Breathe Easy.

Easy for You to Say.

Respiratory Care Awareness and Treatment Options.

For those who live in areas with changing seasons and scenery, OCTOBER is a month that is beautiful in color. Falling leaves, crisp air, apple everything and vibrant colors throughout many landscapes, but, the Fall season can also bring respiratory challenges for many.

In recognition of National Respiratory Care Week—October 23 through 29, we are providing you with aware- ness information on respiratory conditions along with information on treatment availability and options.

Chronic Obstructive Pulmonary Disease (COPD)

Basics about COPD

What is COPD?

According to the Centers of Disease Control and Prevention (CDC), chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis.

Symptoms of COPD include: frequent coughing or wheezing, excess phlegm, mucus, or sputum production, shortness of breath, and trouble taking a deep breath.

Who has COPD?

Chronic lower respiratory disease, primarily COPD, was the fourth leading cause of death in the United States in 2018.¹ Almost 15.7 million Americans (6.4%) reported that they have been diagnosed with COPD.² More than 50% of adults with low pulmonary function were not aware that they had COPD,³ so the actual number may be higher. The following groups were more likely to report COPD in 2013.²

• Women.
• People aged 65 to 74 years and ≥75 years.
• American Indians/Alaska Natives and multiracial non-Hispanics.
• People who were unemployed, retired, or unable to work.
• People with less than a high school education.
• People who were divorced, widowed, or separated.
• Current or former smokers.
• People with a history of asthma.

What causes COPD?

In the United States, tobacco smoke is a key factor in the development and progression of COPD.⁷ Exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role. In the developing world, indoor air quality is thought to play a larger role than it does in the United States. People should try to avoid inhaling tobacco smoke, home and workplace air pollutants, and respiratory infections to prevent developing COPD. Early detection of COPD may change its course and progress.

What are the complications or effects of COPD?

Compared to adults without COPD, those with this disease are more likely to:

Have activity limitations like difficulty walking or climbing stairs.^2,8,9 Be unable to work.^2,8

Need special equipment like portable oxygen tanks.²

Not engage in social activities like eating out, going to places of worship, going to group events, or getting together with friends or neighbors.⁹

Have increased confusion or memory loss.⁸

Have more emergency room visits or overnight hospital stays.¹⁰

Have other chronic diseases like arthritis, congestive heart failure, diabetes, coronary heart disease, stroke, or asthma.^10,11

Have depression or other mental or emotional conditions.^10,11 Report a fair or poor health status.¹²

How is COPD diagnosed?

A simple test, called spirometry, can be used to measure pulmonary—or lung—function and detect COPD in anyone with breathing problems.^3,13

How is COPD treated?

Treatment of COPD requires a careful and thorough evaluation by a physician.³,¹³ COPD treatment can alleviate symptoms, decrease the frequency and severity of exacerbations, and increase exercise tolerance. Treatment options that your physician may consider include:

• Quit smoking. For people who smoke, the most important part of treatment is smoking cessation.
• Avoid tobacco smoke and other air pollutants at home and at work.
• Ask your doctor about pulmonary rehabilitation, which is a personalized treatment program that teaches COPD management strategies to improve quality of life. Programs may include plans that teach people how to breathe better and conserve their energy, as well as provide advice on food and exercise.
• Take medication. Symptoms such as coughing or wheezing can be treated with medication.
• Avoid lung infections. Lung infections can cause serious problems in people with COPD. Certain vaccines, such as flu and pneumococcal vaccines, are especially important for people with COPD. Learn more about vaccination recommendations at https://www.cdc.gov. Respiratory infections should be treated with antibiotics, if appropriate.
• Use supplemental oxygen. Some people may need to use a portable oxygen tank if their blood oxygen levels are low.

