Lung Disease 

Not Cancer

Pneumonia - American Lung Association

  • Together, pneumonia and influenza represented a cost to the U.S. economy in 2004 of $37.5 billion, $5.6 billion due to indirect mortalityI costs and $31.9 billion in directII costs.1

  • Pneumonia and influenza together are ranked as the seventh leading cause of death in the United States.2 Pneumonia consistently accounts for the overwhelming majority of deaths between the two. In 2003, 63,241 people died of pneumonia.3 

  • People considered at high risk for pneumonia include the elderly, the very young, and those with underlying health problems, such as chronic obstructive pulmonary disease (COPD), diabetes mellitus, congestive heart failure and sickle cell anemia. Patients with diseases that impair the immune system, such as AIDS, or those undergoing cancer therapy or organ transplantation, or patients with other chronic illnesses are particularly vulnerable. 

  • A vaccine is also available for bacterial pneumonia. The pneumococcal vaccine protects against 23 types of pneumococcal bacteria populations and is effective in approximately 80 percent of healthy adults. Unfortunately, the vaccine may be less effective in people in high risk groups.6 People over age 65, and those over 2 years in high-risk groups are still advised to receive the pneumonia vaccine.7

  • Influenza vaccination is also recommended since pneumonia often occurs as a complication of the flu. Pneumonia and influenza vaccines are covered by Medicare, as well as some state and private health insurance.

Asthma - American Lung Association

  • Asthma is a reversible obstructive lung disease, caused by increased reaction of the airways to various stimuli. It is a chronic inflammatory condition with acute exacerbations. Asthma can be a life-threatening disease if not properly managed.

  • In 2004, it was estimated that 20.5 million Americans currently have asthma.  Of these, 11.7 million Americans (4 million children under 18) had an asthma attack.1 

  • After a long period of steady increase, evidence suggests that asthma death and prevalence rates continue to plateau and/or decrease. In 2003, there were 4,099 deaths attributed to asthma -- an age-adjusted rate of 1.4 per 100,000. Close to 64% of these deaths occurred in women.3

  • Despite the numerous drugs available, asthma is still poorly controlled.  One study reported that 72 percent of men and 86 percent of women with asthma had symptoms 15 years after they were first diagnosed with the disease. Only 19 percent of these people, however, were still seeing a doctor and only 32 percent used any

    • Asthma is characterized by excessive sensitivity of the lungs to various stimuli. Triggers range from viral infections to allergies, to irritating gases and particles in the air.  Each person reacts differently to the factors that may trigger asthma, including:
      • respiratory infections, colds
      • cigarette smoke
      • allergic reactions to such allergens as pollen, mold, animal dander, feather, dust, food, and cockroaches
      • indoor and outdoor air pollutants, including ozone
      • exposure to cold air or sudden temperature change
      • excitement/stress  
      • exercise

