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Emphysema & COPD

A long-term lung disease in which damaged air sacs trap stale air and make it hard to breathe out — one of the two main forms of COPD. There is no cure, but treatment, pulmonary rehab and daily habits can help you breathe and live better.

Call 911 — or have someone call for you — if you or someone with COPD has:

A rapid increase in shortness of breath is also a reason to call 911 or go to the emergency room (MedlinePlus).

Home oxygen and fire: oxygen is a fire risk, so never smoke or use flammable materials while using it (NHLBI). Oxygen makes things burn much faster; no one should smoke in a room where oxygen is used, and oxygen should be kept at least 6 feet from candles, fireplaces, wood stoves and space heaters (MedlinePlus). FDA notes that people using supplemental oxygen at home are at increased risk of fire (FDA).

What are emphysema and COPD?

COPD (chronic obstructive pulmonary disease) is a condition caused by damage to the airways or other parts of the lung that blocks airflow and makes it hard to breathe. It is progressive, so symptoms often develop slowly but worsen over time (NHLBI). The term covers two main conditions (NHLBI):

  • Emphysema develops when the walls between many of the lungs’ tiny air sacs are damaged. Healthy air sacs are stretchy, filling and emptying like small balloons; in emphysema it is harder for the lungs to move air out (NHLBI). The damage can leave fewer, larger air sacs instead of many tiny ones, making it harder to move oxygen in and carbon dioxide out (MedlinePlus).
  • Chronic bronchitis is caused by repeated or constant irritation and inflammation of the airway lining, with a lot of thick mucus (NHLBI). See our Bronchitis guide.

Most people with COPD have a mix of both (NHLBI). There is no cure, but treatments and lifestyle changes can help manage symptoms (American Lung Association) and slow the disease (NHLBI).

How common is it?

Nearly 16 million U.S. adults have COPD, and many more don’t know they have it (CDC). In 2025, 4.4% of U.S. adults had ever been diagnosed with COPD, emphysema or chronic bronchitis (CDC, FastStats). Over three million people in the U.S. are living with emphysema (American Lung Association).

What causes it?

About 1 in 4 people living with COPD never smoked (American Lung Association), and most are at least 40 when symptoms begin (NHLBI).

Symptoms

At first COPD may cause no symptoms or only mild ones. Common symptoms are shortness of breath, especially with activity; an ongoing cough, often with a lot of mucus and often the first symptom; wheezing; chest tightness; and tiredness. Severe COPD can bring loss of appetite, weight and muscle, anxiety and depression (NHLBI). Because symptoms develop slowly, many people don’t know they have COPD (MedlinePlus).

Flare-ups (exacerbations)

A flare-up is a sudden worsening of symptoms, triggered by things such as smells, cold air, poor air quality, colds, the flu or a lung infection (NHLBI). You may cough or wheeze more, bring up more mucus or mucus of a different color, and find it harder to breathe, for 2 days or more (MedlinePlus). Call your provider right away if symptoms worsen suddenly (NHLBI), and see Your COPD action plan for flare-ups below.

