Logic Library

What is COPD?

COPD (chronic obstructive pulmonary disease) is a lung disease that makes it hard to breathe. It is caused by damage to the lungs over many years, usually from smoking.

COPD is often a mix of two diseases:

• Chronic bronchitis. In chronic bronchitis, the airways that carry air to the lungs (bronchial tubes) get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard for you to breathe.
• Emphysema. In a healthy person, the tiny air sacs in the lungs are like balloons. As you breathe in and out, they get bigger and smaller to move air through your lungs. But with emphysema, these air sacs are damaged and lose their stretch. Less air gets in and out of the lungs, which makes you feel short of breath.

COPD gets worse over time. You can't undo the damage to your lungs. But you can take steps to prevent more damage and to feel better.

What causes COPD?

COPD is almost always caused by smoking. Over time, breathing tobacco smoke irritates the airways and destroys the stretchy fibres in the lungs.

Other things that may put you at risk include breathing chemical fumes, dust, or air pollution over a long period of time. Second-hand smoke also may damage the lungs.

It usually takes many years for the lung damage to start causing symptoms, so COPD is most common in people who are older than 60.

You may be more likely to get COPD if you had a lot of serious lung infections when you were a child. People who get emphysema in their 30s or 40s may have a disorder that runs in families, called alpha-1 antitrypsin deficiency. But this is rare.

What Increases Your Risk

Tobacco smoking

Tobacco smoking is the most important risk factor for COPD. Compared to smoking, other risks are minor.

• Pipe and cigar smokers have less risk of getting COPD than cigarette smokers. But they still have more risk than non-smokers.
• The risk for COPD increases with both the amount of tobacco you smoke each day and the number of years you have smoked.

To learn more, see the topic Quitting Smoking.

Other risks

Family history

Some people may be more at risk than others for getting the disease, especially if they have low levels of the protein alpha-1 antitrypsin, a disorder that runs in families.

Preterm birth

Preterm babies usually need to have long-term oxygen therapy because their lungs are not fully developed. This therapy can cause lung damage (neonatal chronic lung disease) that can increase the risk for COPD later in life.

Asthma

Asthma and COPD are different diseases, even though both of them involve breathing problems. People with asthma may have a greater risk for getting COPD, but the reasons for this are not fully understood.

Risks in the environment

• Outside air pollution. Air pollution may make COPD worse. It may increase the risk of a flare-up, or COPD exacerbation, when your symptoms quickly get worse and stay worse. Try not to be outside when air pollution levels are high.
• Indoor air pollution. Have good ventilation in your home to avoid indoor air pollution.
• Second-hand smoke. It is not yet known whether second-hand smoke can lead to COPD. But a large study showed that children who were exposed to second-hand smoke were more likely to get emphysema than children who weren't exposed.footnote 1 And people who are exposed to second-hand smoke for a long time are more likely to have breathing problems and respiratory diseases.
• Occupational hazards. If your work exposes you to chemical fumes or dust, use safety equipment to reduce the amount of fumes and dust you breathe.

Prevention

Don't smoke

The best way to keep COPD from starting or from getting worse is to not smoke.

There are clear benefits to quitting, even after years of smoking. When you stop smoking, you slow down the damage to your lungs. For most people who quit, loss of lung function is slowed to the same rate as a non-smoker's.

Stopping smoking is especially important if you have low levels of the protein alpha-1 antitrypsin. People who have an alpha-1 antitrypsin deficiency may lower their risk for severe COPD if they get regular shots of alpha-1 antitrypsin. Family members of someone with alpha-1 antitrypsin deficiency should be tested for the condition.

Avoid bad air

Other airway irritants (such as air pollution, chemical fumes, and dust) also can make COPD worse, but they are far less important than smoking in causing the disease.

Get vaccines

Flu vaccines

If you have COPD, you need to get a flu vaccine every year. When people with COPD get the flu, it often turns into something more serious, like pneumonia. A flu vaccine can help prevent this from happening.

Also, getting regular flu vaccines may lower your chances of having COPD flare-ups.

Pneumococcal vaccine

People with COPD often get pneumonia. Getting a shot can help keep you from getting very ill with pneumonia. Children usually get a pneumococcal shot before age 2. Doctors also recommend a pneumococcal shot for everyone age 65 and older even if they got the shot as a child. Talk with your doctor about whether you need a second shot.

Pertussis vaccine

Pertussis (also called whooping cough) can increase the risk of having a COPD flare-up. So making sure you are current on your pertussis vaccinations may help control COPD.

What are the symptoms?

The main symptoms are:

• A long-lasting (chronic) cough.
• Mucus that comes up when you cough.
• Shortness of breath that gets worse when you exercise.

As COPD gets worse, you may be short of breath even when you do simple things like get dressed or fix a meal. It gets harder to eat or exercise, and breathing takes much more energy. People often lose weight and get weaker.

At times, your symptoms may suddenly flare up and get much worse. This is called a COPD exacerbation. An exacerbation can range from mild to life-threatening. The longer you have COPD, the more severe these flare-ups will be.

When you have COPD:

• You have a cough that won't go away.
• You often cough up mucus.
• You are often short of breath, especially when you exercise.
• You may feel tightness in your chest.

COPD exacerbation Many people with COPD have attacks called flare-ups or exacerbations. This is when your usual symptoms quickly get worse and stay worse. A COPD flare-up can be dangerous, and you may have to go to the hospital.

Symptoms include:

• Coughing up more mucus than usual.
• A change in the colour or thickness of that mucus.
• More shortness of breath than usual.
• Greater tightness in your chest.

These attacks are most often caused by infections—such as acute bronchitis and pneumonia—and air pollution.

Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Try not to panic if you start to have a flare-up. Quick treatment at home may help you manage serious breathing problems.

Handling a Flare-Up

If you have COPD, your usual shortness of breath could suddenly get worse. You may start coughing more and have more mucus. This flare-up is called a COPD exacerbation or a COPD attack.

A respiratory tract infection or air pollution could set off an attack. Or it may happen after a quick change in temperature or being around chemicals. You may not always know the cause.

What are the warning signs?

When you have a COPD flare-up, your normal symptoms suddenly get worse:

• You may have more shortness of breath and wheezing.
• You may have more coughing with or without mucus.
• You may have a change in the colour or amount of the mucus.
• You may have a fever.
• You may feel very tired.
• You may be depressed or confused.

Don't panic

Don't panic if you start to have a flare-up. If you are prepared, you may be able to get it under control. Work with your doctor to make a plan for dealing with a COPD attack.

Take your medicines as your doctor says:

• First, use your quick-relief inhaler. If your symptoms don't get better after you use your medicine, have someone take you to the emergency room. Call an ambulance if needed.
• With inhaled medicines, a spacer or a nebulizer may help you get more medicine to your lungs. Ask your doctor or pharmacist how to use them properly. Practice using the spacer in front of a mirror before you have a flare-up. This may help you get the medicine into your lungs quickly.
• If your doctor has given you steroid pills, take them as directed.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Call your doctor if you have to use your antibiotic or steroid pills.

Call 911 if:

• You also are having chest pain.
• You feel like you are suffocating.
• Breathing stops.
• Moderate to severe difficulty breathing occurs. This means a person may have trouble talking in full sentences or breathing during activity.
• Severe chest pain occurs, or chest pain is quickly getting worse.
• You cough up large amounts of bright red blood.

Call your doctor immediately or go to the emergency room if you have been diagnosed with COPD and you:

• Cough up a couple of tablespoons of blood.
• Have shortness of breath or wheezing that is quickly getting worse.
• Start having new chest pain.
• Are coughing more deeply or more often, especially if you notice an increase in mucus (sputum) or a change in the colour of the mucus you cough up.
• Have increased swelling in your legs or belly.
• Have a high fever (over 38.3°C (101°F))
• Develop flu-like symptoms.

