9 Common COPD Triggers and How to Avoid Them

Do you know about the many lung irritants that can set off COPD symptoms? Learn which culprits to avoid with this primer.

By Elizabeth Shimer Bowers

When you have chronic obstructive pulmonary disease (COPD), exposure to certain lung irritants can mean the difference between huffing and puffing and easier breathing. The biggest COPD trigger by far — both in terms of the onset of the condition and managing it down the road — is smoking. But beyond this obvious culprit, there are a number of other lung irritants that can trigger or worsen your COPD symptoms. Make avoiding them a top priority in your efforts to stay healthy with COPD.

Stay Away From Tobacco Smoke
As many as 90 percent of COPD cases are tied to smoking. So one of the best ways to prevent COPD in the first place, as well as keep it from getting worse, is to steer clear of cigarettes. “Smoking causes oxidative stress, which stimulates inflammation in the airways,” says Michael W. Sims, MD, an assistant professor and director of clinical research for the Penn Medicine Airways Biology Initiative in Philadelphia. These damaging effects cause COPD, and they also cause the condition to decline faster by increasing the risk for acute symptoms. And avoiding secondhand smoke is just as important as quitting smoking.

Beware of Indoor Air Pollution
The second most predominant trigger of COPD symptoms is combustible smoke, "such as breathing in smoke while cooking over an open wood fire, or heating your home with a kerosene heater that is poorly ventilated,” Dr. Sims says. According to the World Health Organization, more than 1 million people each year die from COPD that develops as a result of indoor air pollution. These lung irritants are primarily an issue for people in developing countries, but they should be avoided in general to help prevent COPD. To minimize indoor air pollution, avoid using a fireplace or wood-burning stove, and keep your air filters clean.

Take Steps to Avoid Bacterial and Viral Respiratory Infections
“Respiratory viruses, including influenza and pneumonia, are among the most concerning triggers of COPD symptoms,” says Heath Latham, MD, medical director of pulmonary rehabilitation at the University of Kansas Medical Center in Kansas City. “These viruses cause a breakdown in the lining of the airways, creating inflammation and increasing the risk of secondary bacterial infections.” For good COPD management, annual flu and pneumonia vaccines are essential. These vaccinations protect against the viruses that can worsen COPD and develop into a fatal infection. In addition to a yearly flu shot, you can avoid viruses and bacterial infections by following good hand-washing hygiene and steering clear of situations where you’re more likely to be exposed to illnesses.

Consider Outdoor Air Pollution
Although it’s important to stay as active as you can with COPD, you do need to be aware of what’s going on outdoors: Traditional city air pollution can trigger COPD symptoms. Of particular concern are the solid chunks of pollution that come from products of combustion, such as car and truck exhaust. “Some of the particles in city air pollution are so small that they can’t be seen with the eye, but can be breathed deep into the small airways, where they deposit and cause inflammation,” Sims says. Translation for daily COPD management: Stay inside on days when ozone exposure is high. Check your local paper for daily air quality reports, or download the Everyday Health COPD Tracker for weather information plus treatment and condition tips.

Keep Your Home Clear of Indoor Allergens
In addition to monitoring the air quality outside, you’ll need to keep your indoor environment as allergen-free as possible, too. “Dust and dust mites, especially for people who also have asthma, can worsen COPD symptoms,” says Luz Fonacier, MD, an allergist at Winthrop University Hospital in Mineola, N.Y., and a fellow of the American College of Allergy, Asthma, and Immunology. To prevent COPD flare-ups at home, you may need to make changes to your surroundings. Dr. Fonacier recommends covering mattresses, box springs, and pillows with readily available dust mite-resistant covers, and washing sheets and pillowcases weekly in water that is at least 131 degrees Fahrenheit. To further prevent COPD symptoms, she also suggests removing dust-collecting décor, such as stuffed toys, from bedrooms, and replacing carpets with hard floors when practical.

