelegy Ellipta® which include a corticosteroid, a long-acting beta-agonist, and an anticholinergic.

• Phosphodiesterase Inhibitors (PDE3/PDE-4): These medications work to decrease inflammation and relax muscles in the airway. They are not used for flare-ups, but as maintenance therapy. This medication may be used if you have already tried the other therapies above and have continued uncontrolled symptoms. This would be used as add-on therapy. Examples of medications in this class are ensifentrine and roflumilast.

• Biologic Therapy: If a patient continues with uncontrolled symptoms despite optimized inhaled therapy, has had frequent hospitalizations related to COPD, or has required additional oral steroids, then biologic therapy may be considered. These medications work to decrease the amount of certain white blood cells (eosinophils) in your body which helps to decrease inflammation. Examples of medications in this class that are used for COPD include dupilumab and mepolizumab. 

• Using an Inhaler: Most COPD medications are used with an inhaler or a nebulizer. Using these devices correctly is key to getting the full benefit of your medications. Inhalers come in different forms, such as metered-dose, dry powder, and soft mist. You may be given a spacer that attaches to a metered-dose inhaler to help get the full dose of medication. It’s common to be prescribed multiple inhalers and some inhalers can contain more than one medication. Make sure you read the instructions and are educated by your provider or pharmacist to learn how to use each type you are prescribed.

• Newer Therapies (2024-25 updates): The following are newly-developed therapies for COPD:
  
  
  • Nebulised dual inhibitor (PDE3 + PDE4) such as Ensifentrine as add-on therapy for presistent symptoms despite standard therapy.
    
    
  • Biologic therapy (e.g., Dupilumab) considered for COPD patients with type-2 inflammation (eosinophil high) still exacerbating despite triple inhaler therapy.

Risk Factors

Risk factors for asthma include:

• Genetics
• Environmental
  • Mold
  • Dust mites
  • Secondhand smoke
  • Virus
  • Air pollution
  • Pets
• Occupational irritants like chemicals or wood dust

Symptoms

Symptoms of asthma include:

• Coughing
• Shortness of breath
• Chest tightness
• Wheezing

Asthma can be difficult to diagnose. Your doctor will diagnose asthma through a medical history, including family history, and may also ask if there are certain activities or times that bring on symptoms. A physical examination and possibly a breathing test called spirometry to see how your lungs are functioning may be performed. Other tests may include imaging, blood testing, or allergy testing.

You and your doctor will develop a plan to manage your asthma. Management often involves a combination of medication and avoiding your asthma triggers. Depending on severity, you may not require any medications.

Asthma medications can be broken into two groups, quick-relief (bronchodilators) and long-term control (corticosteroids).

Bronchodilators: These quick-relief medications work immediately to expand the passageways into the lungs to relieve the first signs of asthma symptoms. Depending on your type of asthma, you may be instructed to use your quick-relief inhaler before exercising. You may not use your quick-relief medications daily, so it’s important to check to make sure they are not expired. The quick-relief medications classes are:

• Short-acting inhaled beta-agonists(SABA): examples are albuterol and levalbuterol

• Anticholinergics: An example is Atrovent (this would be used in combination with a SABA)

Corticosteroids/Antileukotrienes: These medications that provide long-term control are taken every day to prevent symptoms and asthma attacks. They are prescribed in addition to quick-relief medications when asthma is not well controlled. Your doctor will determine how well your asthma is controlled based on how often you use your quick-relief medication and how often you wake up with asthma symptoms at night. The classes of long-term control medications are:

• Inhaled corticosteroids (sometimes in combination with a long-acting inhaled beta-agonists like salmeterol, formoterol). Be sure to rinse your mouth after using an inhaled corticosteroid to avoid thrush, a fungus in your throat and mouth.

• Antileukotrienes or leukotriene modifiers: examples are montelukast and zafirlukast

Initial therapy for patients with minimum symptoms and low risk of exacerbation can often be treated with as needed therapies, with a preference for an inhaled corticosteroid reliever. Patients with more significant symptoms should be managed with daily treatment. Lastly, for patients who continue to experience exacerbations despite therapy with bronchodilators and corticosteroids, biologic therapy may be considered.

Using an Inhaler: Most asthma medications are used with an inhaler or a nebulizer. Using these devices correctly is key to getting the full benefit of your medications. Inhalers come in different forms, such as metered-dose, dry powder, and soft mist. You may be given a spacer that attaches to a metered-dose inhaler to help get the full dose of medication. It’s common to be prescribed multiple inhalers and some inhalers can contain more than one medication. Make sure you read the instructions and are educated by your provider or pharmacist to learn how to use each type you are prescribed.

Key updates (2024-25): Using SABA alone is no longer recommended for most adults and adolescents as sole therapy, since it addresses bronchoconstriction but not the underlying airway inflammation. Initial therapy in many cases now: a low-dose ICS on a regular basis or, in mild symptoms adults/adolescents, an as-needed low-dose ICS + formoterol (ICS/LABA) as the reliever.

• Biomarkers (FeNO, eosinophils) and phenotyping are increasingly used to refine management.

• Environmental/air-quality/climate triggers (wildfire smoke, extreme temperatures) are more explicitly addressed in recent guidelines.

• Patient education, inhaler technique, self-management plans and trigger-avoidance remain foundational.