If your symptoms (cough, mucus, and/or shortness of breath) suddenly get worse and stay worse, you may be having a COPD flare-up, or exacerbation. Quick treatment for a flare-up may help keep you out of the hospital.

Call your doctor soon for an appointment if:

• Your medicine is not working as well as it had been.
• Your symptoms are slowly getting worse, and you have not seen a doctor recently.
• You have a cold and:
  • Your fever lasts longer than 2 to 3 days.
  • Breathlessness occurs or becomes noticeably worse.
  • Your cough gets worse.
• You have not been diagnosed with COPD but are having symptoms. A history of smoking (even in the past) greatly increases the likelihood that symptoms are from COPD.
• You cough up any amount of blood.

Talk to your doctor

If you have been diagnosed with COPD, talk with your doctor at your next regular appointment about:

• Help to stop smoking. To review tips on how to stop smoking, see the topic Quitting Smoking.
• A yearly flu vaccine.
• A pneumococcal vaccine. Children usually get a pneumococcal shot before age 2. Doctors also recommend a pneumococcal shot for everyone age 65 and older even if they got the shot as a child.
• An exercise program or pulmonary rehabilitation.
• Any updates of your medicines or treatment that you may need.

Who to see

Your family doctor or general practitioner can diagnose COPD and provide a basic treatment plan.

You may need to see a specialist in lung disease, called a respirologist, if:

• Your diagnosis of COPD is uncertain or hard to make because you have diseases with similar symptoms.
• You have unusual symptoms that are not usually seen in people with COPD.
• You are younger than 50 and/or have no history or a short history of cigarette smoking.
• You have to go to the hospital often because of sudden increases in shortness of breath.
• You need long-term oxygen therapy or corticosteroid therapy.
• You and your doctor are considering surgery, such as a lung transplant or lung volume reduction.

How is COPD diagnosed?

To find out if you have COPD, a doctor will:

• Do a physical examination and listen to your lungs.
• Ask you questions about your past health and whether you smoke or have been exposed to other things that can irritate your lungs.
• Have you do breathing tests, including spirometry, to find out how well your lungs work.
• Do chest X-rays and other tests to help rule out other problems that could be causing your symptoms.

If there is a chance you could have COPD, it is very important to find out as soon as you can. This gives you time to take steps to slow the damage to your lungs.

How is it treated?

The best way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.

Your doctor can prescribe treatments that may help you manage your symptoms and feel better.

• Medicines can help you breathe easier. Most of them are inhaled so they go straight to your lungs. If you get an inhaler, it is very important to use it just the way your doctor shows you.
• A lung (pulmonary) rehab program can help you learn to manage your disease. A team of health professionals can provide counselling and teach you how to breathe easier, exercise, and eat well.
• In time, you may need to use oxygen some or most of the time.

People who have COPD are more likely to get lung infections, so you will need to get a flu vaccine every year. You should also get a pneumococcal shot. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably won't be as sick.

How to live well with and manage COPD

There are many things you can do at home to stay as healthy as you can.

• Avoid things that can irritate your lungs, such as smoke and air pollution.
• Use an air filter in your home.
• Get regular exercise to stay as strong as you can.
• Eat well so you can keep up your strength. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

Dealing with flare-ups: As COPD gets worse, you may have flare-ups when your symptoms quickly get worse and stay worse. It is important to know what to do if this happens. Your doctor may give you an action plan and medicines to help you breathe if you have a flare-up. But if the attack is severe, you may need to go to the emergency room or call 911.

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Avoiding Your Triggers

There are many things you can do to avoid triggers and stay as healthy as you can.

Avoid triggers in the air

• Quit smoking. This is the most important thing you can do. Also stay away from other people who are smoking.
• Use an air conditioner or air filter in your home.
• Cook near an open door or window, or turn on your kitchen fan.
• If there is a lot of pollution or dust outside, stay at home and keep your windows closed.

Protect your health

• Get a flu vaccine every year.
• Talk to your doctor about getting a pneumococcal shot.
• Wash your hands to avoid infections.
• Eat healthy foods, exercise, and get enough rest.
• Refill your medicines before you run out.
• Take extra medicines with you when you travel.

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Learning to Breathe Easier

Use these methods when you are more short of breath than normal. Practice them often so you can do them well.

Pursed-lip breathing

Pursed-lip breathing helps you breathe more air out so that your next breath can be deeper. It makes you less short of breath and lets you exercise more.

• Breathe in through your nose and out through your mouth while almost closing your lips.
• Breathe in for about 2 seconds, and breathe out for 4 to 6 seconds.

Breathing with your diaphragm

Breathing with your diaphragm helps your lungs expand so that they take in more air. Your diaphragm is the large muscle that separates your lungs from your belly.

• Lie on your back, or prop yourself up on several pillows.
• Put one hand on your belly and the other on your chest. When you breathe in, push your belly out as far as possible. You should feel the hand on your belly move out, while the hand on your chest does not move.
• When you breathe out, you should feel the hand on your belly move in. When you can do this type of breathing well while lying down, learn to do it while sitting or standing. Many people with COPD find this breathing method helpful.
• Practice this breathing method for 20 minutes at a time, 2 or 3 times a day.

Breathing while bending forward at the waist

Breathing while bending forward can reduce shortness of breath while you are exercising or resting. You can sit or stand to use this breathing method.

To use this breathing method, bend forward slightly at the waist. Keep your back straight. If you are standing, you may want to rest your hands on the edge of a table or the back of a chair.

Bending forward like this may make it easier for you to breathe. It helps your diaphragm move more easily.

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Clearing Your Lungs

There are three things you can do to clear your lungs:

• Controlled coughing. This type of coughing comes from deep in your lungs. It loosens mucus and moves it though your airways.
• Postural drainage. You lie down in different positions to help drain mucus from your lungs.
• Chest percussion. You lightly tap your chest and back. The tapping loosens the mucus in your lungs.

Controlled coughing

Coughing is how your body tries to get rid of mucus. But the kind of coughing you cannot control makes things worse. It causes your airways to close. It also traps the mucus in your lungs.

Controlled coughing comes from deep in your lungs. It loosens mucus and moves it though your airways. It is best to do it after you use your inhaler or other medicine. Follow these steps for controlled coughing:

• Sit on the edge of a chair, and keep both feet on the floor.
• Lean forward a little, and relax.
• Breathe in slowly through your nose, and fold your arms over your belly.
• As you exhale, lean forward. Push your arms against your belly.
• Cough 2 or 3 times as you exhale with your mouth slightly open. Make the coughs short and sharp. Push on your belly with your arms as you cough. The first cough brings the mucus through the lung airways. The next coughs bring it up and out.
• Inhale again, but do it slowly and gently through your nose. Do not take quick or deep breaths through your mouth. It can block the mucus coming out of the lungs. It also can cause uncontrolled coughing.
• Rest, and repeat if you need to.

Postural drainage

Postural drainage means lying down in different positions to help drain mucus from your lungs.

Hold each position for 5 minutes. Do it about 30 minutes after you use your inhaler. Make sure you have an empty stomach. If you need to cough, sit up and do controlled coughing.

