"I No longer suffer from CSR after completing MyTea Magic customized program."

*Disclaimer: Results may vary. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease. Information on this site is provided for informational purposes only, it is not meant to substitute medical advice provided by your physician or any other medical professional. You should not use the information contained on this site for diagnosing or treating a health problem, disease, or prescribing any medication. Please read product label before use. Best results are only achieved when combined with diet and exercise program. Results not typical for any or all claims."  Results may vary.


































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These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease. Information on this site is provided for informational purposes only, it is not meant to substitute medical advice provided by your physician or any other medical professional. You should not use the information contained on this site for diagnosing or treating a health problem, disease, or prescribing any medication. Please read product label before use. Best results are only achieved when combined with diet and exercise program. Results not typical for any or all claims.

Common vision problems - The most common vision problems are refractive errors, more commonly known as nearsightedness, farsightedness, astigmatism and presbyopia. Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina. The length of the eyeball (either longer or shorter), changes in the shape of the cornea, or aging of the lens can cause refractive errors. Most people have one or more of these conditions. Normal: The cornea and lens bend (refract) incoming light rays so they focus precisely on the retina at the back of the eye.What is refraction? Refraction is the bending of light as it passes through one object to another. Vision occurs when light rays are bent (refracted) as they pass through the cornea and the lens. The light is then focused on the retina. The retina converts the light-rays into messages that are sent through the optic nerve to the brain. The brain interprets these messages into the images we see.What are the different types of refractive errors?The most common types of refractive errors are nearsightedness, farsightedness, astigmatism and presbyopia.

Nearsightedness (also called myopia) is a condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. Learn more about nearsightedness.

Farsightedness (also called hyperopia) is a common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. Learn more about farsightedness.

Astigmatism is a condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. Learn more about astigmatism.

Presbyopia is an age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Learn more about presbyopia.

Who is at risk for refractive errors?

Presbyopia affects most adults over age 35. Other refractive errors can affect both children and adults. Individuals that have parents with certain refractive errors may be more likely to get one or more refractive errors.

What are the signs and symptoms of refractive errors?

Blurred vision is the most common symptom of refractive errors. Other symptoms may include:

   Double vision, Haziness, Glare or halos around bright lights, Squinting, Headaches, Eye strain, How are refractive errors diagnosed? An eye care professional can diagnose refractive errors during a comprehensive dilated eye examination. People with a refractive error often visit their eye care professional with complaints of visual discomfort or blurred vision. However, some people don’t know they aren’t seeing as clearly as they could.

How are refractive errors corrected?

Refractive errors can be corrected with eyeglasses, contact lenses, or surgery.

How To Eyesight Improve: Five Steps

You can improve your eyesight in a matter of weeks, following a few simple steps: Never Wear Your Distance Glasses While Reading.

Your distance glasses are meant to let you see clearly far away.  When you use it up-close, you create a lot of eye strain. Since you have gotten your eyes used to this through years and years of increasing prescriptions, you don’t even notice.  But this habit is the #1 cause of progressive myopia! Bad-eyesight-reading, How to do deal with close-up focus  If you can see your screen or book without any glasses, then always take them off.  This usually works for lens diopter strengths of -2 diopters and lower.  If you can’t see your screen without glasses, see if you have any of your previous glasses still.  Try them on, can you see your screen clearly? See how much farther you can see beyond your screen.  Ideally you want the prescription to let you see just as far as you need, but no further. Another option is to buy reading glasses of about +1 to +1.50 and put them over your full distance contact lenses.  Does that limit your distance to just the screen? If so, great! Be sure to buy decent quality lenses (you can tell if they are no good if you get fatigue / headaches from using them). Want more community discussion and help with your myopia?  See our darling Facebook group! Know How To Take Breaks From Close-Up Work. Many resources tell you this, and they are right.  But they are often not right about how much of a break you need, and how to use it. First, work no longer than 2-3 hours before taking a break.  Set yourself a timer on your smartphone, if need be. 3 hours should really be the limit! improve-vision-go-outdoors  After 3 hours at most, get the longest break you can.  An hour would be ideal, though at least 30 minutes will do.  During that time you want to look at distant objects. Reading street signs, car license plates, anything that’s at least a few meters away is best.  If you have glasses that give you a bit of challenge, all the better! If you wear contact lenses, a very slight higher reading glass correction (+0.50) can do the trick. Always, Always Have Good, Natural Ambient Lighting.