References

1. Xu JQ, Murphy SL, Kochanek KD, Arias E. Mortality in the United States, 2018. NCHS Data Brief, Number 355. Hyattsville, MD: National Center for Health Statistics; 2020.
2. Wheaton AG, Cunningham TJ, Ford ES, Croft JB. Employment and activity limitations among adults with chronic obstructive pulmonary disease — United States, 2013. MMWR Morb Mortal Wkly Rep. 2015:64 (11):290–295.
3. Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey 1988-1994. Arch Intern Med. 2000;160:1683–1689.
4. Centers for Disease Control and Prevention. National Vital Statistics System detailed mortality data at Wonder Database website. http://wonder.cdc.gov. Accessed March 3, 2021.
5. Ford ES, Croft JB, Mannino DM, Wheaton AG, Zhang X, Giles WH. COPD surveillance—United States, 1999–2011. Chest.2013;144(1):284–305. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707177/ External. Accessed July 3, 2019.
6. Aryal S, Diaz-Guzman E, Mannino DM. Influence of sex on chronic obstructive pulmonary disease risk and treatment out- comes. Int J Chron Obstruct Pulmon Dis. 2014;9:1145–1154. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206206/. Accessed July 3, 2019.
7. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and productivity losses — United States, 1997–2001. MMWR Morb Mortal Wkly Rep. 2005;54(250):625–628.
8. Greenlund KJ, Liu Y, Deokar AJ, Wheaton AG, Croft JB. Association of chronic obstructive pulmonary disease with increased confusion or memory loss and functional limitations among adults in 21 states, 2011 Behavioral Risk Factor Surveillance System. Prev Chronic Dis. 2016;13:150428. DOI: http://dx.doi.org/10.5888/pcd13.150428.
9. Liu Y, Croft JB, Anderson LA, Wheaton AG, Presley-Cantrell LR, Ford ES. The association of chronic obstructive pulmonary disease, disability, engagement in social activities, and mortality among US adults aged 70 years or older: 1994-2006. Int J COPD. 2014;9:75–83.
10. Wheaton AG, Ford ES, Cunningham TJ, Croft JB. Chronic obstructive pulmonary disease, hospital visits, and co-morbidities— National Survey of Residential Care Facilities, 2010. J Aging Health. 2015;27:480–499.
11. Cunningham TJ, Ford ES, Rolle IV, Wheaton AG, Croft JB. Association of self-reported cigarette smoking with chronic obstructive pulmonary disease and co-morbid chronic conditions in the United States. COPD. 2015;12;276–286.
12. Wheaton AG, Ford ES, Thompson WW, Greenlund KJ, Presley-Cantrell LR, Croft JB. Pulmonary function, chronic respiratory symptoms, and health-related quality of life among adults in the United States—National Health and Nutrition Examination Survey 2007-2010. BMC Public Health. 2013;13:854.
13. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Annals Intern Med. 2011;155:179–191.

Are you often short of breath when doing things like running errands or climbing stairs? Learn if you are at risk for having COPD.

Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, makes breathing hard for the 16 million Americans who have been diagnosed with it. Millions more suffer from COPD but have not been diagnosed and are not being treated. COPD can limit your ability to work or even do simple daily tasks. COPD can also make you more likely to get severely ill from COVID-19.

Could you have COPD?

The main cause of COPD is tobacco smoke, so if you smoke or used to smoke, you are at a higher risk of hav- ing COPD. Exposure to air pollution in the home or at work, family history, and respiratory infections like pneumonia also increase your risk.

How is COPD diagnosed?

COPD is diagnosed using a simple breathing test called spirometry.

How is COPD treated?