How it’s diagnosed: spirometry

The main test is spirometry: you take a deep breath and blow as hard as you can into a tube connected to a small machine, which measures how much air you breathe out and how fast. It can detect COPD before symptoms are noticed and shows how serious it is. A chest X-ray can’t diagnose COPD but can find other conditions. If you are diagnosed with COPD, ask about screening for AAT deficiency (NHLBI). Doctors also draw on the international GOLD strategy report, now in its 2026 edition (GOLD).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Quitting smoking, daily inhaled medicines (long-acting bronchodilators, with inhaled steroids for some), add-on medicines for some people, vaccines, pulmonary rehab, oxygen if levels are low, and procedures or transplant for a few. Pulmonary rehab under Medicare Part B: 20% of the Medicare-approved amount after the yearly deductible ($283 in 2026), plus a per-session copayment in hospital outpatient settings. Part D drug costs are capped at $2,100 in 2026; in 2024 some makers announced $35-a-month inhaler caps for people with private insurance or none. Other care: cost estimate being researched. No cure, but quitting smoking slows lung damage, and treatment and pulmonary rehab can ease breathlessness, cut flare-ups and help you stay active.
Chiropractic No established role in treating emphysema or COPD. Cost estimate being researched. Reviews of manual therapy in COPD found few, low-quality trials and no clear benefit for lung function or quality of life. Not a substitute for inhalers or rehab.
Acupuncture Needle treatments, often weekly over several weeks, alongside standard COPD care. Cost estimate being researched. Some trials and reviews report less breathlessness and longer walking distance, but most studies are small or of moderate quality. An add-on at most.
Herbal medicine No herb replaces COPD medicine. N-acetylcysteine (NAC), a mucus-thinning medicine also sold as a supplement, is the one most studied. Cost estimate being researched. Mucus-thinning medicines including NAC may slightly reduce flare-ups, with little effect on lung function or quality of life. Check with your pharmacist first.
Massage therapy Relaxation massage as comfort care, alongside exercise and pulmonary rehab. Cost estimate being researched. A few small studies; massage for COPD isn’t backed by substantial evidence, though it may ease anxiety for some people.
MBHA Wellness Coach Quitting smoking, pursed-lip and belly breathing, staying active, nutrition, avoiding smoke and polluted air, saving energy, emotional support and a written action plan. Cost estimate being researched. Quitline coaching at 1-800-QUIT-NOW is free. Quitting is the most important step for smokers with COPD. Daily habits can help you breathe easier, spot flare-ups early and stay active.

Approach 1 of 6

Conventional medicine (AMA)

Your treatment plan depends on your symptoms and how severe your COPD is (NHLBI). Treatment can help control symptoms, slow the disease, reduce flare-ups and help you stay active (American Lung Association).

1. Quit smoking — the most important step

For smokers with COPD, the most important part of treatment is to stop smoking (CDC); it is the best way to slow lung damage (MedlinePlus). Continued smoking may also make COPD medicines work less well (American Lung Association). See Quitting smoking below.

2. Inhaled medicines

Inhalers send medicine straight to the lungs. Not all inhalers are used the same way, so ask your provider to show you the right technique (NHLBI).

3. Add-on medicines for some people

4. Vaccines

People with lung disease, including COPD, are at higher risk of serious problems from certain vaccine-preventable diseases (CDC).

5. Pulmonary rehabilitation and oxygen

Pulmonary rehab is one of the best-proven treatments — see the section below. Portable oxygen can help you breathe easier if your blood oxygen levels are low (CDC); tests show whether you need it (American Lung Association). Follow the fire-safety advice at the top of this page.

6. Procedures for selected people

Usually only when serious symptoms haven’t improved with medicines (NHLBI), and only a few people benefit (MedlinePlus): endobronchial valves, one-way valves that let trapped air escape from damaged parts of the lung; lung volume reduction surgery, which removes damaged tissue so the rest works better; and lung transplant for severe disease that doesn’t respond to other treatments (NHLBI).

7. Alpha-1 augmentation therapy

People with emphysema from AAT deficiency may need lifelong augmentation therapy, which raises the AAT protein to help slow lung damage, alongside standard COPD treatment (NHLBI).

If you also have obstructive sleep apnea, ask about CPAP (American Lung Association); we plan a separate Sleep Apnea guide.

What it costs

  • Pulmonary rehab: Medicare Part B covers a comprehensive program if you have moderate to very severe COPD. In a doctor’s office you pay 20% of the Medicare-approved amount; in a hospital outpatient setting you also pay a copayment each session; the Part B deductible applies (Medicare.gov). That deductible is $283 in 2026 (Medicare.gov).
  • Inhalers: under Medicare drug coverage (Part D), out-of-pocket spending on covered drugs is capped at $2,100 in 2026 (Medicare.gov). In 2024 three inhaler makers announced programs capping many asthma and COPD inhalers at $35 a month or less for people with private insurance or no insurance; people on Medicare or Medicaid aren’t eligible for those discounts (American Lung Association).
  • Doctor visits, oxygen, procedures and biologic medicines: MBHA cost estimate being researched.

How well it works — what to expect

COPD is a long-term illness, and it gets worse more quickly if you keep smoking (MedlinePlus). Medicine does not cure COPD, but it can improve symptoms, reduce how often and how badly flare-ups happen, and help you stay more active (American Lung Association).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no established role in treating emphysema or COPD, and no spinal adjustment replaces inhaled medicines, oxygen or pulmonary rehab.