Follow these steps for postural drainage:

• Lie down on a bed or the floor. Use pillows to help you with different positions.
• To drain the front of your lungs
  • Lie on your back. Make sure that your chest is lower than your hips. Put two pillows under your hips. Use a small pillow under your head. Keep your arms at your sides.
  • Then follow these instructions for breathing: With one hand on your belly and the other on your chest, breathe in. Push your belly out as far as possible. You should be able to feel the hand on your belly move out, while the hand on your chest should not move. When you breathe out, you should be able to feel the hand on your belly move in. This is called belly breathing or diaphragmatic (say "die-uh-fruhg-MAT-ik") breathing. You will use it in the other drainage positions too.
• To drain the sides of your lungs
  • Do this step as you lie on one side. Then turn over, and do it on the other side.
  • Place two or three pillows under your hips. Use a small pillow under your head. Make sure your chest is lower than your hips. Use belly breathing. After 5 or 10 minutes, switch sides.
• To drain the back of your lungs
  • Lie on your stomach.
  • Place two or three pillows under your hips. Use a small pillow under your head.
  • Place your arms by your head.
  • Use belly breathing.

Chest percussion

Chest percussion means that you lightly tap your chest and back. The tapping loosens the mucus in your lungs.

Follow these steps to do chest percussion:

• Cup your hand, and lightly tap your chest and back.
• Ask your doctor where the best spots are to tap. Avoid your spine and breastbone.
• It may be easier to have someone do the tapping for you.

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Using Exercise to Feel Better

It is important to remain active and exercise when you have COPD. Activity and exercise can:

• Build muscle strength and endurance. This will help you be more active—you will be able to do more activities for longer amounts of time.
• Reduce shortness of breath.

Exercises for COPD can be done nearly anywhere. They are often done as part of a pulmonary rehabilitation program.

Always consult with your doctor before starting an exercise program. Heart problems, such as coronary artery disease (CAD) or high blood pressure, are common in people who have COPD and may limit exercise options. You may need medical supervision when you start your program.

If you become breathless while doing any of the exercises, rest in a position with your shoulders supported (such as in a chair) and wait until you can breathe easily again.

Exercises for COPD are simple to do and take little time. They generally consist of aerobic exercises, which increase oxygen flow to your muscles, and upper and lower body exercises, which strengthen muscles.

Getting started

To get started with an exercise program:

• Talk to your doctor. He or she may ask that you do specific exercises and will help you figure out not only how often and how long to do your exercises but also how to set your long-term exercise program goals. Although it may take weeks before you are able to reach your goals, how long it takes is not as important as doing the exercises consistently.
• Start slowly and gradually. For each exercise, either time how long you can do it or count the number of times you can do it before you are mildly out of breath. Then rest and move on to the next exercise. Each week, increase the time you spend doing each exercise or how many times you do each one.
• Pick activities that you enjoy.
• Always have a warm-up and cool-down. This is a good time for stretches.
• Pay attention to your breathing. Try to breathe slowly to save your breath. Breathe in through your nose, keeping your mouth closed. This warms and moisturizes the air you breathe. Breathe out through pursed lips.

The following examples are general exercises for people with COPD.

Aerobic exercises

Aerobic exercises increase the amount of oxygen that is delivered to your muscles, which allows them to work longer. This helps you do more activities for longer periods of time.

Any exercise that raises your heart rate and keeps it up for an extended period of time will improve your aerobic fitness. These exercises include walking, using a treadmill, cycling or using a stationary bicycle, swimming, and water aerobics.

Daily activities can also be aerobic: walking to work or to run errands, sweeping (perhaps to fast-paced music), playing actively with children, and walking your dog.

There is an easy way to determine whether your heart rate is at the right level during aerobic exercises:

• If you can't talk and exercise at the same time, you are exercising too hard.
• If you can talk while you exercise, you are doing fine.
• If you can sing while you exercise, you may not be exercising hard enough.

Talk to your doctor before starting aerobic exercise. He or she will help you know how often and how long to exercise and how to set your long-term exercise goals.

Lower body exercises

Knee extensions, leg lifts, and step-ups develop lower body muscles and will help you move around more easily for longer periods of time.

Talk to your doctor before starting these exercises. He or she will help you know how often and how long to exercise and how to set your long-term exercise goals.

• Knee extensions. Sit in a chair with your feet slightly apart. Breathe out as you straighten your knee and raise your lower leg. Breathe in as you bend your knee and return your foot to the floor.
• Leg lifts. Sit in a chair with your feet slightly apart. Breathe out as you lift one leg straight up so that the knee rises toward your shoulder. Breathe in as you return your foot to the floor.
• Step-ups. Start on a flight of stairs with a banister to hold. Breathe out as you take one step up. Breathe in as you step back down.

Upper body exercises

Upper body exercises increase strength in arm and shoulder muscles, which provide support to the rib cage and can help improve breathing. They help in everyday tasks such as carrying groceries and doing housework.

Talk to your doctor before starting these exercises. He or she will help you know how often and how long to exercise and how to set your long-term exercise goals.

• Arm extensions. Start with your arms by your side. Breathe out as you raise one arm to shoulder height, keeping the arm straight and pointing to the side. Breathe in as you return the arm to your side.
• Elbow circles. Sit or stand with your feet slightly apart. Place your hands on your shoulders with your elbows at shoulder level and pointing out. Slowly make a circle with your elbows. Breathe out as you start the circle and breathe in as you complete the circle.
• Elbow breathing. Sit with your feet slightly apart. Lift your elbows to shoulder level and touch your fingertips in front of your chest. Breathe in as you pull your elbows back so that your fingertips separate. Breathe out as you return your elbows and fingertips to the original position.

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Managing depression and anxiety: Knowing that you have a disease that gets worse over time can be hard. It's common to feel sad or hopeless sometimes. Having trouble breathing can also make you feel very anxious. If these feelings last, be sure to tell your doctor. Counselling, medicine, and support groups can help you cope.

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Keeping Your Diet Healthy

If you have chronic obstructive pulmonary disease (COPD), you may have little appetite or feel too tired to prepare and eat meals. But eating regularly and eating healthy foods is important because food:

• Provides your body with the energy it needs to function, such as for breathing and digestion.
• Provides you with the energy you need for daily activities.
• Helps strengthen your body's natural defence system (immune system), making it easier to avoid infections.

You can take simple steps to be sure you eat healthy foods on a regular basis. But because people with COPD often have other health problems that may restrict the foods they can eat, always talk with your doctor or a registered dietitian before making changes in your diet.

People with COPD often have trouble preparing foods and eating. The following tips can make eating easier and help you get necessary nutrition. But if you have other health problems that may restrict the foods you can eat, talk with your doctor or a registered dietitian before making changes in your diet.

Make eating easier

• Choose foods that are easy to prepare.
• Eat in a relaxed atmosphere.
• Eat with friends and family.
• If you eat a main meal, try to eat it early. This way, you will have energy throughout more of the day.
• Try to include a favourite food in your meals.

Avoid shortness of breath while eating

• Stop smoking. It is never too late to quit smoking. No matter how long you have had COPD or how serious it is, quitting smoking will help slow the disease and improve your quality of life.
• Use medicines that make breathing easier and/or clear your airways about 1 hour before eating.
• Rest before eating if eating makes you short of breath or tired.
• Clear your lungs beforehand. Use your bronchodilator medicine before you eat. This can help you breathe better during your meal.
• Eat while sitting up. This helps remove pressure on your lungs.
• If you use oxygen, use it while eating. Eating and digestion require energy, which causes your body to use more oxygen.
• Eat six small meals each day instead of three large ones so that your stomach is never extremely full. A full stomach can interfere with breathing by pushing on the diaphragm.
• Drink your beverage at the end of the meal. Drinking before or during the meal can fill you up more quickly.
• Avoid or eat only small amounts of gas-forming foods (they bloat the abdomen and make breathing difficult). These include onions, cauliflower, broccoli, melons, peas, corn, cucumbers, cabbage, Brussels sprouts, turnips, raw apples, and beans (except green beans). Fried and greasy foods can also cause gas or bloating.
• Eat and chew slowly so you are less likely to become short of breath. Try putting your spoon or fork down between bites to slow your eating speed.
• If you have a hard time breathing in the morning, do not skip breakfast. Have a liquid nutritional drink instead.