If you have COPD, the most important steps you can take to reduce symptoms and improve your quality of life are:

• Quit smoking. For people who smoke, the most important part of treatment is to stop smoking.
• Avoid tobacco smoke and other air pollutants at home and at work. Your doctor may also consider the following treatment options:

• Medicine. Symptoms such as coughing or wheezing can be treated with medicine.
• Pulmonary rehabilitation, a personalized treatment program that teaches you how to manage your COPD symptoms to improve quality of life. Plans may include learning to breathe better, how to conserve your energy, and what types of food and exercise are right for you.
• Prevention and treatment of lung infections. Lung infections can cause serious problems in people with COPD. Certain vaccines, such as flu and pneumonia vaccines, are especially important for people with COPD. Learn more about vaccination recommendations at https://www.cdc.gov. Respiratory infections should be treated with antibiotics, if appropriate.
• Supplemental oxygen. A portable oxygen tank may be needed if blood oxygen levels are low.

Pneumonia

Causes of Pneumonia:

• Viruses, bacteria, and fungi can all cause pneumonia.
• In the United States, common causes of viral pneumonia are Influenza viruses Respiratory syncytial virus (RSV) SARS-CoV-2 (the virus that causes COVID-19) Common causes of bacterial pneumonia are Streptococcus pneumoniae (pneumococcus) and, especially in kids, Mycoplasma pneumoniae.

• The bacteria and viruses that most commonly cause pneumonia in the community are different from those in healthcare settings. However, clinicians are not always able to find out which germ caused someone to get sick with pneumonia.
• Learn more below about the infections that commonly cause pneumonia.

Defining Types of Pneumonia:

• Community-acquired pneumonia is when someone develops pneumonia in the community (not in a hospital).
• Healthcare-associated pneumonia is when someone develops pneumonia during or following a stay in a healthcare setting.
• Healthcare settings include hospitals, long-term care facilities, and dialysis centers.
• Ventilator-associated pneumonia is when someone gets pneumonia after being on a ventilator, a machine that supports breathing.

Infections That Commonly Cause Pneumonia:

• COVID-19
• Human Metapneumovirus (HMPV) Infection
• Human Parainfluenza Virus (HPIV) Infection
• Influenza (Flu)
• Legionnaires' Disease
• Mycoplasma pneumoniae Infection
• Pneumococcal Disease Respiratory Syncytial Virus (RSV) Infection
• Rhinovirus Infection

Other Causes of Pneumonia

Some less common causes of pneumonia include

• Adenovirus infection
• Chlamydia pneumoniae infection
• Chickenpox Fungal infections
• Haemophilus influenzae disease
• Measles Pertussis (whooping cough)
• Psittacosis

Risk Factors for Pneumonia:

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. However, some people are at increased risk for getting pneumonia.

• Being a certain age, having certain medical conditions, and smoking can increase a person's risk for pneumonia.

Certain people are more likely to get pneumonia:

• Adults 65 years or older
• Children younger than 5 years old
• People who have ongoing medical conditions
• People who smoke cigarettes

Pneumonia Prevention:

• Lower your risk of pneumonia with vaccines and other healthy living practices.
• Most of the people affected by pneumonia in the United States are adults.
• CDC data show more than 47,000 people died from pneumonia in the United States during 2020.
• Vaccines and appropriate treatment (like antibiotics and antivirals) could prevent many of these deaths.

In the United States, vaccines can help prevent infection by some of the bacteria and viruses that can cause pneumonia. Learn more about who is recommended each of these vaccines:

• COVID-19
• Haemophilus influenzae type b (Hib) Influenza (flu)
• Measles
• Pertussis (whooping cough) Pneumococcal
• Varicella (chickenpox)

These vaccines are safe, but side effects can occur. Most side effects are mild and go away on their own within a few days. See the vaccine information statements to learn more about common side effects. Encourage friends and loved ones to make sure they are up to date with their vaccines.

Protect your health with these healthy living practices:

• Avoid people who are sick. If you are sick, stay away from others as much as possible to keep from getting them sick.
• You can also help prevent respiratory infections by:
  • Washing your hands regularly
  • Cleaning and disinfecting surfaces that are touched a lot
  • Coughing or sneezing into a tissue or into your elbow or sleeve
  • Limiting contact with cigarette smoke or quitting smoking
  • Taking good care of medical conditions (like asthma, diabetes, or heart disease)

Information from the CDC (Centers for Disease Control and Prevention) website: https://www.cdc.gov

Asthma:

What Is Asthma?

