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Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung diseases where people have difficulty breathing because their airways have been narrowed. It includes chronic bronchitis and emphysema. It is estimated that 1.6 million Canadians live with it – yet it is believed that almost as many have COPD and don’t know it. 

The Lung Health Foundation is committed to supporting those affected by this progressive but treatable disease to live their best life. Here you can find the ‘need to know’ info on COPD, including what causes flare-ups, treatment and management.

Have questions about COPD?

Our Lung Health Line is a free, confidential service offered between 9:00 am – 4:00 pm Monday to Friday. To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-888-344-LUNG (5864) or email at

After hours, you can leave a message and we will return your call. Our educators will give you advice that will help you breathe your best.

People with COPD usually have one or more of these symptoms:

  • a cough that lasts a long time (3+ months)
  • a cough with mucus
  • feeling short of breath while doing everyday activities, such as climbing a flight of stairs or carrying groceries
  • lung infections (colds and the flu) that may last longer than usual
  • wheezing (a whistling sound when you breathe)
  • feeling tired
  • losing weight (without trying to)

Please note that feeling short of breath is not a normal sign of aging. Talk to your health-care provider if you are short of breath when doing everyday activities like walking up the stairs.

Canadian Lung Health Test

Smokers and former smokers are at a higher risk of developing COPD. If you are over 40 and smoke or used to smoke, take this quick test to screen for symptoms of COPD:

  • Do you cough regularly?
  • Do you cough up phlegm regularly?
  • Do even simple chores make you short of breath?
  • Do you wheeze when you exert yourself (exercise, go upstairs?)
  • Do you get many colds and do your colds usually last longer than your friends’ colds?

If you answer “yes” to any of these questions, see your health-care provider to be assessed for COPD. Your health-care provider may send you for a lung function test called “spirometry”.

In 80-90% of cases, COPD is caused by smoking.

  • Cigarette smoking is the most common risk factor, causing 80-90% of COPD cases
  • Other types of tobacco (pipe, cigar, water pipe), second-hand smoke, and cannabis are also risk factors
  • Workplace exposure to dusts, chemical agents and fumes account for approximately 10-15% of all COPD
    • Examples of occupations with an increased risk include farmers, welders, painters, railroad workers, miners, carpenters, metal workers, construction workers, and cement factory workers
  • Air pollution is linked to a decrease in lung function
  • Severe lung infections during childhood
  • Genetics/family history
    • e.g., Alpha-1 Antitrypsin Deficiency is a rare genetic disorder that increases the chance of developing emphysema
    • If one sibling has COPD, another sibling who smokes has a higher risk of developing COPD
  • Asthma/bronchial hyperreactivity:
    • Asthma may be a risk factor for the development of COPD
    • Bronchial hyperreactivity (overly sensitive airways) can exist without a diagnosis of asthma and has been shown to increase the risk of COPD
  • Lower socioeconomic status is a risk factor for COPD
  • Cooking and heating with biomass (e.g., wood, coal, crop waste) in homes with inadequate ventilation (this is more of a risk in developing countries but is also a risk in some parts of Canada due to wood burning)

Quitting smoking is the single most effective step to reduce the risk of developing COPD. COPD can also be caused by more than one risk factor.

A good thing to do regularly is check the Air Quality Health Index (AQHI) at The AQHI provides potential health risks associated with air pollution at a given time and recommends steps to take if you are in an “at risk” group.

To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-866-717-COPD (2673) or email at

Attacks (Flare-Ups)

A COPD flare-up or lung attack happens when usual COPD symptoms get worse over a short period of time (a few hours to 48 hours), or when new symptoms develop. Flare-ups are also called exacerbations. A flare-up can be caused by a lung infection, such as a cold or the flu, smoking and exposure to air pollution, including second hand smoke. If you have COPD, it is important to prevent flare-ups and understand the signs and symptoms of flare-ups. A COPD flare-up may cause further damage to your lungs. To manage your COPD, you need to know:

  • how to prevent flare-ups
  • warning signs and symptoms of a flare-up
  • what to do if you have a flare-up, including when to get emergency help

Symptoms and warning signs of a COPD flare-up

Top 3 symptoms of a flare-up:

  • an unusual increase in shortness of breath
  • increased cough
  • an increase in the amount, thickness or stickiness of your mucus (phlegm) which may be more yellow, green or brown than usual

Other signs and symptoms that may suggest a COPD flare-up:

  • fever
  • symptoms of a common cold, such as headache, runny nose, or sore throat
  • swollen ankles
  • feeling fatigued and generally unwell

What to do if you have these symptoms

If you notice any of these symptoms, follow the advice in your written COPD Action Plan. If you don’t know what to do or if your COPD Action Plan isn’t helping and your symptoms are getting worse, call your health-care provider. If you can’t reach your healthcare provider, go to the nearest hospital emergency department. Act within 48 hours. Do not try to wait it out hoping that you will get better.

