Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Chronic Obstructive Pulmonary Disease (COPD)


Chronic obstructive pulmonary disease (COPD) is preventable and treatable. If you have COPD, you may feel short of breath because less air flows through your lungs. Your breathing tubes become narrow and damaged. COPD can cause other changes in your lungs that cannot be reversed. If you have a severe case you may need oxygen therapy and  COPD can lead to respiratory failure. The most common cause of COPD is smoking. 

There are 2 main types of COPD:

  • Chronic bronchitis causes a productive cough (brings up phlegm) for 3 months or more in 2 consecutive years.
  • Emphysema causes destruction of some of the normal lung tissue.

Some people with COPD also have asthma. Some people will have a mix of both types of COPD and asthma. COPD can be prevented and treated.

Causes and Risk Factors

We know that smoking is a major cause of COPD. However, we do not fully understand what causes every case. While many factors may increase your risk of developing COPD, about a fifth of people with the condition have no known risk factors.

Common risk factors include: 

  • Smoking. Smoking tobacco or marijuana increases your risk. Most people with COPD are smokers.
  • Genetics. History of COPD in your family can increase your risk for developing COPD.
  • Exposure to pollution or secondhand smoke.
  • Allergies. Allergies to hay fever, grass, tree pollen, and/or house dust can increase your risk.


Here are steps you can take to reduce your risk of developing COPD: 

  • Avoid smoking tobacco or marijuana or secondhand exposure to both.
  • Avoid exposure to dust, gases, or fumes.
  • Increase your level of physical activity.


The symptoms of COPD vary between different people. Common symptoms of COPD include:

  • Shortness of breath, usually with exercise, at the onset of COPD. It can worsen over time so that shortness of breath occurs even at rest.
  • Chronic cough with sputum production, beginning in the morning, and then with time, progressing throughout the day. 

More frequent respiratory infections, including acute chest infections like a bad cold or other infection. These can cause the cough to get worse or result in sputum production that is often yellow-green in color, wheezing, and more shortness of breath.

Some people have no symptoms and are diagnosed with COPD as a result of a routine chest X-ray or other tests. Others may not recognize symptoms because they do not exercise enough to cause shortness of breath.


A diagnosis of COPD can be made based on your symptoms, medical history, lung function and chest X-ray.

Lung function test: Spirometry

We may recommend lung function testing, or spirometry. Spirometry is the most accurate way to diagnose COPD.

Spirometry checks your lung function. It looks at how air flows into and out of your lungs, and how oxygen goes back and forth between your lungs and your blood.

Here it is how it is done: 

  • You blow into a mouthpiece attached to a machine (spirometer).
  • The machine measures the rate of flow and volume of the air in your lungs.
  • We may give you inhaled medication during the test. Your response to this medication will help us determine if you have COPD or asthma.

Chest X-ray

Chest X-ray may be helpful in the diagnosis of COPD. We can also use X-ray to look for, and to rule out, other reasons that may be causing  shortness of breath such as pneumonia or lung cancer. 

Pulse oximetry

We use a pulse oximeter, a small device placed on a finger, to measure your level of oxygen saturation at rest, or with exertion, depending on your situation. If you have severe COPD, this test helps us determine if you need home oxygen therapy.


The treatments we recommend will depend upon the severity of your symptoms and your medical history. There are treatments for chronic COPD and treatments for flare-ups of COPD. The goal of treatment is to decrease your symptoms and to improve your ability to enjoy your life. We specifically want to decrease the possibility of flare-ups and increase your ability to exercise.


Commonly used medications include:

  • Beta-agonists or anticholinergics to help keep your breathing tubes open.
  • Inhaled glucocorticoids or corticosteroids to help reduce or prevent inflammation of the lungs.
  • Combinations of beta-agonist, anticholinergic, and glucocorticoid medications can also be used to control COPD.
  • Oral steroids (such as Prednisone) may be used in severe cases. Steroids  can cause problems including thinning of the bones, increase in blood sugar levels, cataracts, and an increased susceptibility to infection. As a result, we only prescribe them  for severe cases and  during flare-ups.
  • Theophylline (a bronchodilator) is rarely used because it is metabolized by the liver, side effects are common, and it interacts with other drugs that you may take.
  • Mucolytics, or medications that thin or break down mucus, are not very effective, so we don’t prescribe them often. 

If you are at risk for heart disease, we may also recommend that you take a statin drug (medication to reduce cholesterol).

Vaccinations are important to prevent COPD from flaring up. We will recommend these vaccinations for you, if you have COPD:

  • Annual influenza vaccine.
  • Pneumonia vaccine, at least once.

Other Treatments

Oxygen. Prescribed for most patients with severe COPD who have low oxygen blood levels. It can improve lifespan and quality of life. 

Surgery. People with emphysema, mainly in the upper part of the lungs, who have a low ability to exercise, may benefit from lung volume reduction surgery. 

Lung transplant. We recommend lung transplant only for people  with severe COPD whose symptoms do not respond to  medical treatment and oxygen. Not all patients qualify for a transplant.  This process requires detailed evaluation and various tests to make sure it is a safe approach in your case. 

Treatment of Flare-Ups

The most common cause of flare ups are viruses and bacteria. Other causes include exposure to pollution or secondhand smoke. If you are experiencing a flare up you may need to go to the emergency department. Adding an inhaler, oral steroids, antibiotics or oxygen are used to treat flare ups. 

Lifestyle Management

Quitting smoking is an important part of your treatment. We can help you find resources that will work for you.

Maintaining an active lifestyle can help prevent loss of lung function. Comprehensive pulmonary rehabilitation, which includes exercise training, may be helpful to improve ability to exercise, decrease shortness of breath, and increase self-care.

Related Health Tools:

Interactive Programs

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.