Eat healthy foods

• Eat a varied diet. Eat fruits and vegetables, dairy products, cereal and grains, and meats.
• Avoid foods that are difficult to chew.
• Don't waste energy consuming foods with little nutritional value, such as potato chips, candy bars, and soft drinks.

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Avoiding Weight Loss

Some people with severe chronic obstructive pulmonary disease (COPD)—especially those with emphysema—may be underweight and malnourished.

• People with COPD often lose weight. When you lose weight, you lose muscle mass, including the muscles that help you breathe. This may make breathing more difficult.
• Some people with COPD weigh too little for good health. It is dangerous to become very underweight.
• To avoid losing weight and muscle mass, you generally need to eat more foods containing fat and protein. Because eating too much fat and targeting certain nutrients (such as protein) may have health risks, always consult with your doctor or a registered dietitian before eating more of these foods to gain weight.

If you are beginning to lose weight and muscle mass, you probably need to eat more protein and get more calories. This generally means eating more foods containing fat and protein. Because eating too much fat and targeting certain nutrients (such as protein) may have health risks, always consult with your doctor or a registered dietitian before eating more of these foods to gain weight. Also, eating small, frequent meals and snacks may be easier than eating big meals.

High-calorie snacks

• Ice cream.
• Pudding.
• Cheese.
• Granola bars.
• Custard.
• Eggs.
• Avocado.
• Crackers with peanut butter.
• Bagels with peanut butter or cream cheese.
• Cereal with half and half.
• Popcorn with margarine and Parmesan cheese.
• High-calorie drinks like whole milk, milkshakes, and nutritional supplements, such as nutrition shakes.

Adding calories to a meal or snack

• Add an egg or egg yolk to meat loaf, macaroni and cheese, or similar foods. Be sure to cook the food after adding the egg.
• Add powdered milk to creamed soups, scrambled eggs, pudding, potatoes, yogurt, and casseroles.
• Add cheese to sandwiches, crackers, casseroles, soups, toast, and pasta.
• Add an extra tablespoon of vegetable oil or olive oil, mayonnaise, butter, margarine, or sour cream to sandwiches, bread, casseroles, soups, cooked cereals, pasta, potatoes, rice, or vegetables.
• Grind up some nuts and sprinkle the dust on puddings, gravy, mashed potatoes, casseroles, salads, and yogurt.

Adding protein to your diet

Milk, milk products, and meats are high in protein. Try to eat more of these foods, or:

• Add skim milk powder to milk, cold cereals, scrambled eggs, soups, and ground meat.
• Add cheese or peanut butter to snacks.
• Choose desserts that use eggs, such as sponge cake, egg custard, and rice pudding.
• Use nutritional supplements high in protein, such as nutrition shakes.

Causes

COPD is most often caused by smoking. Most people with COPD are long-term smokers, and research shows that smoking cigarettes increases the risk of getting COPD.

COPD is often a mix of two diseases: chronic bronchitis and emphysema. Both of these diseases are caused by smoking. Although you can have either chronic bronchitis or emphysema, people more often have a mixture of both diseases.

Other causes

Other possible causes of COPD include:

• Long-term exposure to lung irritants such as industrial dust and chemical fumes.
• Preterm birth that leads to lung damage (neonatal chronic lung disease).
• Inherited factors (genes), including alpha-1 antitrypsin deficiency. This is a rare condition in which your body may not be able to make enough of a protein (alpha-1 antitrypsin) that helps protect the lungs from damage. People who have this disorder and who smoke generally start to have symptoms of emphysema in their 30s or 40s. Those who have this disorder but don't smoke generally start to have symptoms in their 80s.

Examinations and Tests

To diagnose COPD, your doctor will probably do the following tests:

• Medical history and physical examination. These will give your doctor important information about your health.
• Lung function tests, including an FEV1 test. These tests measure the amount of air in your lungs and the speed at which air moves in and out. Spirometry is the most important of these tests.
• Chest X-ray. This helps rule out other conditions with similar symptoms, such as lung cancer.

Tests done as needed

• Arterial blood gas test. This test measures how much oxygen, carbon dioxide, and acid is in your blood. It helps your doctor decide whether you need oxygen treatment.
• Oximetry. This test measures the oxygen saturation in the blood. It can be useful in finding out whether oxygen treatment is needed, but it provides less information than the arterial blood gas test.
• Electrocardiogram (ECG, EKG) or echocardiogram. These tests may find certain heart problems that can cause shortness of breath.
• Transfer factor for carbon monoxide. This test looks at whether your lungs have been damaged, and if so, how much damage there is and how bad your COPD might be.

Tests rarely done

• Alpha-1 antitrypsin (AAT)test. AAT is a protein your body makes that helps protect the lungs. People whose bodies don't make enough AAT are more likely to get emphysema.
• A CT scan. This gives doctors a detailed picture of the lungs.

Regular checkups

Because COPD is a disease that keeps getting worse, it is important to schedule regular checkups with your doctor. Checkups may include:

• Spirometry.
• Arterial blood gas test.
• X-rays or ECGs.

Tell your doctor about any changes in your symptoms and whether you have had any flare-ups. Your doctor may change your medicines based on your symptoms.

Early detection

The sooner COPD is diagnosed, the sooner you can take steps to slow down the disease and keep your quality of life for as long as possible. Screening tests help your doctor diagnose COPD early, before you have any symptoms.

Talk to your doctor about COPD screening if you:

• Are a smoker or an ex-smoker.
• Have had serious asthma symptoms for a long time, and they have not improved with treatment.
• Have a family history of emphysema.
• Have a job where you are exposed to a lot of chemicals or dust.

The U.S. Preventive Services Task Force (USPSTF) doesn't recommend COPD screening for adults who are not at high risk for COPD. And some experts recommend that screening be done only for people who have symptoms of a lung problem.

The Canadian Thoracic Society (CTS) does not recommend screening smokers who do not have symptoms of COPD. But screening is recommended for smokers and ex-smokers age 40 and older who have any of the following symptoms:

• A regular cough and/or production of mucus (sputum)
• Frequent respiratory tract infections, such as colds
• Reports of regular and worsening activity-related wheezing or shortness of breath

COPD gradually gets worse over time

Shortness of breath gets worse as COPD gets worse.

• If you are diagnosed early, before you have a lot of lung damage, you may have very mild symptoms, even when you are active.
• If you are diagnosed later, you may have already lost much of your lung function.
  • If you are active, you may be short of breath during activities that didn't used to cause this problem.
  • If you are not very active, you may not notice how much shortness of breath you have until your COPD gets worse.
• If you have had COPD for many years, you may be short of breath even when you are at rest. Even simple activities may cause very bad shortness of breath.

It's very important to stop smoking. If you keep smoking after being diagnosed with COPD, the disease will get worse faster, your symptoms will be worse, and you will have a greater risk of having other serious health problems.

The lung damage that causes symptoms of COPD doesn't heal and cannot be repaired. But if you have mild to moderate COPD and you stop smoking, you can slow the rate at which breathing becomes more difficult. You will never be able to breathe as well as you would have if you had never smoked, but you may be able to postpone or avoid more serious problems with breathing.