Warning signs of a severe COPD flare-up

Call 911 if you have these signs:

  • chest pain
  • blue lips or fingers
  • confusion, can’t think clearly, or very agitated (upset)
  • drowsy
  • extremely short of breath

Treatment for a COPD flare-up

It’s very important that you treat your COPD flare-up as early as possible. If you treat a flare-up early, you are less likely to need hospital care. To treat a flare-up, follow the instructions in your COPD Action Plan. . A COPD Action Plan gives written instructions from your health-care provider on what to do when your symptoms flare up. Your COPD Action Plan will tell you what extra medicine to take, when to call the health-care provider, and when to go to the emergency department. Your written COPD action plan can help to prevent and treat COPD flare-ups. Remember there are other reasons you may get short of breath, such as pneumonia or heart problems. If you develop shortness of breath and you do not have symptoms to suggest a COPD flare-up, contact your health-care provider.

How to prevent COPD flare-ups:

  • Quit smoking: It’s the best way to prevent COPD and slow down disease prevention
  • Take all of the medications prescribed by your doctor. Ask for help if you have questions about how or when to take medications or what they’re for. Ask your health-care provider to go over inhaler technique with you and learn how to use them properly. Review inhaler technique at every visit
  • Exercise regularly. Many communities offer pulmonary rehabilitation programs. To find one in your area, go to
  • Avoid triggers that can make COPD worse, like air pollution, cigarette smoke and breathing very cold—or hot—or humid—air
  • Take good care of yourself. Eat healthy foods, exercise regularly, and get enough sleep. Staying healthy will help your body fight infections
  • Get your flu shot every year. Ask your health-care provider if you need a pneumonia shot
  • Stay away from people who are sick with a cold or flu
  • Wash your hands properly and often
  • Avoid touching your eyes, nose or mouth. Many people catch colds, flu, and other contagious lung infections from germs on their hands
  • Ask your health-care provider for a personalized written COPD Action Plan.

Download our Managing COPD Flare-Ups.

To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-866-717-COPD (2673) or email at


To diagnosis COPD, your health-care provider will ask you questions about your health history. Some of the questions may include:

  • Do you currently smoke, or did you smoke in the past?
  • How often are you short of breath?
  • What makes your shortness of breath worse?
  • Do you cough? How long have you been coughing?
  • Do you cough up sputum (phlegm, mucus)?
  • Does anyone or did anyone in your family have lung disease?

Tests to Diagnose COPD


Spirometry is the most reliable way to diagnose COPD. It is a simple breathing test that measures the speed and the amount of air you are able to blow out of your lungs. If you are short of breath doing simple tasks, ask your health-care provider about sending you for a spirometry test. Your health-care provider may also refer you for other pulmonary function tests.

Chest X-ray

A chest x-ray may be useful to show some signs of COPD and to rule out other disorders, but should not be used to confirm the diagnosis of COPD.


This test measures the amount of oxygen in your blood using a clip that goes on your finger, toe or earlobe.

To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-888-344-LUNG (5864) or email at

Treatment and Medication

COPD can’t be cured, but it can be treated. Early diagnosis, lifestyle changes and appropriate drug treatments can help you lead a normal and active life, feel better and stay out of hospital.

Your doctor will prescribe the COPD medicines that are right for you. To help you manage your COPD medicines your doctor may also give you a COPD action plan that explains what you should do when you are not feeling well.

COPD Treatment Options

Although there is no cure for COPD, there are many ways to help you manage it. COPD severity ranges from mild to very severe. What is needed to manage COPD is different from one person to the next. Here are some of the strategies that can help you take control:

Work With Your Health-Care Provider

  • Work with your health-care provider on finding the right treatments for you.
  • Ask your health-care provider to fill out a COPD action plan for you. An action plan can help you decide what to do if you think you might be having a COPD flare-up or lung attack (exacerbation).
  • Review your COPD action plan with your health-care provider at every visit.
  • Ask your health-care provider for a referral to a local COPD education program, pulmonary rehabilitation program, or support program.
  • Schedule regular follow-up visits with your health-care provider

Live a Smoke-Free Life

If you smoke, quitting is the most important step you can take to slow the progression of the disease.