What the research says

Safety

Mild, short-lived side effects such as soreness, stiffness or headache are common after spinal manipulation; serious problems are rare (NCCIH). People with COPD may have thinning bones (osteoporosis) (MedlinePlus), so talk with your lung care team before any hands-on treatment.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied as an add-on to standard COPD care, mostly for breathlessness and walking distance. The American Lung Association notes that complementary therapies such as acupuncture cannot treat COPD but may improve symptoms and quality of life (American Lung Association).

What the research says

In short: acupuncture may give some people extra relief from breathlessness when used alongside — never instead of — inhalers and pulmonary rehab. Better-quality studies are still needed.

Safety

Relatively few complications have been reported, but nonsterile needles and improper technique have caused serious problems, including infections and punctured organs (NCCIH). Choose a licensed practitioner and tell them about your lung condition and any blood thinners you take.

What it costs

MBHA cost estimate being researched.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement replaces inhalers or other COPD medicines. Never stop standard treatment without talking to your provider, and be wary of any product that promises to cure COPD (American Lung Association). Some herbs and supplements can interact with medicines, so tell your providers and pharmacist about everything you take (NCCIH). We don’t list doses here.

N-acetylcysteine (NAC)

NAC is a mucus-thinning (mucolytic) medicine. A Cochrane review of 38 trials with more than 10,000 people with chronic bronchitis or COPD — testing NAC and similar medicines — found a small reduction in the chance of a flare-up and in days of disability, but little effect on lung function or quality of life. Newer studies showed less benefit than older ones, so the benefit may be smaller than first thought (Cochrane review, 2019). In the U.S., NAC was approved as a new drug before it was sold as a supplement, so FDA says it is excluded from the legal definition of a dietary supplement — although FDA has said it won’t act against certain NAC products labeled as supplements (FDA). Ask your doctor or pharmacist before trying it.

Don’t smoke herbs or vape

Herbal cigarettes with no tobacco are still dangerous to your health because they give off tar, particles and carbon monoxide (American Cancer Society). E-cigarette aerosol can contain cancer-causing chemicals, heavy metals and tiny particles that can be inhaled deep into the lungs (CDC), and no e-cigarette has been approved by FDA as a quit-smoking aid (CDC).

Before you try any herb or supplement, talk with your doctor or pharmacist, especially if you take other medicines (NCCIH), and make sure it won’t interfere with your standard treatment (American Lung Association).

Approach 5 of 6

Massage therapy

Massage is not a treatment for emphysema or COPD itself, but some people find it relaxing, and the American Lung Association lists massage among complementary therapies that may help with anxiety and quality of life when used with standard care (American Lung Association).

What the research says

Safety

The risk of harm from massage appears low, though rare serious problems such as blood clots, nerve injury or broken bones have been reported, mostly with vigorous massage or in people at higher risk, such as older adults (NCCIH). Tell your therapist about your lung condition and any oxygen you use.

What it costs

MBHA cost estimate being researched.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your care team’s advice into daily habits that protect your lungs and help you stay active.

Quitting support

A coach can help you set a quit date, plan for cravings and stick with treatment, alongside free, confidential phone coaching from 1-800-QUIT-NOW (CDC). See Quitting smoking below.

Breathing techniques

Pursed-lip breathing slows your breathing and keeps the airways open longer: sit and relax your shoulders, breathe in slowly through your nose, then purse your lips as if to whistle and breathe out slowly, for longer than you breathed in. Belly (diaphragmatic) breathing: breathe in through your nose and feel your belly rise, then breathe out through your mouth two to three times as long. If you are still short of breath, call 911 (American Lung Association). Pulmonary rehab teaches these techniques too (NHLBI).

Staying active

Physical activity can strengthen the muscles that help you breathe; ask your provider which activities are safe for you (NHLBI). Walking builds strength: ask how far to walk and increase slowly (MedlinePlus).

Nutrition and weight

Breathlessness and tiredness can make it hard to eat enough, which can worsen symptoms and raise the risk of infection; smaller, more frequent meals and resting before eating may help (NHLBI). If it is hard to keep your weight up, ask a provider or dietitian about higher-calorie foods (MedlinePlus).

