November is Chronic Obstructive Pulmonary Disease (COPD) Awareness Month—a chance to educate the public on this serious lung disease that affects 16.4 million adults in the U.S., according to the American Lung Association (ALA), and to provide resources for those diagnosed with the disease to help them live fuller, more active lives. Awareness is clearly needed: Despite being largely a preventable disease, rates of COPD are expected to grow 23% in the next 25 years, according to projections in a 2023 study in the Journal of the American Medical Association. Today, the ALA estimates that more than 300 million people worldwide could be living with COPD.

The good news? There are more effective therapies available for COPD today than even just a decade ago, offering hope for higher quality of life and breathing function for people living with this condition. To provide insight on the current COPD landscape—and share some promising developments that may be coming just around the corner—we spoke with Jordan Lee, M.D., a pulmonary critical care specialist at Queen’s Pulmonary and Critical Care Group in Honolulu, HI, and panelist for the ALA’s upcoming webinar on COPD management.

HealthCentral: How have COPD treatment options improved during the past 10 years?
Jordan Lee, M.D.: When I was first going through medical training in 2014, we would always treat COPD patients with just one or two inhalers: a long-acting muscarinic agent to relax airway muscles, as well as a long-acting beta agonist, like a bronchodilator, which also relaxes tightened muscles. Those are still very helpful but in general, we have a better understanding now when it comes to the pathophysiology of COPD and how it’s affected by chronic airway
Because of that, there’s been a shift toward triple therapy for COPD, which includes those two options, as well as inhaled corticosteroids. That’s become the gold standard because it’s hitting three different pathways in the respiratory system, leading to better breathing. This [approach] reduces symptoms and lowers the rate of COPD exacerbations in a year.

Abstract

To explore opportunities for improving care based on the experiences and perspectives of different types of COPD patients based on the Information-Motivation-Behavioral skills (IMB) model with poor self-management behaviors. We used ethnographic methods (over 1000 h of observations for 30 participants), and conducted 34 semi-structured interviews with different patient profiles. Data were transcribed verbatim and analysed using thematic analysis. According to the IMB model, we divided participants into three categories, namely low-information and low motivation group, high information but low motivation group and low-information but strong motivation group. The first group had limited opportunities to acquire knowledge and decreased memory capacity. Also, patients did not feel the seriousness of COPD, or thought that self-management was not important, which led to the lack of self-management knowledge and motivation for this group of patients. In the second group, patients were pessimistic about the cure of the disease because of too much information or too much attention to the details of knowledge, which was also the reason why patients were unwilling to implement self-management although they had mastered enough knowledge. The third patient profile, with strong motivation, would seek health information resources through various channels. Because of this, they could easily acquire incorrect or unscientific information, which would make the situation worse. This qualitative study suggested COPD patients exhibited distinct self-management experiences, barriers, and recommendations due to variations in information processing and motivational characteristics. Future research should tailor precise self-management strategies based on individual patient profiles.

Introduction

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with no cure that can cause a range of symptoms including dyspnea, cough, expectoration and systemic inflammation, especially in the elderly¹. Self-management has been advocated for mitigating disease progression, curbing medical costs, and enhancing health-related quality of life among COPD patients². Despite the prevalent reports on the benefits of self-management, COPD patients continue to exhibit a suboptimal level of self-management skills. For example: In a study, researchers used the Chinese version of Chronic Disease Self-Management Study Program (CDSSP) to evaluate the self-management behaviors of COPD patients, which includes the frequency of exercise, cognitive symptom management, and communication with physician. Findings from this study showed that participants had a low level of self-management behaviors³. The factors contributing to this status are many and likely include the knowledge of self-management and the motivation to implement it, as advocated by the Information-Motivation-Behavioral skills (IMB) model: as individuals acquire knowledge regarding health management strategies and their motivation intensifies, they progressively master and refine the behavioral skills required for positive transformation. In essence, the IMB model highlights the pivotal role of these three components in fostering a proactive stance towards health management (Fig. 1)⁴. Among COPD patients exhibiting suboptimal self-management behaviors, a subset may possess limited self-management knowledge, some may be devoid of motivation for sustained self-care, while others may experience both these deficiencie⁵. Nevertheless, the self-management experiences and barriers faced by COPD patients lacking either information, motivation, or both, may vary significantly. Qualitative research may help improve the quality of care that people receive through providing a detailed and nuanced picture of their experiences. However, previous qualitative studies have primarily focused on exploring the experiences and barriers of self-management among COPD patients. The results showed that the main barriers to the low self-management ability of COPD patients was the limited understanding of self-management knowledge or related to patients’ negative emotions, and emphasized the importance of health literacy and psychological counseling from their family^6,7. However, these previous studies did not notice the differences between COPD patients. For example, a study showed that even if patients had a wealth of self-management knowledge, their self-management ability was still low⁵. This showed that there were other factors affecting self-management ability in COPD patients. An in-depth analysis of patients with varying factors of self-management barriers and the differences in their self-management experiences and barriers has not been conducted.