  • Call the Lung Health Foundation’s Information Line to ask a certified respiratory educator for advice on quitting smoking. In Ontario call 1-888-344-LUNG (5864).
  • Download or order the Journey 2 Quit workbook to help you on your journey towards a smoke- free life
  • Work towards making your home smoke-free. If you smoke, consider quitting or take your smoking outside. If someone else in your home smokes, talk to them about quitting or ask them to smoke outside at all times.

Take Your Medications as Prescribed

  • Take your COPD medications as prescribed
  • Learn how to use your inhalers properly and check that you are using them correctly at every visit to your health-care provider
  • If you have been prescribed oxygen therapy, use it as directed

Reduce Your Risk of a COPD Flare-Up

  • Get a flu vaccine every year and ask your health-care provider about getting a pneumonia vaccine
  • Use a proper hand-washing technique to reduce the risk of getting an infection
  • Stay away from people who are sick with a cold, flu, or other infection
  • Try to avoid irritants and allergens that can cause your symptoms to worsen

Stay Active

  • Daily exercise is important for everyone including people with COPD. Even if you have severe COPD, you can still exercise – exercise within your limits, and take plenty of breaks.
  • Ask your health-care provider for advice on developing a regular exercise routine.
  • Ask to be referred to a pulmonary rehabilitation program.

Lung Transplantation

Lung transplantation may be an option for some people with very advanced COPD who meet certain criteria and do not smoke. If a person qualifies for a lung transplant, they are put on a wait list. How long the wait might be depends on the availability of organs.

COPD Medications

COPD medications can reduce your symptoms and reduce your risk of having a COPD flare-up. Your health-care provider will prescribe medications to help you manage your COPD. You may also be given a written COPD action plan that explains what steps you can take when your COPD symptoms get worse. It is important to take your COPD medications as prescribed. If you have any questions about medication side effects, ask your health-care provider or pharmacist.


If you have COPD, your main symptom might be shortness of breath. You could get short of breath when you exercise, when you do chores, when you have a cold, or for no known reason.

Bronchodilator medications open up the airways (breathing tubes) in your lungs. When your airways are more open, it’s easier to breathe. Your health-care provider may prescribe more than one kind of bronchodilator to treat your COPD.

There are two main types of bronchodilators:

  1. Beta2-agonists, for example:
    • Airomir® (salbutamol)
    • Bricanyl® (terbutaline)
    • Foradil® (formetarol)
    • Onbrez® (indacetarol)
    • Serevent® (salmeterol)
    • Ventolin® (salbutamol)
  2. Anticholinergics, for example:
    • Atrovent® (ipratropium)
    • Incruse™ (umeclidinium)
    • Seebri® (glycopyrronium)
    • Spiriva® Respimat® (tiotropium)
    • Tudorza® (aclidinium)

Some bronchodilators work quickly while others take a little longer to work.

Rapid-onset bronchodilators (also called quick-relief inhalers) act quickly and start to relieve shortness of breath within minutes. They are often used as needed, to help relieve sudden shortness of breath. Quick-relief medications usually come in a blue inhaler such as Airomir®, Bricanyl® and Ventolin®. Keep your quick-relief inhaler with you at all times so that you have quick access when you need it.

Theophylline medications work by relaxing your airways. Although not commonly used, they may be prescribed in combination with other bronchodilators. Theophylline medications can cause many possible side effects. If you are taking a theophylline medication you may need to see your health-care provider regularly to make sure the amount in your blood is not too high.

Combination inhalers combine two different medications into one inhaler. Combination inhalers can be more convenient since you won’t have to use two different inhalers. Examples of combination inhalers with two bronchodilators include:

  • Anoro™ (umeclidinium combined with vilanterol)
  • Combivent® Respimat® (ipratropium combined with salbutamol)
  • Duaklir™ (aclidinium combined with formoterol)
  • Inspiolto™ Respimat® (tiotropium combined with olodaterol)
  • Ultibro® (indacaterol combined with glycopyrronium)

Examples of combination inhalers with corticosteroid and a long-acting bronchodilator include:

  • Advair® (fluticasone combined with salmeterol)
  • Breo® (fluticasone combined with vilanterol)
  • Symbicort® (budesonide combined with formoterol)

Corticosteroid Pills

Corticosteroid medications also come as pills (e.g., Medrol®, Prednisone®). Corticosteroid pills have many more possible side effects than inhaled corticosteroids. Corticosteroid pills are often used for short periods of time, usually when you have a COPD flare-up. However, in some cases they may need to be taken on a regular basis if your health-care provider feels that you would benefit from them. If you need to take corticosteroid pills on a regular basis, your health-care provider will work with you to keep you on the lowest dose necessary.