Risk Factors

Risk factors for lung cancer include:

• Smoking tobacco—up to 90% of lung cancer deaths are linked to cigarette smoking.
• Exposure to tobacco smoke (secondhand smoke)
• Air pollution, or substances found with some types of employment like asbestos, arsenic, diesel exhaust.
• Family history
• History of radiation therapy to chest
• Radon exposure—radon is a tasteless, scentless gas that forms in rocks, soil or water and can get enter cracks or holes in homes and build up. Long term exposure to this gas can cause lung cancer.

Symptoms

Like many cancers, symptoms can vary and, often, there are no symptoms in earlier stages of lung cancer. Here are some of the symptoms associated with lung cancer (please note that these symptoms could be attributable to many noncancerous conditions as well). 

• A cough that gets worse or doesn’t go away
• Chest pain
• Coughing up blood
• Difficulty breathing or wheezing
• Feeling tired constantly
• Unexplained weight loss

Lung cancer diagnosis begins with radiological imaging like an X-ray, MRI, CT or PET scan to identify suspicious areas that might be cancer when symptoms are present. A sample of cells will be collected from any identified areas to confirm diagnosis. This cell sample could be collected in sputum (mucous coughed up from your lungs), fluid collected around your lungs, or tissue through a biopsy. Your doctor will decide what imaging and what method of cell collection is most appropriate for you.

The type of lung cancer determines the method of treatment. Some treatments for lung cancer include chemotherapy, surgery, radiation, or targeted therapy (using specific drugs to block the growth or spread of the cancer). You and your doctor will discuss what treatment is best for you. 

Taking recommended vaccinations and practicing good hand hygiene are other steps that should be taken to prevent respiratory infections as your lungs are in a compromised state.

Preventive Measures

Preventive measures for respiratory illnesses:

• Wash your hands
• Clean and sanitize shared surfaces
• Cover your mouth and nose when you sneeze or cough
• Avoid sick people
• Don't smoke and avoid exposure to tobacco smoke
• Get up-to-date recommended vaccines: influenza, COVID-19 (with updated formulations), RSV (for eligible adults and infants), and pneumococcal vaccines

IMPORTANT NOTE ABOUT ANTIBIOTIC USE FOR RESPIRATORY ILLNESSES: Antibiotics are used to fight infections caused by bacteria. Antibiotics are not generally recommended for respiratory illnesses like bronchitis because these illnesses are typically caused by viruses. Even when bacteria causes the respiratory infection, it is often not advised to take antibiotics, but rather to allow the infection to run its course. Overuse of antibiotics can lead to the presence of bacteria in your body that do not respond to antibiotic treatment (also called “antibiotic-resistant” bacteria). Side effects of antibiotics can range from minor rashes to serious conditions including antibiotic-resistant infections such as c-diff that results in diarrhea and colon damage.

Therapeutic measures that are recommended for respiratory illnesses include:

• Get plenty of rest
• Drink plenty of fluids to help thin out your mucus
• Take a steamy shower or breathe in the steam from a hot bowl of water
• Use a clean humidifier or cool mist vaporizer
• Suck on lozenges—this can soothe a sore throat (not appropriate for kids under five years old)
• Try honey to relieve cough for adults and children over one year old
• Use saline nasal spray or drops for a stuffy nose; a bulb suction to clear mucus in young children
• Talk with your doctor or pharmacist about over-the-counter medications that may help relieve symptoms

Although, in general, respiratory illnesses will improve on their own, please contact your doctor if you experience:

• Fevers of 100.4 or greater
• Bloody mucus
• Difficulty breathing
• Symptoms for longer than three weeks
• Repeated episodes of bronchitis
• Any other symptoms that are severe or concerning

As noted above, antibiotics are often not advised for treatment of respiratory illnesses. Over-the-counter medications can help manage common symptoms of respiratory illnesses, including stuffy/runny nose, sore throat, and cough.

Preventive Measures

Preventive measures for COVID-19 include:

• Wash your hands
• Cover your mouth and nose when you sneeze or cough
• Avoid sick people
• Clean and sanitize shared surfaces
• Get vaccinated

Symptoms

Symptoms can appear from 2-14 days after exposure and can expand beyond the list provided below, but these are some of the more commonly reported:

• Fever or chills
• Loss of smell or taste
• Sore throat
• Cough, runny nose, or congestion
• Difficulty breathing
• Nausea, vomiting, diarrhea
• Headache or body aches
• Fatigue

Because COVID-19 shares many similar symptoms to other respiratory or gastrointestinal viruses, the only way to confirm it’s COVID is to test. If you test positive, stay home and isolate from others in your home for the first five days; you may need to isolate longer if you have not been fever free for 24 hours or your symptoms aren’t improving.

If you were exposed to COVID-19, the CDC recommends masking for 10 full days after the exposure and testing 6 days after your exposure. Recommendations are to complete the 10 days of masking if you do test negative as you could test positive or develop symptoms after day 6.

Therapeutic measures for COVID-19 include:

• Drink plenty of fluids
• Get plenty of rest
• Talk with your doctor or pharmacist about over-the-counter medicines that may help manage your symptoms

In addition to over-the-counter medications to manage symptoms, antiviral medications have been authorized by the FDA to treat mild to moderate COVID-19 in people who are likely to get very sick from the virus. The oral antiviral medications must be taken within five days of developing symptoms and within seven days of intravenous medications. Dosage of oral antivirals for COVID-19 is based upon your renal (kidney) function, so make sure to let your pharmacist know if you have renal disease.