Smoking - American Lung Association

    • Smoking is directly responsible for 87 percent of all lung cancer deaths in America each year.  In 1987, lung cancer surpassed breast cancer as the leading cause of cancer deaths among women in the U.S.2
    • Current female smokers aged 35 or older are 12 times more likely than nonsmoking females to die prematurely from lung cancer.3 In 2006, an estimated 72,130 women will die of lung cancer.4
    • Smoking is directly responsible for 80 percent of Chronic Obstructive Pulmonary Disease (COPD) deaths in women each year.5 In 2002, 51 percent of all COPD deaths were in women.  This is the third year in a row that women have outnumbered men in deaths attributable to COPD.6
    • Current female smokers aged 35 or older are 10.5 times more likely than nonsmoking females to die from emphysema or chronic bronchitis otherwise known as COPD.7
    • Cigarette smoking kills an estimated 178,408 women in the United States annually.  Women smokers who die of a smoking-related disease lose on average 14.5 years of potential life.8
    • Women who smoke also have an increased risk for developing cancers of the oral cavity, pharynx, larynx (voice box), esophagus, pancreas, kidney, bladder, and uterine cervix.9 
    • Women who smoke double their risk for developing coronary heart disease.10 
    • Postmenopausal women who smoke have lower bone density than women who never smoked. Women who smoke have an increased risk for hip fracture than never smokers. Cigarette smoking also causes skin wrinkling that could make smokers appear less attractive and prematurely old.11
    • Women have been extensively targeted in tobacco marketing dominated by themes of an association between social desirability, independence, weight control and smoking messages conveyed through advertisements featuring slim, attractive, and athletic models.12 
    • Teenage girls often start to smoke to avoid weight gain and to identify themselves as independent and glamorous, which reflect images projected by tobacco ads. Social images can convince teens that being slightly overweight is worse than smoking. Cigarette advertising portrays cigarettes as causing slimness and implies that cigarette smoking suppresses appetite.13
    • In 2004, 22 percent of high school girls were current smokers, meaning they smoked at least once in the 30 days preceding the survey.14
    • In 2003, 10.7 percent of mothers smoked during pregnancy.  It is estimated that only 25 percent of women quit smoking once they become pregnant.15 
    • Cigarette smoking during pregnancy can cause serious health problems for both mother and child, such as pregnancy complications, premature birth, low-birth-weight infants, stillbirth and infant death.16  
    • Mothers who smoke can pass nicotine to their children through breast milk.  Cigarette smoking not only passes nicotine on to the fetus; it also prevents as much as 25 percent of oxygen from reaching the placenta. Smoking during pregnancy accounts for 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries and about 10 percent of all infant deaths.17 
    • Additionally, infants are more likely to develop colds, bronchitis, and other respiratory diseases if secondhand smoke is present in the home or day care center.  Maternal smoking has also been linked to asthma among infants and young children. The odds of developing asthma are twice as high among children whose mothers smoke more than 10 cigarettes a day.18
    • Reducing frequency of smoking may not benefit the baby. A pregnant woman who reduces her smoking pattern or switches to lower tar cigarettes may inhale more deeply or take more puffs to get the same amount of nicotine as before.19
    • The most effective way to protect the fetus is to quit smoking. If a woman plans to conceive a child in the near future, quitting is essential. A woman who quits within the first three or four months of pregnancy can lower the chances of her baby being born premature or with health problems related to smoking.20
    • Women who quit smoking greatly reduce their risk of developing smoking-related diseases and dying prematurely.  In 2003, 48.9 percent of women smokers tried to quit smoking for at least one day.21
    • Women who quit smoking relapse for different reasons than men.  Stress, weight control, and negative emotions, lead to relapse among women.22
    • A recent study found among middle-aged smokers and former smokers, with mild or moderate chronic obstructive pulmonary disease, both breathed easier after quitting. After one year the women who quit smoking had 2 times more improvement in lung function compared with the men who quit.23

COPD - American Lung Association

(Chronic Bronchitis and Emphysema)

August 2006

Chronic obstructive pulmonary disease (COPD) is a term referring to two lung diseases, chronic bronchitis and emphysema, that are characterized by obstruction to airflow that interferes with normal breathing.  Both of these conditions frequently co-exist, hence physicians prefer the term COPD. It does not include other obstructive diseases such as asthma.