Complications

Other health problems from COPD may include:

• More frequentlung infections, such as pneumonia.
• An increased risk of thinning bones(osteoporosis), especially if you use oral corticosteroids.
• Problems with weight. If chronic bronchitis is the main part of your COPD, you may need to lose weight. If emphysema is your main problem, you may need to gain weight and muscle mass.
• Heart failure affecting the right side of the heart (cor pulmonale).
• A collapsed lung (pneumothorax). COPD can damage the lung's structure and allow air to leak into the chest cavity.
• Sleep problems because you are not getting enough oxygen into your lungs.

Hospice palliative care

Treatment for COPD is getting better and better at helping people live longer. But COPD is a disease that keeps getting worse, and it can be fatal.

Hospice palliative care is a kind of care for people who have diseases that don't go away and that often get worse over time. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit. You can have this care along with treatment to cure your illness.

A time may come when treatment for your illness no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left.

Hospice palliative care providers will work to help manage shortness of breath and other symptoms or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you. You and your doctor can decide when you may be ready for hospice palliative care.

Treatment

The goals of treatment for COPD are to:

• Slow down the disease by quitting smoking and avoiding triggers, such as air pollution.
• Limit your symptoms, such as shortness of breath, with medicines.
• Increase your overall health with regular activity.
• Prevent and treat flare-ups with medicines and other treatment.

Pulmonary rehab can help you meet these goals. It helps train your mind, muscles, and heart to get the most out of damaged lungs. The program involves a team of health professionals who help prevent or manage the problems caused by COPD. It typically combines exercise, breathing therapy, advice for eating well, and other education.

Self-care

Much of the treatment for COPD includes things you can do for yourself.

Quitting smoking is the most important thing you can do to slow the disease and improve your quality of life.

Other things you can do that really make a difference including eating well, staying active, and avoiding triggers. To learn more, see Living With COPD.

Medicines

Medicine for COPD is used to:

• Reduce shortness of breath.
• Control coughing and wheezing.
• Prevent COPD flare-ups, also called exacerbations, or keep the flare-ups you do have from being life-threatening.

Most people with COPD find that medicines make breathing easier.

Some COPD medicines are used with devices called inhalers or nebulizers. It's important to learn how to use these devices correctly. Many people don't, so they don't get the full benefit from the medicine.

Medication choices

• Bronchodilators are used to open or relax your airways and help your shortness of breath.
  • Short-acting bronchodilators ease your symptoms. They are considered a good first choice for treating stable COPD in a person whose symptoms come and go (intermittent symptoms). They include:
    • Anticholinergics (such as ipratropium).
    • Beta2-agonists (such as salbutamol or terbutaline).
    • A combination of the two (such as a combination of salbutamol and ipratropium).
  • Long-acting bronchodilators help prevent breathing problems. They help people whose symptoms do not go away (persistent symptoms). They include:
    • Anticholinergics (such as aclidinium, tiotropium, or umeclidinium).
    • Beta2-agonists (such as formoterol or salmeterol).
    • A combination of the two, or a combination of a beta2-agonist and a corticosteroid medicine.
• Phosphodiesterase-4 (PDE4) inhibitors are taken every day to help prevent COPD exacerbations. The only PDE4 inhibitor available is roflumilast (Daxas).
• Corticosteroids(such as prednisone) may be used in pill form to treat a COPD flare-up or in an inhaled form to prevent flare-ups. They are often used if you also have asthma.
• Other medicines include methylxanthines, which generally are used for severe cases of COPD. They may have serious side effects, so they are not usually recommended.

Tips for using inhalers

The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This doesn't always mean that the medicine won't help. Try the medicine for a while before you decide if it is working.

Metered-dose inhalers (MDIs) and nebulizers work equally well. MDIs are easier to carry. Nebulizers usually need to be plugged in.

Many people don't use their inhalers right, so they don't get the right amount of medicine. Ask your health care provider to show you what to do. Read the instructions on the package carefully.

Most doctors recommend using spacers with metered-dose inhalers. But you should not use a spacer with a dry powder inhaler.

Other treatment you may need

If COPD gets worse, you may need other treatment, such as:

• Oxygen treatment. This involves getting extra oxygen through a face mask or through a small tube that fits just inside your nose. It can be done in the hospital or at home.
• Ventilation devices. These are machines that help you breathe better or breathe for you. They are used most often in the hospital during COPD flare-ups.
• Alpha-1 antitrypsin injections (such as Prolastin). These medicines can help people who have alpha-1 antitrypsin deficiency.
• Treatment for muscle weakness and weight loss. Many people with severe COPD have trouble keeping their weight up and their bodies strong. This can be treated by paying attention to eating regularly and well.
• Help with depression. COPD can affect more than your lungs. It can cause stress, anxiety, and depression. These things take energy and can make your COPD symptoms worse. But they can be treated. If you feel very sad or anxious, call your doctor.
• Surgery. Surgery is rarely used for COPD. It's only considered for people who have severe COPD that has not improved with other treatment.
  • Lung volume reduction surgery removes part of one or both lungs, making room for the rest of the lung to work better. It is used only for some types of severe emphysema.
  • Lung transplant replaces a sick lung with a healthy lung from a person who has just died.
  • Bullectomy removes the part of the lung that has been damaged by the formation of large, air-filled sacs called bullae. This surgery is rarely done.

Dealing with flare-ups

COPD flare-ups, or exacerbations, are when your symptoms—shortness of breath, cough, and mucus production—quickly get worse and stay worse.

Work with your doctor to make a plan for dealing with a COPD flare-up. If you are prepared, you may be able to get it under control. Don't panic if you start to have one. Quick treatment at home may help you prevent serious breathing problems.

A flare-up can be life-threatening, and you may need to go to your doctor's office or to a hospital. Treatment for flare-ups includes:

• Quick-relief medicines to help you breathe.
  • Anticholinergics (such as ipratropium or tiotropium)
  • Oral corticosteroids (such as methylprednisolone or prednisone)
  • Beta2-agonists (such as salbutamol or terbutaline)
• Machines to help you breathe. The use of a machine to help with breathing is called mechanical ventilation. Ventilation is used only if medicine isn't helping you and your breathing is getting very difficult.
  • Non-invasive positive pressure ventilation (NPPV) forces air into your lungs through a face mask.
  • With invasive ventilation, a breathing tube is inserted into your windpipe, and a machine forces air into your lungs.
  • Oxygen to help you breathe. Oxygen treatment can be done in the hospital or at home.
• Antibiotics. These medicines are used when a bacterial lung infection is considered likely. People with COPD have a higher risk of pneumonia and frequent lung infections. These infections often lead to COPD exacerbations, or flare-ups, so it's important to try to avoid them.

Controlling COPD Amid COVID-19

Full report from the American Lung Association here.

Having a chronic lung disease means that you can be more likely to get severely ill and have complications from COVID-19. This makes it more important than ever for you to follow all the guidelines to minimize your risk of infection – with a continued emphasis on staying home and physically distanced from others. We know that isn’t easy.