Remember Your Seasonal Allergies
“Some studies show that people prone to allergies may have an increased risk of COPD in the first place, and COPD symptoms may worsen during allergy season,” Sims says. Expect COPD symptoms to get worse during the season you’re most prone to allergies, be it spring, summer, or fall. “Allergies may act as a lung irritant directly through allergic inflammation, or indirectly through allergic rhinitis and postnasal drip,” he says. “Postnasal drip may stimulate the nerves at the back of the nose, which can enhance cough and aggravate COPD symptoms.” For better COPD management, try antihistamines to help reduce allergic reactions and stay indoors when seasonal allergies strike. Talk to your doctor if you continue to experience allergy symptoms despite these efforts.

Stamp Out Strong Scents
Do you experience COPD symptoms around cleaning agents, air fresheners, diesel fumes, scented candles, paint fumes, and other products with strong odors? “If one of these items is a lung irritant for you, COPD symptoms such as chest tightness and shortness of breath will immediately set in,” Sims says. To better manage COPD, avoid any scents and fumes that cause symptoms for you.

Look Out for Weather Extremes
COPD symptoms often get worse when it’s very hot and humid or, for some, bitterly cold outside. You can’t control the weather, but you can create your home environment. “The majority of people with COPD have more symptoms in hot, humid conditions," Dr. Latham says. "For these people, the only way to prevent COPD symptoms is to stay in a cool, air-conditioned environment." For those whose COPD symptoms get worse in the cold, Latham suggests wearing a scarf over your face and breathing through your nose to warm and humidify the air when you’re outside.

Seek Relief for Psychological Stress
Stress can impair even your best efforts at COPD management by dampening the immune system and leaving you more vulnerable to infections that can worsen your symptoms. “Stress can also enhance the sensation of shortness of breath in people with COPD,” Sims says. He adds that former smokers are more likely to turn back to cigarettes when they’re stressed, further worsening COPD. Make stress relief part of your daily plan. Ask your family and friends for help when you need it, and consider joining a support group to talk to others with COPD

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COPD Triggers: How to Prevent a Flare

Host: Carolynn Delany

Guest: Robert T. Schreiber, MD
February 27, 2012

Carolynn Delany:

Welcome to this Everyday Health podcast, “COPD Triggers: How to Prevent a Flare.” I'm your host, Carolynn Delany. Anyone coping with chronic illness knows there are good days and bad days. We're here today to become more aware and hopefully prevent those bad days from happening as often. Joining us today is Dr. Robert Schreiber, a pulmonary medicine specialist at Nassau Chest Physicians and director of the surgical ICU at St. Francis Hospital in Roslyn, New York. Dr. Schreiber and Nassau Chest Physicians are also actively involved with the American Lung Association in New York. Thanks for being with us today, Dr. Schreiber.

Dr. Schreiber:

I'm very glad to be here with you today, Carolynn.

Carolynn Delany:

Dr. Schreiber, we hear the terms "trigger" and "flare" quite often. Can you please help us understand what they mean and why certain elements cause COPD symptoms to flare?

Dr. Schreiber:

Carolynn, we use the words "flare" and "exacerbation" interchangeably for our patients with COPD, and what this really refers to is a temporary worsening of their emphysema [or chronic bronchitis]. Patients will have increased shortness of breath, wheezing, and coughing, and frequently we'll see increased sputum production. The sputum may change and be increased in terms of amount, thickness, color, going from clear to gray or yellow, and even sometimes bloody.

Carolynn Delany:

Dr. Schreiber, what are some common COPD triggers that can actually cause the flare‑up to happen?

Dr. Schreiber:

Carolynn, I think the number one trigger that we see would be infections. This can be anything from a cold to more serious things like bronchitis or pneumonia. Other things that we commonly see causing flare‑ups can be exposure to smoke, whether primary smoke from the patient smoking themselves or inhalation of secondhand smoke if they are out in a restaurant or some other venue where other people are smoking and they inhale other people's smoke.

Of course, other things like weather, whether it be hot or cold or humid or dry air, can also affect many people. Air pollution is a common trigger for many of our patients, particularly in those hot, humid days during the summer when the air quality gets very bad. That's a frequent cause of triggers during those air polluted days. And just general stress sometimes can bring on an exacerbation.