Let’s talk about a dirty little secret in COPD care: most people are using their inhalers all wrong. Studies show that up to 90% of patients don’t use their devices correctly. Think about that. You could be doing everything else right—taking your walks, eating well—but if that vital medicine isn’t getting deep into your lungs where it belongs, you’re just going through the motions.

It’s like having a key to your front door, but fumbling with the lock. You never quite get inside. The result? Poor symptom control, more flare-ups, and a feeling that your treatments “just don’t work.”

The Usual Suspects: Where Your Inhaler Routine Goes Wrong

Different inhalers have different tricks. Here’s where things often fall apart:

The Spray-and-Pray (Metered-Dose Inhalers): The classic “puffer” requires a perfect sync between pressing the canister and breathing in slowly. A split-second mistiming, and the medicine sprays onto your tongue or the back of your throat instead of your airways.
The Weak Suck (Dry Powder Inhalers): These devices don’t spray; they require you to breathe in forcefully and deeply to pull the powder out. A gentle, shallow breath won’t cut it.
The Exhale Fumble: Blowing into your inhaler before you inhale can ruin the dose in a dry powder device.
The Forgotten Hold: Not holding your breath for 5-10 seconds after inhaling means the medicine doesn’t have time to settle in your lungs.
Take Control: Become the Boss of Your Puffs

You don’t have to be part of that 90%. You can make sure every dose counts.

Demand a Demo. Don’t Just Nod. The next time you see your doctor or pharmacist, don’t just say “I’ve got it.” Bring your inhaler and show them your technique. Let them coach you. There’s no shame in getting it right.
Ask About a Spacer. If you use a metered-dose inhaler (puffer), a spacer or valved holding chamber is a game-changer. It acts like a middleman, holding the medicine in a chamber so you can inhale it slowly and deeply, with no timing required. It dramatically improves how much medicine reaches your lungs.
Stick to the Script. Rescue inhalers (like albuterol) are for sudden symptoms. Maintenance inhalers are for every day, whether you feel great or not. Using your maintenance meds consistently is what keeps the inflammation down and prevents bad days. Skipping them because you “feel fine” is like canceling your insurance right before a storm.
Your inhaler is one of the most powerful tools in your toolbox. But a tool is only as good as the person using it. Take the time to master it. Your lungs will thank you for it.

Let’s talk about a dirty little secret in COPD care: most people are using their inhalers all wrong. Studies show that up to 90% of patients don’t use their devices correctly. Think about that. You could be doing everything else right—taking your walks, eating well—but if that vital medicine isn’t getting deep into your lungs where it belongs, you’re just going through the motions.

It’s like having a key to your front door, but fumbling with the lock. You never quite get inside. The result? Poor symptom control, more flare-ups, and a feeling that your treatments “just don’t work.”

The Usual Suspects: Where Your Inhaler Routine Goes Wrong

Different inhalers have different tricks. Here’s where things often fall apart:

The Spray-and-Pray (Metered-Dose Inhalers): The classic “puffer” requires a perfect sync between pressing the canister and breathing in slowly. A split-second mistiming, and the medicine sprays onto your tongue or the back of your throat instead of your airways.
The Weak Suck (Dry Powder Inhalers): These devices don’t spray; they require you to breathe in forcefully and deeply to pull the powder out. A gentle, shallow breath won’t cut it.
The Exhale Fumble: Blowing into your inhaler before you inhale can ruin the dose in a dry powder device.
The Forgotten Hold: Not holding your breath for 5-10 seconds after inhaling means the medicine doesn’t have time to settle in your lungs.
Take Control: Become the Boss of Your Puffs

You don’t have to be part of that 90%. You can make sure every dose counts.

Demand a Demo. Don’t Just Nod. The next time you see your doctor or pharmacist, don’t just say “I’ve got it.” Bring your inhaler and show them your technique. Let them coach you. There’s no shame in getting it right.
Ask About a Spacer. If you use a metered-dose inhaler (puffer), a spacer or valved holding chamber is a game-changer. It acts like a middleman, holding the medicine in a chamber so you can inhale it slowly and deeply, with no timing required. It dramatically improves how much medicine reaches your lungs.
Stick to the Script. Rescue inhalers (like albuterol) are for sudden symptoms. Maintenance inhalers are for every day, whether you feel great or not. Using your maintenance meds consistently is what keeps the inflammation down and prevents bad days. Skipping them because you “feel fine” is like canceling your insurance right before a storm.
Your inhaler is one of the most powerful tools in your toolbox. But a tool is only as good as the person using it. Take the time to master it. Your lungs will thank you for it.