COPD flare-ups can be caused by viral infections (e.g., the flu) or bacterial infections (e.g, bacterial pneumonia). If you have a bacterial infection, you may be prescribed an antibiotic. If you have a viral infection, antibiotics will not help.

It’s important to take your antibiotics as directed by your health-care provider. If antibiotics are not taken as prescribed, infections can sometimes become stronger and harder to treat.

Your health-care provider may give you an antibiotic prescription to have available for when you feel you are having a COPD flare-up or lung attack (exacerbation). If you have a COPD action plan, it can help guide you on when to start using the antibiotics.

Non-Steroidal Anti-Inflammatory Pill

Daxas® (roflumilast) is a non-steroidal anti-inflammatory pill. It may be prescribed if you have severe COPD associated with chronic bronchitis (cough, sputum) and you have frequent COPD flare-ups or lung attacks (exacerbations).

Supplemental Oxygen

Regular low oxygen levels in your blood is called hypoxemia (hi-pox-eem-ee-a). In order to know if you require oxygen, your health-care provider will order a test called an arterial blood gas.

Oxygen is only prescribed when the oxygen level in your blood stays below a normal range. Most people with COPD feel short of breath due to the level of lung disease and being able to breathe out stale air yet have a normal oxygen level in their blood. Therefore, if you feel short of breath, it does not necessarily mean that your oxygen level is low.

Research shows that the main benefit from oxygen therapy is that it can help you live longer when you have a low blood oxygen level and you use it at least 15 hours per day. For some people, oxygen therapy may help reduce shortness of breath if part of the reason for your shortness of breath is due to low oxygen levels.

Learn more about supplemental oxygen with our Oxygen Therapy in COPD fact sheet.


  • Don’t smoke. If you have never smoked, don’t start. Smoking is the number one cause of COPD. Experts say 80-90% of COPD cases are caused by smoking. If you already smoke, consider quitting. It’s NEVER too late to quit! There are many effective medications and smoking cessation programs. Contact the Lung Health Foundation’s Lung Health Information Line for more information at 1-888-344-LUNG (5864).
  • Avoid second-hand smoke. Second-hand smoke exposure adds to the risk of COPD. Ask the smokers around you to take it outside
  • Try to avoid air pollution. Adjust your outdoor activity level based on the Air Quality Health Index (AQHI), and a great tool used to forecast air pollution levels is When possible, keep windows, doors and blinds doors closed to block the sun and heat. Use an air conditioner or fan to maintain a comfortable temperature.
  • Find out how to protect yourself if you work in an industry that exposes you to coal dust, chemical fumes, concrete dust, mineral dust and cotton or grain dusts.
  • Know your family history. Do you know of anyone in your family who developed early onset COPD (before the age of 40)? There is an inherited disease called Alpha 1 antitrypsin deficiency that may make you more susceptible to COPD. If you know of someone in your family who was diagnosed at an early age, it is extremely important not to smoke. If your health-care provider thinks you may have this gene, a blood test can be ordered.
To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-888-344-LUNG (5864) or email at

A common symptom of COPD is to feel short of breath when you exercise. You may be tempted to stop exercising to avoid shortness of breath. But the less you move, the shorter of breath you will become. Regular exercise is one of the most important ways to help manage COPD.

Avoid the downward spiral of inactivity. Here’s how it happens:

  1. You get short of breath when you exercise, so you become less active.
  2. When you are less active, you become less fit and shorter of breath.
  3. This increased shortness of breath in turn causes you to be even more inactive.

Exercise is important for everyone including people with COPD. Learning other aspects of managing COPD such as breathing and energy management and medication can help you to exercise more. You may also want to join a pulmonary rehabilitation program if there is one in your community.

Pulmonary rehabilitation teaches people with lung disease many skills that can help to improve exercise tolerance, reduce shortness of breath and fatigue, and conserve (manage) energy. It is also a great way to be in touch with other people who also have lung disease.

Some communities also offer an exercise maintenance program that allows people to continue exercising once they have completed a pulmonary rehabilitation program. In some communities, where there is no pulmonary rehabilitation program, a community exercise maintenance program can fill the need to exercise in a safe, supervised setting.

Find out if there is a pulmonary rehabilitation program or an exercise maintenance program in your area.