Carolynn Delany:

Well, you know, you mentioned avoiding smoking and being around others who are smoking. Is it also important to stay away from chimney smoke and stovetop smoke?

Dr. Schreiber:

Certainly for some people this can also be an irritant and trigger for a COPD exacerbation. Smoke is composed of a variety of chemicals, including particulates of carbon and all sorts of chemicals, and may have carbon monoxide sometimes, so our patients with COPD have to be careful around any type of smoke. Usually chimney smoke and stovetop smoke aren't toxic, but they can act as irritants.

Carolynn Delany:

Well, a flare‑up can happen at any time and all of the triggers you've mentioned are good ones to look out for, but are there others that only affect some people? If so, how should they learn to identify, watch out for, and deal with them?

Dr. Schreiber:

Different people will flare up from different triggers. The most important thing that I can do as a doctor is not sit down and say to someone, “you have to avoid,” and then give them a list of things. You have to tell them, “Listen, you have to pay attention to what bothers you.”

I don't play ice hockey, but I love to watch it, and there's a phrase that you have to skate with your head up, which really means that you have to look around you and be aware of your environment and see what's going on all the time, and that's really what it's about for our patients. You have to tell them, “Pay attention to what's going on, see what bothers you, and then, of course over time, you can learn what you can and cannot be around so that you can breathe more easily.”

Carolynn Delany:

That's a good point. I mean, some people might be more sensitive to extra dust in their home or scented laundry detergents, but it may not bother anybody else.

Dr. Schreiber:

That's exactly correct. I think in general, most people need fresh, circulating air so that nothing particularly settles or irritates their lungs. Other triggers, though, you have to kind of learn about those things, as you mentioned, like the scented laundry or fragrances and stuff, and see what really bothers you or not.

Carolynn Delany:

Well, why is it important for someone with COPD to maintain his or her overall health?

Dr. Schreiber:

The current state of the art in pulmonary medicine suggests that COPD exacerbations can gradually cause further loss of lung function, and clearly as healthcare professionals we all want to preserve our patients' lung function so that they can stay healthy, remain independent, and continue to perform their activities of daily living as best as possible. I think everyone feels that that should be a goal for themselves, and we as physicians want to try to do that for our patients.

Trying to stay healthy is really the most important thing here. As I said, infections are probably the number one cause of triggers, so hand washing and sanitizers will help prevent picking up colds. Obviously, if you know somebody is sick it's best to stay away from them. And immunizations are important to try to help prevent people catching influenza and pneumonia.

Carolynn Delany:

I see. I see. All great tips. Well, if you do find yourself in a flare what's the first and perhaps best thing you can do to help treat it and get you back to feeling normal?

Dr. Schreiber:

I think we all have to think of having a plan and that life is not just full of surprises, so patients with COPD have to recognize that things are going to happen, and what am I going to do when it happens. So the first thing to do is to remove yourself from the trigger if it's possible.

There is a way of breathing we call pursed-lip breathing where you breathe in through your nose and out through your mouth with your lips together when you exhale, and this helps to control the breathing pattern. It helps you breathe more efficiently. If you do it slowly, you get actually more oxygen in with less work of breathing, and that's a very helpful technique that your healthcare provider could probably teach you to do.

When the trigger happens, I tell my patients to drink extra fluids and try to get some extra rest. I almost always will have them have available a quick‑acting medication. Usually it's an inhaler, although sometimes it's a nebulized medicine that they can inhale that should help to open up the bronchial tubes.

And of course, if these things don't help they should really get in touch with their healthcare provider to see if there can be an adjustment of their medicines, see if they need a stronger bronchodilator or an antibiotic or possibly a course of prednisone. If those things fail, sometimes emergency room treatment or hospitalization even is required, but hopefully we can cut that off at the pass and try to keep people away from the hospitals.