The quality of the light matters to your eyes, like the quality of air matters to your lungs, and the quality of food to your body.  Junk light = poor eyesight!


If you can be sitting next to a window while working, that would be ideal.  Not an option? In that case consider buying a natural light emulating bulb for your desk lamp.  Usually referred to as “full spectrum UV bulbs” you can buy these online as well as some local stores.  You will notice a difference when you have quality light consistently! Outdoor, Distance Vision Makes For Happy Eyes.

Your eyes first started to get blurry at a distance from too much close-up (called pseudo myopia, you can learn more about that here).  Things got worse from there from wearing your first pair of glasses while reading, and spending way too much time indoors in front of a screen (or book).


If you want better eyesight, you need to do the opposite of what caused the problem.  Less time in front of screens, and not wearing the biggest possible prescription all the time is key to your success.

  1.  Measure Your Eyesight, Begin To Understand What Your Eyes Need.

You don’t need an optometrist to measure your eyesight.  All you need is a measuring tape (or just a printer and this file).  You can also print an eye chart and test your current prescription.


Using our measurement resources and keeping a log of results will start showing you how much your eyesight changes.  How you slept the night before, stress, diet, lighting, it all affects how far you can see clearly. Start measuring your eyes, keep track of the results, and begin to understand strain as well as the impact of better habits.


Want to know more?  Here are some resources to get you started:

   Understand the importance of blur horizon for eyesight health.

   The four pillars of healthy eyesight.

   Active focus:  they key stimulus to improve your vision.

   Measure your eyesight:  printable eye charts.

   Advanced home optometry:  how-to use a test lens kit.

   Why not wearing glasses at all is a bad idea.

   Here is how to keep your child’s vision healthy (check this article also).


P.S.:  Your eyes aren't "broken".

It's your lens use and habits that keep making your eyes "worse".  And the massive hundred billion dollar optics industry loves it. They keep you in ever increasing prescriptions, and tell you stories of some mysterious genetic "myopia illness".

It's nonsense.  Your eyes are perfectly healthy.  

Look at Corinne's post in our Facebook group:  At 62 years old she made it from -3.00 diopters to 20/20 vision - using endmyopia, and Jake's many bearded wisdoms:

BackTo20/20.  Corinne and thousands of others have done it.

You got screwed into living behind those nerd goggles, paying mainstream optometry to "treat" your "illness" with fashion brands and bullshit and 2-for-1 lens sales.  You can stick with that program, or you can click below for my 7-day, 7-session guide, and get maybe rid of your myopia forever.

Stop being a good nerd goggles sheeple.  Click the link, and find out what's really going on.

The Best Exercises to Improve Eyesight

Can we improve our eyesight on our own, or are we stuck with the quality of vision we have? Can exercises and other natural remedies help us avoid deterioration of our eyes with age? It’s a popular topic, and not without controversy. Opinions vary widely on the effectiveness of eye exercises, and no research has proven them able to, for instance, improve your prescription. But there are some exercises that certainly promote healthy eyesight.

Do Eye Exercises Work?

We primarily think of “exercise” as relating to muscles and the expending of energy. We exercise by running, going to the gym, doing aerobics or lifting weights. During exercise, we’re pushing our limits, putting pressure on our muscles and bones to increase our endurance and become physically stronger. Our muscles respond to a workout with soreness, we then replenish ourselves with rest, nutrition and water. In turn, the next time we exercise we may be able to lift more weights or run farther.


Exercise means something different when referring to your eyes. We aren’t talking about building endurance; just because you can work on a computer for 7 hours one day doesn’t mean it will be easier for you to work on that computer for 8 hours the next day. Rather, “exercise” in the case of your eyes means that there are natural things you can do to keep your eyes healthier and promote good vision.

The most well-known name in the field of eye exercises is Dr. William Bates, an ophthalmologist who received his medical degree in 1885, saw patients and was an instructor in ophthalmology at the New York Postgraduate Hospital and Medical School. He explored why some patients with refractive errors seemed to spontaneously improve, and developed the theory of “natural” eye correction, i.e. using various techniques to rest and exercise the eyes and restore a person’s eyesight without corrective lenses. It is often likened to “physical therapy for the eyes” in its stated ability to reverse functional vision problems, in large part to a conscious relaxation of the eyes.