Fitness for Breath is an exercise maintenance program with several locations across Ontario. To learn more, visit the Fitness for Breath website at

If there is no pulmonary rehabilitation or exercise maintenance program near you, here are a couple of tips to stay active:

  • Develop your own exercise program with guidance from your health-care provider. An exercise program should include:
    • Aerobic exercise
    • Strength/resistance training (e.g., light weights, elastic resistance bands)
    • Stretching/flexibility exercises
  • “Pursed lip breathing” can help improve how well your lungs move air in and out of your lungs. Learn how to do the pursed lip breathing technique with the Breathlessness fact sheet
  • Walking aids such as rollators can reduce the shortness of breath you may experience while walking

Learn more about the importance of exercise with COPD (both aerobic and strength building):

Try to exercise regularly or you will lose the benefits of it. Aim for at least three times per week and work towards 30 minutes at a time. You can start with a few minutes at a time and when you are comfortable, try to increase the time. Physical activity can help you maintain independence, increase energy level, improve mood and could help keep you out of the hospital.

No. Only people who have a low level of oxygen in their blood need supplemental oxygen. Regular low oxygen levels in your blood is called hypoxemia (hi-pox-eem-ee-a). In order to know if you require oxygen, your health-care provider will order a test called an arterial blood gas.

The main benefit from oxygen therapy used as prescribed (at least 15 hours per day) is that it can:

  • Help you live longer
  • Reduce shortness of breath to some extent
  • Allow you to exercise more easily

Learn more about supplemental oxygen with our Oxygen Therapy in COPD fact sheet

Oxygen is not addicting. If it has been prescribed, you need to use it. Avoiding it because you believe you will become addicted or for any other reason will not help you. It is important to know however that oxygen is considered to be a drug. Do not increase the level unless a health-care provider has advised you to.

Quitting smoking is the single most important step you can take to slow down the rate of lung function worsening, improve your health and your quality of life. These are so many health benefits to quitting smoking. When you quit smoking:

  • Your lungs will be healthier over time
  • You will live longer than if you continued smoking
  • You will have fewer COPD symptoms

The Air Quality Health Index (AQHI) can help you to monitor outdoor air quality and adjust your outdoor activity accordingly. On those days when you know that smog levels will be high, you may decide to limit your time spent outdoors and exercise indoors. You may be more comfortable staying inside in a cool environment that is air-conditioned or shaded. Find more information and your current and forecast AQHI levels at

  • You will be asked what medications you currently take so it is a good idea to always have an up- to-date list of all your medications (including how much you take and how often) that you can bring with you
  • You will be asked questions about your COPD
  • You will be given medications to open your airways so you can breathe easier.
  • Your pulse, temperature and blood pressure will be taken.
  • You may be given oxygen with a mask
  • An attachment may be placed on one of your fingers. This measures the oxygen in your blood.
  • An intravenous or IV may be started. This provides another way of giving you medication to open your airways.
  • You may be given an anti-inflammatory to decrease swelling in your airways.
  • You may be given an antibiotic if your flare-up is due to a lung infection.

Within 2-3 days of leaving the hospital, you should call your doctor for an appointment. You and your doctor need to talk about why you ended up in the emergency room so you can prevent it from happening again. Your doctor will also need to know about any medications you were given, any new drugs or any increase in the dose of your usual medications. Your doctor can also tell you how long to keep taking the medication prescribed at the hospital before returning to your regular medication routine. Your doctor may also want you to see a respiratory educator who can help you manage your COPD.

COPD Action Plan

A COPD Action Plan is a written set of instructions from your doctor. It explains what medication you should be taking on a daily basis when you feel well and how to increase your medication if your breathing problems get worse. Your action plan can help you to deal with any problems before they get worse. An action plan can help you recognize early signs of a flare-up and what steps you can take.

A respiratory educator can help you to manage your flare-up with an action plan.

It is important to see your doctor on a regular basis in order to help manage your COPD.

You should go to emergency when your breathing is getting much worse, your treatment is not improving your breathing or you feel uncomfortable staying at home because of your breathing.

If you do not see your doctor on a regular basis and instead go to emergency for ongoing care, you may not benefit from the follow-up that your doctor and health team can provide.

Download a COPD Action Plan and fill it out with the help of your healthcare provider.

Support for your COPD

The Lung health foundation’s Lung Health Information Line

The Lung Health Foundation’s Lung Health Information Line is a free, confidential lung information service offered between 8:30 am – 4:30 pm Monday to Friday, Eastern time. To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-888-344-LUNG (5864) or email at After hours, you can leave a message and we will return your call. Our educators will answer your questions about COPD symptoms, diagnosis and treatment, and help you learn about managing your COPD.

Free Resources

Our resources offer plenty of information on how to make living with COPD easier. You can download them or order printed copies by calling The Lung Health Information Line at 1-888-344-LUNG (5864).

Groups and Programs

Find a COPD rehabilitation program, support group or education centre near you. Find a lung health support group in Ontario.


To speak with a Certified Respiratory Educator (a healthcare professional with special training in COPD) call 1-888-344-LUNG (5864) or email at