For COPD Awareness Month, a top pulmonologist clears the air about chronic obstructive pulmonary disease as he shares new and emerging treatment options.

November is Chronic Obstructive Pulmonary Disease (COPD) Awareness Month—a chance to educate the public on this serious lung disease that affects 16.4 million adults in the U.S., according to the American Lung Association (ALA), and to provide resources for those diagnosed with the disease to help them live fuller, more active lives. Awareness is clearly needed: Despite being largely a preventable disease, rates of COPD are expected to grow 23% in the next 25 years, according to projections in a 2023 study in the Journal of the American Medical Association. Today, the ALA estimates that more than 300 million people worldwide could be living with COPD.

The good news? There are more effective therapies available for COPD today than even just a decade ago, offering hope for higher quality of life and breathing function for people living with this condition. To provide insight on the current COPD landscape—and share some promising developments that may be coming just around the corner—we spoke with Jordan Lee, M.D., a pulmonary critical care specialist at Queen’s Pulmonary and Critical Care Group in Honolulu, HI, and panelist for the ALA’s upcoming webinar on COPD management.

HealthCentral: How have COPD treatment options improved during the past 10 years?
Jordan Lee, M.D.: When I was first going through medical training in 2014, we would always treat COPD patients with just one or two inhalers: a long-acting muscarinic agent to relax airway muscles, as well as a long-acting beta agonist, like a bronchodilator, which also relaxes tightened muscles. Those are still very helpful but in general, we have a better understanding now when it comes to the pathophysiology of COPD and how it’s affected by chronic airway
Because of that, there’s been a shift toward triple therapy for COPD, which includes those two options, as well as inhaled corticosteroids. That’s become the gold standard because it’s hitting three different pathways in the respiratory system, leading to better breathing. This [approach] reduces symptoms and lowers the rate of COPD exacerbations in a year.

HC: What makes you most hopeful about emerging and experimental COPD therapies?
Dr. Lee: What’s fascinating right now is the use of biologic therapy, which are injectable medicines that can dampen the inflammatory process in the lungs. For example, Dupixent [dupilumab] was just approved by the FDA last year, and it’s already an exciting option, particularly for patients who have both asthma and COPD, or who have moderate-to-severe COPD alone. Biologics, in general, are showing good response rates, especially for those who don’t respond to triple therapy, so I expect this to be an area that expands with more usage and more data.

Another option that’s likely to be promising for the future is a procedure called an endobronchial valve, which is minimally invasive and addresses issues in the upper regions of the lungs. In the past, surgery would have required a more extensive, open-chest procedure—a lung volume reduction—in which damaged parts of the lungs are removed so the healthier parts can expand, and blood flow can be redistributed to those areas. While that’s still an option for some patients, use of the valve can have the same effect without being a major operation that requires much more recovery time.

HC: Is COPD reversible if you begin treatment in its earliest stages?
Dr. Lee: For the most part, those with COPD have had years of exposure to some type of damaging substance, usually cigarette smoke, which is the majority of COPD cases. But there can also be secondhand smoke or environmental toxins. Unfortunately, these patients have long-term damage that’s not reversible, although the symptoms can be managed. Unlike the liver, which has a degree of regenerative capacity, the lungs are not as resilient. Once they’re damaged, you’re kind of stuck. However, it’s true that beginning treatment as early as possible can have some effect, especially if it involves smoking cessation, so you’re not continuing to damage lung tissue.

If you have COPD, you know the main symptoms all too well: the shortness of breath, the persistent cough, the fatigue. But what about the other health issues that often show up uninvited? The truth is, COPD rarely travels alone. It often brings along other chronic conditions—known as comorbidities—that can complicate your health picture.

Understanding these connections is crucial because treating COPD isn’t just about your lungs; it’s about managing your whole health.

The Usual Suspects: Who Else Might Be at the Table?

1. Heart Disease: This is the most common and serious partner to COPD. The strain of low oxygen levels and inflammation can weaken your heart over time. Conditions like high blood pressure, heart failure, and coronary artery disease are frequent companions. Action Step: Monitor your blood pressure and report any new chest discomfort or swollen ankles to your doctor immediately.
2. The Anxiety and Depression Duo: Struggling to breathe is terrifying. It’s no wonder that feelings of panic, anxiety, and depression are common. This isn’t a “weakness”—it’s a physiological and emotional response. Action Step: Talk to your doctor about these feelings. Counseling, support groups, and sometimes medication can dramatically improve your quality of life.
3. Osteoporosis: Weakened bones are more common in people with COPD. This can be due to chronic inflammation, long-term use of corticosteroid medications, and reduced physical activity. Action Step: Ask your doctor about a bone density scan and ensure you’re getting enough calcium and Vitamin D.
4. Sleep Apnea: When COPD and sleep apnea occur together, it’s called “Overlap Syndrome.” This combination is particularly dangerous, leading to even lower oxygen levels at night. Action Step: If you snore loudly, wake up gasping, or feel exhausted despite a full night’s sleep, ask your doctor about a sleep study.