While anecdotal evidence supporting the Bates Theory is plentiful, attempts to prove any scientific results have fallen short. Both the American Academy of Ophthalmology and the American Optometric Association say that natural methods don’t work.

Eye Exercises to Improve Vision

Despite the cautions above, there are some things you can do to make life easier on your eyes and, in turn, perhaps improve your vision:


   Blinking: When we blink, our eyelids spread tears across the surface of our eyes, which moistens them and helps remove irritants. The average person blinks every 3 or 4 seconds, or about 15-20 times a minute. However, when we watch television or work on a computer for long periods of time, we blink less. If you consciously work on blinking more often while focusing on these types of activities, your eyes will not be as dry or fatigued. Give your eyes a break: Try to change your activity for about 10 minutes of every hour spent on the computer or reading. Use this time to go to the restroom, make phone calls or distribute things around the office. Nutrition for your eyes: Antioxidants can help preserve your vision and reduce the risk of some eye diseases. The primary nutrients here include:  Lutein & zeaxanthin (green leafy vegetables and eggs)   Vitamin C (citrus fruits and vegetables)   Vitamin E (nuts, sweet potatoes and fortified cereals) Essential fatty acids (olive oil, nuts, eggs and cold-water fish) and Zinc (spinach, beef, shrimp, beans and seeds)  Don’t smoke: Smoking can harm your eyes just as easily as it does your internal organs. When compared with non-smokers, smokers have double the risk for forming cataracts, triple the risk of age-related macular degeneration, twice the risk of dry eyes, twice the risk of uveitis, and can double the risk of getting diabetes, which can lead to diabetic retinopathy. Get enough sleep: You’re aware how a lack of sleep affects many parts of your body, but you may not know that it affects vision as well. Sleep deprivation can contribute to or be a cause of eye strain, dry eyes, tunnel vision, double vision and visual errors. How to Ensure Healthy Eyesight Remember, while these activities help your eye health, they can’t repair eye disease or conditions like farsightedness, nearsightedness or astigmatism, which relate to the shape of the eye and how it focuses light toward the retina. But taking care of your eyes, protecting them from sunlight with UV-protective sunglasses, eating and sleeping well and doing a couple of exercises can benefit your vision in the long run.

    If your eye strain won’t go away, talk to your doctor about computer glasses.

   Move the screen so your eyes are level with the top of the monitor. That lets you look slightly down at the screen.

   Try to avoid glare from windows and lights. Use an anti-glare screen if needed.

   Choose a comfortable, supportive chair. Position it so that your feet are flat on the floor.

   If your eyes are dry, blink more.

   Rest your eyes every 20 minutes. Look 20 feet away for 20 seconds. Get up at least every 2 hours and take a 15-minute break.




Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.


Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production.


Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.


COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.


COPD care at Mayo Clinic



COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years.


Other signs and symptoms of COPD may include:


   Shortness of breath, especially during physical activities


   Chest tightness

   Having to clear your throat first thing in the morning, due to excess mucus in your lungs

   A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish

   Blueness of the lips or fingernail beds (cyanosis)

   Frequent respiratory infections

   Lack of energy

   Unintended weight loss (in later stages)

   Swelling in ankles, feet or legs


People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days.


The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes.

Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.

How your lungs are affected

Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times — like the branches of a tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli).

Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale.

Causes of airway obstruction include:

   Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.

   Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways.

Cigarette smoke and other irritants

In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers may develop COPD.

In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lung can occur in infants and children, not only adults with long smoking histories.

For adults with COPD related to AAt deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs.

Risk factors

Risk factors for COPD include:

   Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke.

   People with asthma who smoke. The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more.

   Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs.

   Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD.

   Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin.

   Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease.


   Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections.

   Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk.

   Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk.

   High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension).

   Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression.


Unlike some diseases, COPD has a clear cause and a clear path of prevention. The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is to never smoke — or to stop smoking now.


A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a chronic lung disease that makes it hard to breathe. The disease is increasingly common, affecting millions of Americans, and is the third leading cause of death in the U.S. The good news is COPD is often preventable and treatable.  Here you'll find information, resources and tools to help you understand COPD, manage treatment and lifestyle changes, find support and take action.


The American Lung Association is committed to supporting those affected by COPD. We offer a variety of resources and information about the disease. Check out some of our key COPD support and education resources featured below. Or scroll down to explore our entire COPD section.