Carolynn Delany:

Right. Well, Dr. Schreiber, thank you for sharing great information about how to recognize and prevent a flare when you're living with COPD.

Dr. Schreiber:

Well, Carolynn, as always it's my pleasure to speak with you and help our patients. And don't forget our patients should also contact their local chapter of the American Lung Association for further tips because they're a great resource for more information, too.

Carolynn Delany:

They certainly are. You've been listening to an Everyday Health podcast, “COPD Triggers: How to Prevent a Flare.” For more information on COPD, visit EverydayHealth.com. I'm Carolynn Delany for Everyday Health. Thanks for joining us.

http://www.everydayhealth.com/copd/podcasts/how-to-prevent-a-copd-flare-transcript.aspx

COPD Blog: COPD During the Dog Days of Summer

Robert T. Schreiber, MD, an American Lung Association in New York expert

It’s hot, hazy, and humid here in the United States. The “dog days of summer” produce poor air quality with high humidity and air pollution that makes it hard to breathe, particularly for people with COPD. Air pollution can irritate the bronchial tubes and alveoli (air sacks in the lungs) in people with and without lung diseases. For people with COPD, the resulting bronchospasm can lead to a “breathing attack” requiring further treatment, such as increased bronchodilator therapy and corticosteroids. If not managed properly, emergency room treatment and hospitalization can result. So what can you do to get through these hot and humid days?

1: Be aware. You can follow the air quality index on your iPhone with the Everyday Health COPD Tracker, or by watching your local weather forecast, reading the newspaper, or going to a Web site such as www.stateoftheair.org by the American Lung Association. Based on the air quality where you live, you can take actions to protect yourself.

2. Stay indoors. If the air pollution levels are high, try to stay indoors and avoid breathing the noxious gases out there. You can limit the time you spend outside by only doing things that “have to be done” on bad air quality days. Put off errands and visits that can wait. Shop for food and go to doctor’s appointments early in the day (best choice) or late in the day (second choice) when it’s not as hot. Air pollution levels usually are lowest in the mornings, so if you have to go out, get up early.

3. Run your air conditioner. Some people don’t like to use air conditioners since it makes them feel cold, or they might be trying to keep down the electric bill. But air conditioners aren’t just for lowering the temperature; they remove humidity and filter the air, keeping the air clean. They can be kept on a low setting (preferably with an energy saving model), and the living area doesn’t have to be cold — the air conditioner should be used to keep the home free of hot, humid, polluted air.

4. Change your exercise routine. Exercising increases your respiratory rate and depth of breath, increasing your minute ventilation, or the amount of air you breathe in a minute. This means your lungs are exposed to more air, and if it’s polluted, you’re more likely to have a difficult time breathing. Medical studies have shown that people who exercise in air pollution have a drop in lung function. So, keep your workouts indoors (at a gym or with home equipment) in air conditioning, and if you want to exercise outside, go early in the morning when the air quality is usually best.

5. Drink fluids. Many people don’t realize that your body loses a lot of fluid to stay cool in the heat, even when you don’t feel sweaty. This is especially true for older people, who may be even less aware of becoming dehydrated. You can also lose extra fluid while staying indoors in air conditioning. It’s a good idea to increase your liquid intake by at least an extra two glasses a day on very hot days, even if you’re inside.

It’s not easy getting through the hottest days of the year if you have COPD. Hopefully, these tips will make it easier for you to breathe well during the summertime, until the air quality improves and the temperature moderates.Dr. Schreiber is board certified in internal medicine and pulmonary diseases by the American Board of Internal Medicine. He is a member of Nassau Chest Physicians, P.C., who are actively involved with the American Lung Association in New York. Schreiber is director of the SICU at St. Francis Hospital, medical director of the Oyster Bay Cove Village Police Department, and a member of the Nassau County Medical Reserve Corps. He is on the professional staffs of St. Francis Hospital, North Shore University Hospital (Manhasset and Plainview), and St. Joseph Hospital.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/summer-humidity-and-copd-blog.aspx

Living With COPD

With ongoing care and preventive strategies, you can manage your COPD symptoms and keep them under control.