1. Get vaccinated. When a COVID-19 vaccine is available to you, we encourage you to utilize this safe and effective tool to prevent severe illness from occurring. Don’t forget your flu and pneumonia vaccinations either!
2. Get tested and get treated. If you have symptoms of COVID-19, it’s important to get tested. There are new treatments available that may reduce your risk of severe illness from COVID-19, but you need to start them quickly. Speak with your doctor about your options.
3. Reopening communities doesn’t mean the virus is gone. Stay home if you can and maintain distance of at least six feet from others when you must be out. For example, supporting local restaurants through curbside pickup or delivery options is a lower risk to your health than dining in.
4. Lung health emergencies are still emergencies. If you are having a flare-up from your lung disease or experiencing new symptoms that trouble you – call your doctor and come up with a plan together.
5. Keep taking your prescribed medications as directed. Whether you take oral or inhaled medication, it’s important to continue your regimen as prescribed.
   • If you use a  nebulizer  to take your medication at home, it is safe to continue doing so. However, if you have suspected or diagnosed COVID-19, speak with your healthcare provider about additional precautions to take when using your nebulizer.
   • Consider mail order pharmacy options for your controller medications. And if your insurance allows, secure a 90-day supply of prescription medications.
6. Stay connected. Maintaining at least six feet of distance between others is necessary for your physical health but maintaining connections with others is important for your emotional health. Join the Better Breathers Club Network or one of the American Lung Association's online support communities to connect to others in similar situations.
7. Check your sources. Misinformation is everywhere.

Are you ready to quit?

Maybe you have already taken your last puff or are ready to quit today. That's great. This information will help you keep your resolve to kick the habit for good.

It's okay if you aren't ready now. But you may want to quit at some point. So keep learning and preparing yourself. Many smokers do quit. You can too.

Why do you want to quit?

Think about why you want to quit. Maybe you want to protect your heart and your health and live longer. Or maybe you want to be a good role model for your kids or spend your money on something besides cigarettes. Your reason for wanting to change is important. If your reason comes from you—and not someone else—it will be easier for you to try to quit for good.

How can you quit?

Quitting smoking is hard. Some people who have quit say that it was the hardest thing they have ever done. But most smokers eventually are able to quit smoking. And you don't have to do it alone. Ask your family, friends, and doctor to help you. Get what you need to help you quit for good.

• Get ready. If you're ready to quit right now, go ahead. Medicines and support can help you stay on track. But if you want to plan ahead, you don't have to stop right away. Set a date to quit. Pick a time when you won't have a lot of stress in your life. Think about cutting down on smoking before your quit date. You can try to decrease the number of cigarettes you smoke each day as a way to quit smoking. Get rid of ashtrays, lighters, or spit cups before you quit. Talk to your partner or friends about helping you stay smoke-free. Don't let people smoke in your house.
• Change your routine. For example, if you smoke after eating, take a walk instead.
• Use medicine. It can help with cravings and stress, and it doubles your chances of quitting smoking.footnote 1 You can buy nicotine gum, inhalers, lozenges, or patches without a prescription. Your doctor may also prescribe medicine, such as bupropion (Zyban) or varenicline (Champix). If you take varenicline, you can stop smoking a little bit at a time, which may increase your chance of quitting.
• Get support. Seek help from:
  • Online programs, such as www.smokershelpline.ca which includes a text messaging service, support forums, and a telephone helpline (1-877-513-5333).
  • Free smartphone, tablet, or hand-held computer apps, such as the U.S. National Cancer Institute's QuitPal.
  • Doctors, nurses, or therapists for counselling.
  • A friend who has quit smoking.
  • Most provinces have smoker's helplines you can call or websites you can visit for information and support.
    • In Alberta, visit www.albertaquits.ca or call 1-866-710-7848.
    • In British Columbia, visit www.quitnow.ca or call 811.
    • In Quebec, visit tobaccofreequebec.ca or call 1-866-527-7383.
    • In Ontario and Saskatchewan, visit smokershelpline.ca or call 1-877-513-5333.

For more information, or to find support in provinces or territories not listed above, go to gosmokefree.gc.ca or call 1-866-366-3667.

After you quit, try not to smoke at all—not even one puff. Prevent a slip (smoking one or two cigarettes) or relapse (returning to regular smoking) by avoiding smoking triggers, at least at first. These triggers can include friends who smoke, alcohol, and stress. Don't keep cigarettes in your house or car. If you do slip, stay calm. Remind yourself that you have a plan, and think about how hard you've worked to quit for good.

Why is it so hard to quit?

Quitting is hard because your body depends on the nicotine in tobacco. Giving it up is more than just kicking a bad habit. Your body has to stop craving the nicotine. Nicotine gum, lozenges, patches, and other medicines can help reduce the cravings without the harmful effects of smoking.

You also have to change your habits. You may not even think about smoking. You just do it. You may not realize it, but seeing someone smoke—or just seeing cigarettes—may cause you to want to smoke. You may smoke when you drink alcohol or when you are stressed. Or maybe you have a cigarette with coffee. Before you quit, think of new ways to handle these things. For example, call a friend or practice deep breathing when you feel stressed. Try chewing sugarless gum instead of smoking. Go for a walk when you have a break at work. When you first start your quit, it's okay to stay around non-smokers. And it's okay to avoid situations where you may be tempted to smoke (like occasions where alcohol will be served) until you feel more confident about staying smoke-free.

What if you feel bad when you are trying to quit?

You are likely to crave cigarettes and to have withdrawal symptoms. You may feel grouchy or restless or you may have a hard time concentrating for the first 2 to 3 weeks after you quit. It may be hard to focus on tasks. Or you may have trouble sleeping and want to eat more. But you won't feel bad forever, and medicine can help. Using medicines and products like nicotine gum or patches can help with cravings and make it easier to resist smoking.

Prepare for roadblocks

Possible roadblock	What you need to know
Cravings and nicotine withdrawal. Symptoms include feeling grouchy or having trouble sleeping or concentrating.	Here are some things that can help: Take medicine to help control the symptoms. Using medicine can double your chances of quitting. Get active. Start a new activity, take a class, or read a book on a subject that interests you. Get counselling and phone support. Try to avoid smoking triggers. Distract yourself with a walk, household chore, or a game.
Failure in the past	If you weren't able to quit in the past, don't lose hope. Each time you try to quit, you will be stronger and will have learned more about what helps and what makes it harder. Most people try to quit many times before they can quit for good.
Weight gain	You may gain some weight when you stop smoking. Don't try to avoid this by going on a strict diet at the same time. This will make it even harder to stop smoking. You can take steps to lower your chance of gaining weight: By being more active. This will also help you feel better. By using stop-smoking medicines. They can help you get through the worst of your cravings and may help you avoid putting on too much weight.
Depression or nervousness	Medicines or counselling can help treat nervousness or depression. Talk to your doctor or therapist.
Lack of support	Support can improve your chances of quitting. Look for people who have stopped smoking, or seek out those family and friends who support your goal to quit. Online and phone support can also help: Call 1-866-366-3667 or go to gosmokefree.gc.ca/quit to find information and support in your province. Stop-smoking programs, such as the Canadian Cancer Society's One Step at a Time program (www.cancer.ca) or QuitNet (www.quitnet.com) Check with your provincial ministry of health or local health unit for programs to quit smoking.
Living with or being around someone who smokes	It would be easier for you to quit if those around you didn't smoke. Discuss quitting together. If this isn't an option, talk to the person(s) about not smoking around you and about not leaving their cigarettes in places where you might see them. When you can, avoid places where others are smoking.
Alcohol	If you enjoy smoking when you drink alcohol, you may need to cut down or give up alcohol when you quit smoking, at least for a while.
Stress	Stress can lead to smoking, but smoking doesn't really make stress go away. To control stress, learn what causes your stress and how to change the way you react.
Missing your smoking habits or not being able to avoid smoking triggers	Assess your tobacco use to discover your smoking triggers. For some people, morning coffee and going out with friends are common smoking triggers. Drinking coffee. Change the way you have coffee: the place, the coffee mug, everything that you did when you were smoking. Or if just drinking coffee makes you want to smoke, try taking a walk during coffee breaks instead. Going out with friends. If drinking makes you want to smoke, see about going to a movie rather than going out for drinks.
Teen issues, such as fitting in with the crowd and dealing with stress	Healthier skin, cleaner teeth, and being seen as more attractive to others are just a few reasons for teenagers to quit smoking. Quitting can help student athletes perform their best at their sport. Teenagers who are smoke-free have an easier time being active. And being physically active can help you deal with stress in healthier ways than by smoking.