Managing COPD is a team sport, and your team captain—your primary care doctor—needs to see the whole playing field. By keeping an eye on these “other guests,” you can create a comprehensive health plan that protects more than just your lungs.

When people look at you, they see your physical self. They might notice you get winded easily. What they can’t see is the invisible weight you carry every day: the frustration, the grief for the life you once had, the anxiety about your next breath, and the loneliness that can come with a chronic illness.

This emotional burden is real, and it’s heavy. Acknowledging it is the first step toward lifting it.

Tending to Your Emotional Landscape:

1. Grieve, Then Grow: It’s normal and healthy to grieve the loss of your former abilities. Allow yourself to feel that sadness. But don’t set up camp there. The goal is to acknowledge the loss, then slowly begin building a new, fulfilling life within your current capabilities.
2. Break the Isolation Cycle: COPD can be an isolating disease. You cancel plans because you don’t feel well, and soon, people stop inviting you. Fight this cycle. Be the one to initiate contact. Invite a friend over for a cup of tea and a chat. A short, seated visit can do wonders for your spirit.
3. Find Your New Tribe: Sometimes, the people who understand you best are those walking the same path. A COPD support group (in-person or online) can be a lifeline. It’s a place to share tips, vent without judgment, and be reminded that you are not alone in this fight. Your “tribe” gets it.
4. Redefine Your Purpose: Maybe you can’t coach the soccer team anymore, but you can share your wisdom in other ways. Could you mentor a young person over the phone? Write down your family stories? Finding a new sense of purpose, no matter how small it seems, gives you a reason to get up in the morning and shifts your focus from what you’ve lost to what you still have to give.

Your mental health is the foundation upon which everything else is built. By caring for your mind and spirit with the same diligence you care for your lungs, you build the resilience needed not just to live with COPD, but to live well.

Let’s talk about a dirty little secret in COPD care: most people are using their inhalers all wrong. Studies show that up to 90% of patients don’t use their devices correctly. Think about that. You could be doing everything else right—taking your walks, eating well—but if that vital medicine isn’t getting deep into your lungs where it belongs, you’re just going through the motions.

It’s like having a key to your front door, but fumbling with the lock. You never quite get inside. The result? Poor symptom control, more flare-ups, and a feeling that your treatments “just don’t work.”

The Usual Suspects: Where Your Inhaler Routine Goes Wrong

Different inhalers have different tricks. Here’s where things often fall apart:

• The Spray-and-Pray (Metered-Dose Inhalers): The classic “puffer” requires a perfect sync between pressing the canister and breathing in slowly. A split-second mistiming, and the medicine sprays onto your tongue or the back of your throat instead of your airways.
• The Weak Suck (Dry Powder Inhalers): These devices don’t spray; they require you to breathe in forcefully and deeply to pull the powder out. A gentle, shallow breath won’t cut it.
• The Exhale Fumble: Blowing into your inhaler before you inhale can ruin the dose in a dry powder device.
• The Forgotten Hold: Not holding your breath for 5-10 seconds after inhaling means the medicine doesn’t have time to settle in your lungs.

Take Control: Become the Boss of Your Puffs

You don’t have to be part of that 90%. You can make sure every dose counts.

1. Demand a Demo. Don’t Just Nod. The next time you see your doctor or pharmacist, don’t just say “I’ve got it.” Bring your inhaler and show them your technique. Let them coach you. There’s no shame in getting it right.
2. Ask About a Spacer. If you use a metered-dose inhaler (puffer), a spacer or valved holding chamber is a game-changer. It acts like a middleman, holding the medicine in a chamber so you can inhale it slowly and deeply, with no timing required. It dramatically improves how much medicine reaches your lungs.
3. Stick to the Script. Rescue inhalers (like albuterol) are for sudden symptoms. Maintenance inhalers are for every day, whether you feel great or not. Using your maintenance meds consistently is what keeps the inflammation down and prevents bad days. Skipping them because you “feel fine” is like canceling your insurance right before a storm.

Your inhaler is one of the most powerful tools in your toolbox. But a tool is only as good as the person using it. Take the time to master it. Your lungs will thank you for it.