It is inevitable that your life will change after being diagnosed with COPD. The good news is that you can find support to help you make lifestyle changes, better manage your COPD and enhance your quality of life.

Learn more

Help Us Fight COPD


Please join us in fighting for much needed funding for COPD research, public policies and community programs that can help prevent COPD and make living with COPD easier.

Learn more

COPD Research


COPD research helps us understand how the disease is caused, how it develops and how it is best treated. See some of the current topics American Lung Association funded researchers are investigating.

Learn more

Lung Health & Diseases


   Lung Disease Lookup


       Learn About COPD

       COPD Symptoms, Causes & Risk Factors

       Diagnosing and Treating COPD

       Living With COPD

       Help Us Fight COPD

       Questions to Ask Your Doctor about COPD

       COPD Research

       Patient Resources and Videos


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COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it.


At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include


   A cough that produces a lot of mucus

   Shortness of breath, especially with physical activity


   Chest tightness


Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD.


NIH: National Heart, Lung, and Blood Institute

Start Here


   Chronic Obstructive Pulmonary Disease (COPD) (American Thoracic Society) - PDF

   Chronic Obstructive Pulmonary Disease (COPD) (Centers for Disease Control and Prevention)

   COPD: Learn More, Breathe Better From the National Institutes of Health (National Heart, Lung, and Blood Institute)


Diagnosis and Tests


   Blood Gases Test (American Association for Clinical Chemistry)

   Breathlessness (American Thoracic Society) - PDF

   Pulmonary Function Tests From the National Institutes of Health (National Heart, Lung, and Blood Institute) Also in Spanish

   Spirometry (Mayo Foundation for Medical Education and Research)

   Stages of COPD (American Association for Respiratory Care) - PDF

   What is Bronchoscopy? From the National Institutes of Health (National Heart, Lung, and Blood Institute) Also in Spanish


   Living with COPD: Nutrition (American Lung Association)

   Oxygen Therapy (American Lung Association)

   Pulmonary Rehabilitation: MedlinePlus Health Topic From the National Institutes of Health (National Library of Medicine) Also in Spanish

   Pulse Oximetry (American Thoracic Society) - PDF

   Techniques to Bring Up Mucus (National Jewish Health)


Related Issues


   Asthma and COPD: Differences and Similarities (American Academy of Allergy, Asthma, and Immunology)

   Sleep Problems in Asthma and COPD (American Thoracic Society) - PDF

   Traveling with Portable Oxygen (American College of Chest Physicians) - PDF




   Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema (National Center for Health Statistics)

   Chronic Obstructive Pulmonary Disease (COPD): Data and Statistics (Centers for Disease Control and Prevention)


   ClinicalTrials.gov: Lung Diseases, Obstructive From the National Institutes of Health (National Institutes of Health)

   ClinicalTrials.gov: Pulmonary Disease, Chronic Obstructive From the National Institutes of Health (National Institutes of Health)


Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine)


   Article: Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive...

   Article: Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD.

   Article: Different durations of corticosteroid therapy for exacerbations of chronic obstructive...

   COPD -- see more articles


Reference Desk


   What Are the Lungs? From the National Institutes of Health (National Heart, Lung, and Blood Institute)

COPD: Unique to Older Adults (AGS Foundation for Health in Aging) Depending upon the stage of chronic obstructive pulmonary disease, other doctors besides the patient's primary care physician may be involved and may include pulmonologists, lung surgeons, and/or other professionals such as pulmonary rehabilitation specialists and other team members.

   Individuals should contact their doctors about COPD if they experience any of the signs or symptoms of COPD.


Quick GuideCOPD Lung Symptoms, Diagnosis, Treatment

COPD Lung Symptoms, Diagnosis, Treatment

Symptoms of COPD include chronic cough, shortness of breath, and recurrent lung infections


COPD is characterized by a longstanding (chronic) obstruction to air flow out of the lungs. It can take different forms and have different symptoms. Symptoms of COPD can vary in severity. Examples include:

Chronic obstructive pulmonary disease is a slowly progressive obstruction of airflow into or out of the lungs. The incidence of COPD has almost doubled since 1982. Experts have estimated about 32 million persons in the United States have COPD. The disease occurs slightly more often in men than in women. The symptoms (for example, shortness of breath, coughing) come on slowly and many people are consequently diagnosed after age 40-50, although some are diagnosed at a younger age. COPD patients may exhibit symptoms of chronic bronchitis, emphysema, and asthma.