Will you gain weight?

You may worry about gaining weight after you stop smoking. This is understandable. In fact, many smokers do gain weight during their quit attempt. In your plan to quit smoking, include eating healthy snacks and doing some physical activity to help you avoid weight gain during your quit.

If you do gain weight, you can focus on losing it after you have successfully quit smoking. Be patient with yourself and try to tackle one change at a time.

You can take steps to lower your chance of gaining weight:

• Try to be active. Exercise can also improve your mood and reduce your craving for a cigarette.
  • If you haven't been getting much exercise, start walking every day, gradually increasing how far you walk. Or take a beginning yoga class.
  • If you are already active, see about joining others for a sport you enjoy, such as biking, hiking, or playing volleyball.
• Eat more fruits, vegetables, and whole grains, and eat fewer high-fat foods. Cutting back on food (dieting) can make quitting smoking harder.
• Try not to substitute food for cigarettes. Instead, chew gum, or chew on a drinking straw or a coffee stirrer.

Use quit-smoking medicines or nicotine replacement. They may make gaining weight less likely while you are quitting smoking.

What if you start smoking again?

Most people quit and restart many times before they stop smoking for good. If you start smoking again after you quit, don't give up. If you return to smoking, but smoke less than before, try to keep your smoking at that lower level so it will be easier to quit in the future. Also, if you are ready to try to quit again soon, do so. You do not need to wait to try again. Each time you quit, even if it is just for a short time, you get closer to your long-term goal.

Remind yourself that by quitting you may avoid serious health problems and live longer. Remember your reasons for quitting. Maybe you want to protect your heart and your health and live longer.

Each time you quit, you learn more about what helps and what gets in the way. Think about why you started smoking again and about what you will do differently next time. If you tried to quit without medicines or counselling, think about trying them next time. If you did use a medicine and counselling, think about trying a different type next time, or think about changing other things in your life, like travel routines and recreation. Medicines and nicotine replacement (gum, patches, lozenges) can double your chances of success. And using medicines and counselling is even more effective. You can do it!

Use a mobile app (iPhone)

QuitNow!

iPhone rating: 4.6 stars

Price: Free with in-app purchases

QuitNow! makes quitting easier by helping you focus your energy into four sections — your new ex-smoker status, 70 ex-smoker achievements to keep you motivated, a strong ex-smoker community, and your newfound health improvements. Browse frequently asked questions or ask the QuitNow! bot questions of your own.

Smoke Free

iPhone rating: 4.8 stars

Price: Free with in-app purchases

This app takes a science-backed approach with more than 20 evidence-based techniques to help you quit smoking for good. Log your cravings and get tips for managing them, plus insights into craving patterns and graphs to monitor your overall progression. You also have the option of participating in a rigorous scientific experiment that will help more people quit smoking successfully.

Quit Genius

iPhone rating: 4.5 stars

Price: Free

This app uses behavioral modification tools based on the ideas behind Cognitive Behavioral Therapy (CBT) to help you gain control over your own actions as you try to quit. Rather than forcing you to quit right away, the app allows you to set your own goals for quitting. The app then rewards you by telling you how much money you’ve saved, how many years of your life you’ve regained, and offers tools that can help you slowly but surely reach the finish line of quitting.

My QuitBuddy

iPhone rating: 4.4 stars

Price: Free

My QuitBuddy is quite literally a “companion” app to help you track the differences in your health and lifestyle when you quit smoking. Using a live map of your body showing how much healthier your lungs and other parts of your body are, along with lists of how much money you’ve saved and tar you avoided putting in your body, My QuitBuddy is on your side. The app will even give you little games to play, such as doodling, to help take your mind off your cravings.

quitSTART

Use a mobile app (Android)

QuitNow!

Android rating: 4.6 stars

Price: Free with in-app purchases

QuitNow! makes quitting easier by helping you focus your energy into four sections — your new ex-smoker status, 70 ex-smoker achievements to keep you motivated, a strong ex-smoker community, and your newfound health improvements. Browse frequently asked questions or ask the QuitNow! bot questions of your own.

Smoke Free

Android rating: 4.7 stars

Price: Free with in-app purchases

This app takes a science-backed approach with more than 20 evidence-based techniques to help you quit smoking for good. Log your cravings and get tips for managing them, plus insights into craving patterns and graphs to monitor your overall progression. You also have the option of participating in a rigorous scientific experiment that will help more people quit smoking successfully.

SmokeFree

Android rating: 4.2 stars

Price: Free

There are two ways to quit with SmokeFree. Choose the quit mode if you’re highly motivated, or use the reduce mode if you need more time. This app acts as your companion during the quitting process, helping you slowly reduce your cigarette use so your body adapts. Features include rich motivational tips, personal stats, and financial and health achievements.

Quit Tracker

Android rating: 4.7 stars

Price: Free with in-app purchases

This app is a motivational tool which tracks the health and financial benefits you’ll enjoy every day you resist a cigarette. Use the app to track how close you are to living a smoke-free life, how much money you’re saving, and how much life you’ve regained. There’s also a timeline that shows you how quickly you start enjoying health benefits.

EasyQuit

Android rating: 4.8 stars

Price: Free

With this app, you can watch all aspects of your health improve, from your blood circulation and oxygen levels to your senses of taste and smell. Use the slow mode to help you stop smoking slowly, with a customized plan just for you. Earn badges as rewards and try the memory game when cravings strike.

Flamy

Android rating: 4.8 stars

Price: Free with in-app purchases

Flamy doesn’t waste any time. Right off the bat, the app offers you a 14-day challenge to quit smoking in two weeks or a “one less every day” option that lets you gradually remove cigarettes from your lifestyle. The app also offers games that distract you from cravings, plus challenges for you and your friends so that you can motivate each other to quit smoking. Quitting smoking isn’t easy, but Flamy makes it feel like a true accomplishment.

Stop Smoking

Android rating: 4.4 stars

Price: Free with in-app purchases

This app will help you do exactly what it says: stop smoking. And it will stop at nothing to make sure you have the right tools to quit: a tracker telling you how much money you’ve saved, a diary to track your progress or share with other app users, and even a feature that allows you to see how the money you’ve saved can be used for items on your Amazon wishlist.

Stop Smoking Counter

Android rating: 4.8 stars

Price: Free with in-app purchases

This app is meant to be an all-in-one data tracker, information source, and support system. It’ll tell you how much nicotine and tar you’re saving your body from plus the other benefits of quitting. Hear stories and tips from people who have successfully quit using a variety of methods, and follow proven quitting methods first introduced by British author Allen Carr.

Smoking Log

Android rating: 4.5 stars

Price: Free

This app is all about goals: you enter each cigarette you smoke and then set your own goals for quitting. Then, the app gives you tools and information to show you how you’re coming along every day in relation to those goals and how you can stay motivated to quit. You’ll see a dashboard and charts that show your progress over time, stats that track your smoking habits over time, and notifications that measure your progress towards your goals.

quitSTART

Sign up for a free texting program

• US & Canada

• Canada Only

Free telephone helplines

• US: Free & confidential coaching through telephone quitline: 1-800-QUIT-NOW (1-800-784-8669)

• Canada: Free & confidential coaching through telephone quitline: 1-866-366-3667

More free online sources like the page you’re on right now!