By the National Heart, Lung, and Blood Institute

COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progress of the disease. You can:

• Avoid lung irritants
• Get ongoing care
• Manage the disease and its symptoms
• Prepare for emergencies

Avoid Lung Irritants

If you smoke, quit. Smoking is the leading cause of COPD. Talk to your doctor about programs and products that can help you quit. Many hospitals have programs that help people quit smoking, or hospital staff can refer you to a program.

Try to avoid secondhand smoke and other lung irritants that can contribute to COPD, such as air pollution, chemical fumes, and dust. Keep these irritants out of your home. If your home is painted or sprayed for insects, have it done when you can stay away for awhile.

Keep your windows closed and stay at home (if possible) when there's a lot of air pollution or dust outside.

Get Ongoing Care

If you have COPD, it's important to get ongoing medical care. Take all of your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring all of the medicines you're taking when you have medical checkups.

Talk with your doctor about whether and when you should get flu and pneumonia vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia.

Manage COPD and Its Symptoms

You can do things to help manage your disease and its symptoms. Depending on how severe your disease is, you may ask your family and friends for help with daily tasks. Do activities slowly. Put items that you need often in one place that's easy to reach.

Find very simple ways to cook, clean, and do other chores. Some people find it helpful to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help moving things around in your house so that you will not need to climb stairs as often.

Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off.

Prepare for Emergencies

If you have COPD, knowing when and where to seek help for your symptoms is important. You should seek emergency care if you have severe symptoms, such as trouble catching your breath or talking.

Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms.

Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you're taking.

Source: The National Heart, Lung and Blood Institute (NHLBI). The NHLBI does not recommend or endorse any company advertised on this site.

http://www.everydayhealth.com/health-report/chronic-obstructive-pulmonary-disease/living-with-copd.aspx

What is Bad Ozone?

Sometimes we hear that ozone is good, as in the ozone layer, and sometimes we hear that ozone is bad as in air pollution or smog.  How can it be both good and bad?  This depends on where it is in the environment and how it is formed.  


This page will discuss the so called "bad ozone" or "ground level ozone".  To learn about "good ozone" by clicking on this link.  


In the Earth’s lower atmosphere, near ground level, ozone is formed when pollutants emitted by cars, power plants, chemical plants, and other sources react chemically in the presence of sunlight. 


Ozone pollution is a concern during the summer months when the weather conditions needed to form ground-level ozone—lots of sun, hot temperatures—normally occur.

Ozone can irritate your respiratory system, causing you to start coughing, feel an irritation in your throat and/or experience an uncomfortable sensation in your chest. Ozone can reduce lung function and make it more difficult for you to breathe as deeply and vigorously as you normally would. 


When this happens, you may notice that breathing starts to feel uncomfortable. If you are exercising or working outdoors, you may notice that you are taking more rapid and shallow breaths than normal. 


Ozone can aggravate asthma. When ozone levels are high, more people with asthma have attacks that require a doctor’s attention or the use of additional medication. One reason this happens is that ozone makes people more sensitive to allergens, which are the most common triggers for asthma attacks. Also, asthmatics are more severely affected by the reduced lung function and irritation that ozone causes in the respiratory system. 


Ozone can inflame and damage cells that line your lungs. Within a few days, the damaged cells are replaced and the old cells are shed—much in the way your skin peels after a sunburn. 


Ozone may aggravate chronic lung diseases such as emphysema and bronchitis and reduce the immune system’s ability to fight off bacterial infections in the respiratory system.

This is why ozone water treatment systems are designed to remove ozone before the vent gas is released into the environment.

Here are some additional links on ground level ozone:

Ozone and Your Health (USEPA)
Smog - Who Does it Hurt? (USEPA)
Summertime Safety: Keeping Kids Safe from Sun and Smog (USEPA)USEPA Ozone Air Quality StandardsUS Ozone Air Quality Trends


gotquestions http://www.spartanwatertreatment.com/ground-level-ozone.html