  • COPD is the fourth leading cause of death in America, claiming the lives of 122,283 Americans in 2003 and the number of women dying from the disease has surpassed the number seen in men.1 
  • This is the fourth consecutive year in which women have exceeded men in the number of deaths attributable to COPD.  In 2003, over 63,000 females died compared to 59,000 males.2
  • Smoking is the primary risk factor for COPD. Approximately 80 to 90 percent of COPD deaths are caused by smoking. Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked.  Male smokers are nearly 12 times as likely to die from COPD as men who have never smoked.3
  • Other risk factors of COPD include air pollution, second-hand smoke, history of childhood respiratory infections and heredity.  Occupational exposure to certain industrial pollutants also increases the odds for COPD.  A recent study found that the fraction of COPD attributed to work was estimated as 19.2% overall and 31.1% among never smokers.4
  • In 2004, 11.4 million U.S. adults (aged 18 and over) were estimated to have COPD.5 However, close to 24 million U.S. adults have evidence of impaired lung function, indicating an under diagnosis of COPD.6
  • An estimated 638,000 hospital discharges were reported; a discharge rate of 21.8 per 100,000 population. COPD is an important cause of hospitalization in our aged population. Approximately 65% of discharges were in the 65 years and older population in 2004.7
  • In 2004, the cost to the nation for COPD was approximately $37.2 billion, including healthcare expenditures of $20.9 billion in direct health care expenditures, $7.4 billion in indirect morbidity costs and $8.9 billion in indirect mortality costs.8
  • Chronic bronchitis is the inflammation and eventual scarring of the lining of the bronchial tubes. When the bronchi are inflamed and/or infected, less air is able to flow to and from the lungs and a heavy mucus or phlegm is coughed up. The condition is defined by the presence of a mucus-producing cough most days of the month, three months of a year for two successive years without other underlying disease to explain the cough.
  • This inflammation eventually leads to scarring of the lining of the bronchial tubes. Once the bronchial tubes have been irritated over a long period of time, excessive mucus is produced constantly, the lining of the bronchial tubes becomes thickened, an irritating cough develops, and air flow may be hampered, the lungs become scarred. The bronchial tubes then make an ideal breeding place for bacterial infections within the airways, which eventually impedes airflow.9
  • In 2004, an estimated 9 million Americans reported a physician diagnosis of chronic bronchitis. Chronic bronchitis affects people of all ages, but is higher in those over 45 years old.10
  • Females are more than twice as likely to be diagnosed with chronic bronchitis as males. In 2004, 2.8 million males had a diagnosis of chronic bronchitis compared to 6.3 million females.11
  • Symptoms of chronic bronchitis include chronic cough, increased mucus, frequent clearing of the throat and shortness of breath.12
  • Chronic bronchitis doesn't strike suddenly and is often neglected by individuals until it is in an advanced state, because people mistakenly believe that the disease is not life-threatening. By the time a patient goes to his or her doctor the lungs have frequently been seriously injured. Then the patient may be in danger of developing serious respiratory problems or heart failure.
  • Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.  As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, which is important to keep airways open.  The patient experiences great difficulty exhaling.13
  • Emphysema doesn't develop suddenly.  It comes on very gradually. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema. Of the estimated 3.6 million Americans ever diagnosed with emphysema, 91 percent were 45 or older.14
  • Of the emphysema sufferers, 54.8 percent are male and 45.2 percent are female. However, within in the past year, the prevalence rate for women has seen a 20 percent increase where as men have seen a decreased of 19 percent.15
  • Symptoms of emphysema include cough, shortness of breath and a limited exercise tolerance. Diagnosis  is made by pulmonary function tests, along with the patient's history, examination and other tests.16 
  • Alpha1 antitrypsin deficiency-related (AAT) emphysema is caused by the inherited deficiency of a protein called alpha1-antitrypsin (AAT) or alpha1-protease inhibitor. AAT, produced by the liver, is a "lung protector." In the absence of AAT, emphysema is almost inevitable. It is responsible for 5% or less of the emphysema in the United States.17
  • An estimated 100,000 Americans, primarily of northern European descent, have AAT deficiency emphysema. Another 25 million Americans carry a single deficient gene that causes Alpha-1 and may pass the gene onto their children.18
  • Symptoms of AAT deficiency emphysema usually begin between 32 and 41 years of age and include shortness of breath and decreased exercise capacity.  Smoking significantly increases the severity of emphysema in AAT-deficient individuals.19
  • Blood screening is primarily used to diagnose whether a person is a carrier or AAT-deficient. If children are diagnosed as AAT-deficient through blood screening, they may undergo a liver transplant.20 In addition, a DNA-based cheek swab test has been recently developed for the diagnosis of AAT-deficiency.21
  • A recent study suggested that there are at least 116 million carriers among all racial groups, worldwide.22

COPD Treatment

  • The quality of life for a person suffering from COPD diminishes as the disease progresses. At the onset, there is minimal shortness of breath.  People with COPD may eventually require supplemental oxygen and may have to rely on mechanical respiratory assistance.23
  • A recent American Lung Association survey revealed that half of all COPD patients (51%) say their condition limits their ability to work.  It also limits them in normal physical exertion (70%), household chores (56%), social activities (53%), sleeping (50%) and family activities (46%).24
  • None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease.  Therefore, the goal of pharmacotherapy for COPD is to provide relief of symptoms and prevent complications and/or progression of the disease with a minimum of side effects.25
  • Bronchodilator medications (prescription drugs that relax and open air passages in the lungs) are central to the symptomatic management of COPD.  They can be inhaled as aerosol sprays or taken orally.26
  • Additional treatment includes antibiotics, oxygen therapy, and systemic glucocorticosteroids. The efficacy of inhaled glucocorticosteroids continues to be under study, however short-term benefit has been demonstrated.  Chronic treatment with systemic steroids involves the risk of serious side effects; therefore these are used mostly for acute exacerbations.27
  • Pneumonia and influenza vaccines should be given to COPD patients.28  Those with COPD should also live a healthy lifestyle by exercising, avoiding cigarette smoke and other air pollutants, and eating well.29
  • Pulmonary rehabilitation is a preventive health-care program provided by a team of health professionals to help people cope physically, psychologically, and socially with COPD.30
  • Lung transplantation is being performed in increasing numbers and may be an option for people who suffer from severe emphysema. Additionally, lung volume reduction surgery (LVRS) has shown promise and is being performed with increasing frequency. However, a recent study found that emphysema patients who have severe lung obstruction with either limited ability to exchange gas when breathing or damage that is evenly distributed throughout their lungs are at high risk of death from the procedure.31
  • In August 2003, the Centers for Medicare and Medicaid Services (CMS) announced that they intend to cover LVRS for people with non-high risk severe emphysema, who meet the criteria stated in the National Emphysema Treatment Trial (NETT). In addition, CMS has decided that LVRS is "reasonable and necessary" only for qualified patients that undergo therapy before and after the surgery.  CMS is currently composing accreditation standards for LVRS facilities and will use these standards to determine where the surgery will be covered.32
  • Treatments for AAT deficiency emphysema including AAT replacement therapy (a life-long process) and gene therapy are currently being evaluated.  It is hoped that a clinical trial on gene therapy will take place within the decade.33

For help with treatment decisions online, click through the COPD Lung Profiler™.