Asthma is a disease that affects your lungs. It is one of the most common long-term diseases of children, but adults can have asthma, too. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning.

If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs. We don't know all the things that can cause asthma, but we do know that genetic, environmental, and occupational factors have been linked to developing asthma. If someone in your

immediate family has asthma, you are more likely to have it.

"Atopy," the genetic tendency to develop an allergic disease, can play a big part in developing allergic asthma. However, not all asthma is allergic asthma. Being exposed to things in the environment, like mold or dampness, some allergens such as dust mites, and secondhand tobacco smoke have been linked to developing asthma.

Air pollution and viral lung infection may also lead to asthma. Occupational asthma occurs when someone who never had asthma develops it because he or she is exposed to something at work. This can happen if you develop an allergy to something at work such as mold or if you are exposed to irritants such as wood dust or chemicals at work over and over at lower levels or all at once at higher levels.

How Can You Tell if You Have Asthma?

It can be hard to tell if someone has asthma, especially in children under age 5. Having a doctor check how well your lungs work and check for allergies can help you find out if you have asthma. During a checkup, a doctor will ask if you cough a lot, especially at night.

• He or she will also ask whether your breathing problems are worse after physical activity or at certain times of year.
• The doctor will then ask about chest tightness, wheezing, and colds lasting more than 10 days.
• He or she will ask whether anyone in your family has or has had asthma, allergies, or other breathing problems.
• Finally, the doctor will ask questions about your home and whether you have missed school or work or have trouble doing certain things.
• The doctor may also do a breathing test, called spirometry, to find out how well your lungs are working by testing how much air you can breathe out after taking a very deep breath before and after you use asthma medicine.

What Is an Asthma Attack?

An asthma attack may include coughing, chest tightness, wheezing, and trouble breathing. The attack happens in your body's airways, which are the paths that carry air to your lungs. As the air moves through your lungs, the airways become smaller, like the branches of a tree are smaller than the tree trunk.

During an asthma attack, the sides of the airways in your lungs swell and the airways shrink. Less air gets in and out of your lungs, and mucous that your body makes clogs up the airways.

You can control your asthma by knowing the warning signs of an asthma attack, staying away from things that cause an attack, and following your doctor's advice.

When you control your asthma:

• you won't have symptoms such as wheezing or coughing,
• you'll sleep better,
• you won't miss work or school,
• you can take part in all physical activities, and you won't have to go to the hospital.

Asthma, continued

What Causes an Asthma Attack?

An asthma attack can happen when you are exposed to "asthma triggers." Your asthma triggers can be very different from someone else's asthma triggers. Know your triggers and learn how to avoid them. Watch out for an attack when you can't avoid your triggers. Some of the most common triggers are tobacco smoke, dust mites, outdoor air pollution, cockroach allergen, pets, mold, smoke from burning wood or grass, and

infections like flu.

How Is Asthma Treated?

• Take your medicine exactly as your doctor tells you and stay away from things that can trigger an attack to control your asthma.
• Everyone with asthma does not take the same medicine. You can breathe in some medicines and take other medicines as a pill.
• Asthma medicines come in two types—quick-relief and long-term control. Quick-relief medicines control the symptoms of an asthma attack. If you need to use your quick-relief medicines more and more, visit your doctor to see if you need a different medicine. Long-term control medicines help you have fewer and milder attacks, but they don't help you while you are having an asthma attack.
• Asthma medicines can have side effects, but most side effects are mild and soon go away. Ask your doctor about the side effects of your medicines.

Remember – you can control your asthma. With your doctor's help, make your own asthma action plan.

Decide who should have a copy of your plan and where he or she should keep it. Take your long-term control medicine even when you don't have symptoms.

Information from the CDC (Centers for Disease Control and Prevention) website: https://www.cdc.gov