What are the signs and symptoms of COPD?

Chronic obstructive pulmonary disease is a slowly progressive disease so it is not unusual for the initial signs and symptoms to be a bit different from those in the late stages of the disease. There are many ways to evaluate or stage chronic obstructive pulmonary disease, often based on symptoms.


Usually the first signs and symptoms of COPD include a productive cough usually in the morning, with colorless or white mucus (sputum).


The most significant symptom of chronic obstructive pulmonary disease is breathlessness, termed shortness of breath (dyspnea). Early on, this symptom may occur occasionally with exertion, and eventually may progress to breathlessness while doing a simple task such as standing up, or walking to the bathroom. Some people may develop wheezing (a whistling or hissing sound while breathing). Signs and symptoms of chronic obstructive pulmonary disease include:

   Cough, with usually colorless sputum in small amounts

   Acute chest discomfort

   Shortness of breath (usually occurs in patients aged 60 and over)

   Wheezing (especially during exertion)

As the disease progresses from mild to moderate, symptoms often increase in severity:  Respiratory distress with simple activities like walking up a few stairs Rapid breathing (tachypnea)  Bluish discoloration of the skin (cyanosis) Use of accessory respiratory muscles Swelling of extremities (peripheral edema)  Over-inflated lungs (hyperinflation)

   Wheezing with minimal exertion    Course crackles (lung sounds usually with inspiration)  Prolonged exhalations (expiration)

   Diffuse breath sounds  Elevated jugular venous pulse  COPD: Symptoms, Causes & Treatment

Understanding COPD Slideshow  COPD (Chronic Obstructive Pulmonary Disease) QuizCOPD:Energy-Boosting Foods for COPD Energy Foods for COPD Slideshow Pictures What are the four stages of COPD?

One way to stage chronic obstructive pulmonary disease is the Global Initiative for Chronic Obstructive Lung Disease program (GOLD). The staging is based on the results of a pulmonary function test. Specifically, the forced expiratory volume (how much air one can exhale forcibly) in one second (FEV1) of a standard predicted value is measured, based on the individual patient's physical parameters. The staging of chronic obstructive pulmonary disease by this method is as follows:

   Stage I is FEV1 of equal or more than 80% of the predicted value

   Stage II is FEV1 of 50% to 79% of the predicted value

   Stage III is FEV1 of 30% to 49% of the predicted value

   Stage IV is FEV1 of less than 30% of predicted value or an FEV1 less than 50% of predicted value plus respiratory failure

Other staging methods are similar but are based on the severity of the shortness of breath symptom that is sometimes subjective. The above staging is measurable objectively, providing the patient is putting forth their best effort.

What causes COPD? The primary cause of chronic obstructive pulmonary disease is cigarette smoking or exposure to tobacco smoke. It is estimated that 90% of the risk for development of chronic obstructive pulmonary disease is related to tobacco smoke. The smoke also can be secondhand smoke (tobacco smoke exhaled by a smoker and then breathed in by a non-smoker).

Other causes of chronic obstructive pulmonary disease are: Prolonged exposure to air pollution, such as that seen with burning coal or wood and with industrial air pollutants

   Infectious diseases: Infectious diseases that destroy lung tissue in patients with hyperactive airways or asthma also may contribute to causing this COPD.

Damage to the lung tissue over time causes physical changes in the tissues of the lungs and clogging of the airways with thick mucus. The tissue damage in the lungs leads to poor compliance (the elasticity, or ability of the lung tissue to expand). The decrease in elasticity of the lungs means that oxygen in the air cannot get by obstructions (for example, thick mucus plugs) to reach air spaces (alveoli) where oxygen and carbon dioxide exchange occurs in the lung. Consequently, the person exhibits a progressive difficulty, first coughing to remove obstructions like mucus, and then in breathing, especially with exertion.

What are the risk factors for developing COPD?

People who smoke tobacco are at the highest risk for developing chronic obstructive pulmonary disease. Other risk factors include exposure to secondhand smoke from tobacco and exposure to high levels of air pollution, especially air pollution associated with wood or coal. In addition, individuals with airway hyper-responsiveness such as those with chronic asthma are at increased risk.