For more information on COPD, please review the Chronic Bronchitis and Emphysema Morbidity and Mortality Trend Report in the  Data and Statistics section of our website or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).


COPD: Are You at Risk?


COPD is the 4thleading cause of death in the United States. The disease kills more than 120,000 Americans each year—that’s 1 death every 4 minutes—and causes serious, long-term disability. The number of people with COPD is increasing. More than 12 million people are diagnosed with COPD and an additional 12 million likely have the disease and don’t even know it.


COPD is a serious lung disease that over time makes it hard to breathe. You may have heard COPD called other names, like emphysema or chronic bronchitis.

In people who have COPD, the airways—tubes that carry air in and out of your lungs—are partly blocked, which makes it hard to get air in and out.


Many people with COPD avoid activities that they used to enjoy because they become short of breath more easily.

Symptoms of COPD include:

  • Constant coughing, sometimes called “smoker’s cough”
  • Shortness of breath while doing activities you used to be able to do
  • Excess sputum production
  • Feeling like you can’t breathe
  • Not being able to take a deep breath
  • Wheezing

When COPD is severe, shortness of breath and other symptoms can get in the way of doing even the most basic tasks, such as doing light housework, taking a walk, and even bathing and getting dressed.

COPD develops slowly, and can worsen over time, so be sure to report any symptoms you might have to your doctor as soon as possible, no matter how mild they may seem.


Most people who are at risk for getting COPD have never even heard of it and, in many cases, don’t even realize that the condition has a name. Some of the things that put you at risk for COPD include:


COPD most often occurs in people age 40 and over with a history of smoking (either current or former smokers), although as many as 1 out of 6 people with COPD never smoked. Smoking is the most common cause of COPD—it accounts for as many as 9 out of 10 COPD-related deaths.

Environmental Exposure

COPD can also occur in people who have had long-term exposure to things that can irritate your lungs, like certain chemicals, dust, or fumes in the workplace. Heavy or long-term exposure to secondhand smoke or other air pollutants may also contribute to COPD.

Genetic Factors

In some people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. While very few people know they have AAT deficiency, it is estimated that as many as 100,000 Americans have it. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants.


Everyone at risk for COPD who has a cough, sputum production or shortness of breath, should be tested for the disease. The test for COPD is called spirometry.


Spirometry can detect COPD before symptoms become severe. It is a simple, noninvasive breathing test that measures the amount of air a person can blow out of the lungs (volume) and how fast he or she can blow it out (flow). Based on this test, your doctor can tell if you have COPD, and if so, how severe it is. The spirometry reading can help your doctor determine the best course of treatment.

How Spirometry Works

Image of a man taking spirometry testSpirometry is one of the best and most common lung function tests. The test is done with a spirometer, a machine that measures how well your lungs function, records the results, and displays them on a graph for your doctor. You will be asked to take a deep breath, then blow out as hard and as fast as you can using a mouthpiece connected to the machine with tubing. The spirometer then measures the total amount of air exhaled, called the forced vital capacity or FVC, and how much you exhaled in the first second, called the forced expiratory volume in 1 second or FEV1. Your doctor will use the results to assess how well your lungs are working and whether or not you have COPD.


There are many things people at risk for COPD can do:

Quit Smoking

If you smoke, the best thing you can do to prevent more damage to your lungs is to quit. To help you quit, there are many online resources and several new aids available from your doctor. Visit;; or call 1-800-QUIT NOW for more information.

Avoid Exposure to Pollutants

Try to stay away from other things that could irritate your lungs, like dust and strong fumes. Stay indoors when the outside air quality is poor. You could also stay away from places where there might be cigarette smoke.

Visit Your Doctor on a Regular Basis

See your doctor regularly even if you are feeling fine. Make a list of your breathing symptoms and think about any activities that you can no longer do because of shortness of breath. Be sure to bring a list of all the medicines you are taking to each doctor’s visit.

Do your best to avoid crowds during flu season. It is also a good idea to get a flu shot every year, since the flu can cause serious problems for people with COPD. You should also ask your doctor about the pneumonia vaccine.

Take Precautions Against the Flu

Do your best to avoid crowds during flu season. It is also a good idea to get a flu shot every year, since the flu can cause serious problems for people with COPD. You should also ask your doctor about the pneumonia vaccine.


If you think you might be at risk for COPD, get a simple breathing test. Talk with your doctor about treatment options. You can take steps to make breathing easier and live a longer and more active life.

For more information, visit

Or contact the National Heart, Lung, and Blood Institute at