Clean air and smoke days

Avoid secondhand smoke, fumes and dust; check local air quality and stay indoors with windows closed when pollution is high (NHLBI). People with COPD are among those most at risk from wildfire smoke: set up a clean-air room with a portable air cleaner (not an ozone-generating one) and use a MERV 13 or higher filter if your system can take it (AirNow).

Saving energy

Keep things you use often in one easy-to-reach place, use a wheeled cart and long-handled tools, and limit stair climbing (NHLBI); the American Lung Association has more tips for dressing, bathing and housework (American Lung Association). Rest between activities (MedlinePlus).

Anxiety, depression and support

Living with COPD can bring fear, anxiety, depression and stress. Talking with your provider or a counselor, joining a support group, and leaning on family and friends can help (NHLBI). See our Anxiety and Depression guides. The American Lung Association’s free Lung HelpLine is 1-800-LUNG-USA (1-800-586-4872) (American Lung Association).

Using a written action plan

A coach can help you fill in, keep and actually use the action plan you make with your provider — see the next section (American Lung Association).

Another approach

Pulmonary rehabilitation

Pulmonary rehabilitation is a supervised medical program that helps people with lung diseases such as COPD live and breathe better (NHLBI).

What it includes

  • Exercise training for your arms, legs and breathing muscles.
  • Breathing techniques such as pursed-lip breathing, and ways to clear mucus.
  • Education on your medicines, spotting flare-ups early, quitting smoking and saving energy during daily tasks.
  • Counseling for stress, anxiety or depression, and nutrition advice (NHLBI).

Programs usually involve 2 or 3 sessions a week for several weeks or months (NHLBI), and some can be done by phone, web or app (NHLBI).

How well it works

A Cochrane review of 65 trials with 3,822 people with COPD found that pulmonary rehab relieves breathlessness and fatigue, improves emotional well-being and gives people more control over their condition — improvements the authors call moderately large and clinically significant (Cochrane review, 2015).

Paying for it

Medicare Part B covers pulmonary rehab for moderate to very severe COPD; see What it costs under Conventional medicine (Medicare.gov). Ask your doctor for a referral.

Another approach

Quitting smoking

Quitting is the most important part of treatment for smokers with COPD (CDC), and avoiding smoke is the best way to slow damage to your lungs (MedlinePlus). Quitting and other lifestyle changes can help you feel better, stay more active and slow the disease (NHLBI).

  • Get help: counseling plus medicine gives the best chance of success (CDC); call 1-800-QUIT-NOW for free coaching (CDC).
  • Medicines: nicotine patches, gum and lozenges, prescription nicotine inhalers and nasal sprays, and the prescription pills varenicline and bupropion (CDC). Ask your provider which is right for you.
  • Not vapes or herbal cigarettes: see Herbal medicine above.
  • Make your home smoke-free: make sure no one smokes in your home (MedlinePlus).

We plan a separate Smoking guide with more on quitting.

Another approach

Your COPD action plan for flare-ups

Work with your provider on a written action plan so you know what to do when symptoms change (MedlinePlus). The American Lung Association’s plan lists your medicines and when to take them, when to call your provider and when to get emergency care, using three zones (American Lung Association):

  • Green zone — a good day. Keep taking your daily medicines and oxygen as prescribed, even when you feel well.
  • Yellow zone — more symptoms than usual, such as more breathlessness, tiredness or coughing, or mucus that changes color or thickness. Slow down and follow your plan, which may include your quick-relief medicine or starting a prescribed antibiotic or other medicine. Call your provider if symptoms don’t improve.
  • Red zone — severe symptoms. Call 911 or get medical care right away (American Lung Association).

At the first sign of a flare-up

Try not to panic. Take medicines as your provider directed, use oxygen if prescribed, and use pursed-lip breathing to slow your breathing and help you relax. If symptoms don’t improve within 48 hours or keep getting worse, contact your provider or go to the hospital (MedlinePlus).

Preventing flare-ups

Stop smoking, avoid smoke and polluted air, stay up to date on vaccines, wash your hands often and stay away from people with colds (MedlinePlus). Keep phone numbers for your provider, your hospital and someone who can drive you, plus a list of your medicines, close at hand (NHLBI).

Member stories

Living with Emphysema & COPD? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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