• Centers for Disease Control and Prevention
• Canada: Provincial and territorial services
• WebMD
• SmokeFree.gov
• HelpGuide
• American Lung Association
• Breathe Lung Association

Smoking and COVID-19

COVID-19 has many people feeling stressed, alone, or worried about their health. It’s a lot to deal with if you’re trying to stop smoking or stay smokefree if you've already quit. But not smoking (or using any tobacco products) is one of the best ways to protect and improve your health.

As a smoker, you or the people who care about you may be worried about a connection between COVID-19 and smoking. Scientists are still learning about the disease, but we know that:

• Being a current smoker increases your risk for severe illness from COVID-19.
• Smoking weakens the immune system, which makes it harder for your body to fight disease.
• If you continue to smoke, you have a greater risk for respiratory infections like pneumonia, colds, or flu.
• COVID-19 impacts many of the same organs of the body as smoking. For those with heart or lung disease caused by smoking, you are at increased risk for severe illness from COVID-19.

But there is good news: Soon after you stop smoking your body begins to heal. Within the first few weeks and months, your lungs start to work better and your risk for a heart attack goes down. The longer you go without smoking, the more time your body has to recover. No matter how old you are or how long you've been smoking, quitting smoking improves your health and can add years to your life.

Get the full report entitled "Tobacco and COVID-19" in this memo from Public Health Ontario.

What is vaping?

Vaping products (aka electronic cigarettes or e-cigarettes) do not:

• produce smoke
• contain tobacco
• involve burning

Except for nicotine, vaping products typically contain:

• a fraction of the 7,000 chemicals found in tobacco smoke
• lower levels of several of the harmful chemicals found in smoke

Vaping products are devices that heat a liquid into an aerosol that is inhaled into the lungs. These devices are commonly called vapes, mods, e-hookahs, sub-ohms, tank systems and vape pens.

The liquid (sometimes referred to as e-juice) in a vape product contains a combination of ingredients, usually including nicotine (the highly addictive drug found in tobacco products), propylene glycol, vegetable glycerine and flavouring. Many of these substances are considered safe for ingestion (eating); however, when these liquids are heated they create new chemicals that may not be safe to inhale. For example, the heating process can create chemicals like formaldehyde and other contaminants such as nickel, tin and aluminum.

We recommend the following for Canadians considering the use of vaping products:

• Learn the facts: Vaping has significant health risks and understanding the potential short and long-term health outcomes before vaping is recommended. There is accumulating evidence that e-cigarettes cause serious lung disease.
• Non-smokers, pregnant women and people who have quit smoking should not vape.
• Younger people should be educated to understand their increased risk of nicotine addiction compared with the general population and should be strongly encouraged not to vape.
• If you are vaping:
  • monitor for symptoms affecting your lung health and let your healthcare provider know you vape. If you smoke and are using vaping to quit, know that there is not significant evidence to suggest vaping as an effective cessation support. Our recommendation is: do not vape.
• Talk to a health professional about clinically proven options for quitting.

Flavours and Youth

There are more than 7,000 flavours of e-juice available to lure young Canadians and kids. These range from cotton candy to chocolate or mango. Young people are drawn to flavours more than any other group. In fact, more than 83 per cent of young e-cigarette users (15-19 years of age) report using fruit and candy/dessert flavoured vapes. Dressing up a nicotine-based product with candy and dessert flavoured names hides the product’s harm and increases its appeal. There is more to flavoured e-juices than hides behind the vapour.

Aside from addicting a new generation of Canadians to nicotine, there are a lot of unknown health risks.

While the chemicals used in flavoured e-juices have been tested as safe for eating, they have not been tested for inhalation. When heated, the liquids create chemicals that could cause long-term harm to the lungs. The heating process can create chemicals like formaldehyde and other contaminants such as nickel, tin and aluminum.

Flavours were banned in tobacco because of their clear marketing toward young people and the vaping should not be treated any differently. Eliminating inviting flavours from vaping products is essential to protecting kids’ lungs.

What are the health effects of vaping?

Any time we breathe in anything, other than medication or fresh air into our lungs, there is a potential to cause harm. Vaping is no different. We are still collecting more research to fully understand the long-term health effects to inform Canadians. But at this point, we do already know that there is harm connected to vaping.

• Nicotine dependence: vaping products contain large amounts of nicotine, which is a highly addictive drug. For instance, 1 Juul Pod (Juul is one brand name of a vaping product) has the same amount of nicotine as 20 cigarettes (approximately one pack). This means people may develop dependence quickly and it may even increase your chances of smoking traditional cigarettes.
• Negative lung health effects of tobacco use include worsening of existing lung conditions, lung cancer and COPD among others.
• Short-term symptoms: Individuals should watch for signs of cough, shortness of breath, chest pain, nausea, vomiting and/or diarrhea. These may be signs of lung damage. If you are experiencing these symptoms, seek medical attention.
• Lung disease: Vaping can make asthma and other existing lung diseases worse. Breathing in the harmful chemicals from vaping products can cause irreversible (cannot be cured) lung damage, lung disease and, in some cases, death. Some chemicals in vaping products can also cause cardiovascular disease and biological changes that are associated with cancer development.

Vaping: Use it to quit smoking. Then quit vaping?

The evidence to support vaping as a smoking cessation tool is inconclusive. Those who smoke intending to quit smoking by using vaping devices should make an informed decision and know that vaping may provide a less harmful alternative but it still carries risk. The potential harms need to be considered before making a decision to vape. It is also important that people know that the use of vaping products has also been linked to initiation of cigarette smoking, which could lead to an endless cycle of smoking behaviour and nicotine addiction. More research needs to be done to find out whether vaping products can be considered a safer cessation (quitting) tool.

Individuals wanting to quit should try evidence-based methods (counseling, nicotine replacement products and prescription drugs) first and consult with a medical professional to determine the best approach to help them quit all products, including exploring a number of existing pharmaceutical and therapy-based methods that are evidence -based. For help with quitting, visit https://www.lung.ca/lung-health/smoking-and-tobacco.

Vaping take-aways:

• Learn the facts: Vaping is not without risk and so understanding the potential short and long-term health outcomes before vaping is recommended.
• Youth, those who do not smoke, pregnant women and people who have quit smoking should not vape.
• Younger people should be educated to understand their increased risk of nicotine addiction compared with the general population and should be strongly encouraged to not try or start vaping.
• If you smoke and are using vaping to quit, e-cigarettes may be less harmful than traditional cigarettes. Things to consider:
  • Monitor for symptoms affecting your lung health and let your healthcare provider know you vape.
  • Do not smoke and vape during the same time period.
  • Talk to a health professional about options for quitting.
  • The ultimate goal is to quit all nicotine products, including vaping.

Vaping alternatives for stress relief

Details coming soon.

• Deep breathing exercises.
• Meditation.
• Mindfulness meditation.
• Progressive muscle relaxation.
• Mental imagery relaxation.
• Relaxation to music.
• Counseling, to help you recognize and release stress.

Vaping and Cannabis

Cannabis products containing concentrated levels of THC, such as hash oil, can be vaped with an e-cigarette. Dried cannabis can also be vaped in the cartridge of the e-cigarettes. It is more discrete and less noticeable when young people consume cannabis oils and concentrates using a vaporizer rather than smoking dried cannabis in a joint or a pipe, as it does not leave a telltale smell.

In the US – vaping THC killed 60 people and 1000s had cases of serious lung disease. Cannabis products that are purchased illegally through the black or grey market risk being contaminated with additives or chemicals carrying THC oils that are dangerous to inhale.

It’s important to note that cannabis products like cannabis oils and concentrates for use in vaping devices are legal for retail sale only at licensed outlets in Canada.