There is a genetic factor called alpha-1 antitrypsin deficiency that places a small percentage (less than 1%) of people at higher risk for COPD (and emphysema) because a protective factor (alpha-1 antitrypsin protein) for lung tissue elasticity is decreased or absent.

Other factors that may increase the risk for developing chronic obstructive pulmonary disease include intravenous drug use,immune deficiency syndromes, vasculitis syndrome,connective tissue disorders, and genetic problems such as Salla disease (autosomal recessive disorder of sialic acid storage in the body). What other diseases or conditions contribute to COPD?

In general, three other non-genetic problems related to the lung tissue play a role in chronic obstructive pulmonary disease. 1) chronic bronchitis, 2) emphysema, and 3) infectious diseases of the lung.

   Chronic bronchitis and emphysema, are thought by many to be variations of chronic obstructive pulmonary disease and considered part of the progression of chronic obstructive pulmonary disease by many researchers. Chronic bronchitis is defined as a chronic cough that produces sputum for three or more months during two consecutive years.

   Emphysema is an abnormal and permanent enlargement of the air spaces (alveoli) located at the end of the terminal bronchioles in the lungs.

   Infectious diseases of the lung may damage areas of the lung tissue and contribute to chronic obstructive pulmonary disease.

What tests diagnosis COPD?

xposure to secondhand smoke, and/or

   exposure to air pollutants, and/or a history of lung disease (for example, pneumonia).

In adition, the person may be sent to a lung specialist (pulmonologist) to determine their FEV1 level that is used by some physicians to stage COPD as described above in the section that describes the stages of COPD.

What is the treatment for COPD?

There are many treatments for chronic obstructive pulmonary disease. The first and best is to stop smoking immediately.

Medical treatments of chronic obstructive pulmonary disease drugs, for example, nicotine replacement therapy, beta-2 agonists and anticholinergic agents (bronchodilators), combined drugs using steroids and long-acting bronchodilators, mucolytic agents, oxygen therapy, and surgical procedures such as bullectomy, lung volume reduction surgery, and lung transplantation.

The treatments are often based on the stage of chronic obstructive pulmonary disease, for example:

   Stage I - short-acting bronchodilator as needed

   Stage II - short-acting bronchodilator as needed and long-acting bronchodilators plus cardiopulmonary rehabilitation

   Stage III - short-acting bronchodilator as needed long-acting bronchodilators cardiopulmonary rehabilitation and inhaled glucocorticoids for repeated exacerbations  Stage IV - as needed, long-acting bronchodilators, cardiopulmonary rehabilitation, inhaled glucocorticoids, long-term oxygen therapy, possible lung volume reduction surgery and possible lung transplantation (stage IV has been termed "end-stage" chronic obstructive pulmonary disease)

The first line of therapy that involves medication is related to smoking cessation with nicotine replacement therapy. Nicotine replacement therapy can help patients quit smoking tobacco because it can help reduce the withdrawal symptoms due to nicotine. Replacement therapies include nicotine-containing chewing gum and patches that allow nicotine to be absorbed through the skin. In these types of therapy, nicotine is gradually reduced. This medication can work well for those patients who are seriously attempting to quit tobacco.

Oral Medications to Quit Smoking (Smoking Cessation)

   Some medications are used "off label" (that is, they are normally prescribed for another condition) to help people quit smoking. These drugs are recommended by the Agency for Healthcare Research and Quality to help smokers kick the habit, but have not been approved by the FDA for this use. These medications include nortriptyline (Pamelor), an older type of antidepressant. It's been found to help smokers double their chances of quitting compared to taking no medicine. Another drug used off label is clonidine (Catapres). Normally used to treat high blood pressure it can help smokers quit.




Bronchodilators are used for COPD treatment because they open up the airway tubes and allow air to more freely pass in and out of the lung tissue. There are both short-term (several hours) and long-term (12 or more hours) types of bronchodilators Other bronchodilators such as theophylline (Elixophyllin, Theo-24) are occasionally used, but are not favored because of unwanted side effects including anxiety, tremors, seizures, and arrhythmias.

Also on the market are combined to drugs using steroids and long-acting bronchodilators. Roflumilast (Daxas, Daliresp) is a new drug that inhibits the enzyme phosphodiesterase type 4, has been utilized in patients with symptoms of chronic bronchitis.


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