Respiratory Diseases: Asthma, COPD, Pneumonia, Symptoms, Causes, and Treatment

Introduction

Respiratory diseases are a large family of conditions that affect the airways, lung tissue, blood vessels of the lungs, and the muscles and structures of breathing. They are among the leading causes of disability, hospital admissions, and death worldwide. The Global Burden of Disease project ranks chronic respiratory diseases as the third leading cause of death globally after cardiovascular disease and cancer, and acute lower respiratory infections (mainly pneumonia) remain a top cause of mortality in children under 5 and in older adults.

The scale and shape of the problem. Asthma affects approximately 300 million people worldwide and causes around 1,000 deaths per day, most of which are preventable. Chronic obstructive pulmonary disease (COPD) affects an estimated 480 million people globally and is responsible for over 3 million deaths annually. Acute respiratory infections, including community-acquired pneumonia (CAP), account for roughly 1 million adult hospital admissions and 50,000 deaths each year in the United States alone. Tobacco smoke remains the single largest modifiable cause of chronic respiratory disease, followed by household and outdoor air pollution, occupational exposures, and respiratory infections in early life.

The last two years have brought meaningful updates. The GOLD 2025 and 2026 strategy documents for COPD have refined the diagnostic approach (formalizing pre- and post-bronchodilator spirometry pathways and recognizing pre-COPD and PRISm as precursor states), strengthened the role of newer therapies including the first biologic agent approved for COPD and a nebulized PDE3/4 inhibitor (the first new drug class in 30 years), and added explicit sections on cardiovascular risk and the influence of climate change. The GINA 2025 strategy for asthma reinforces ICS-formoterol as the preferred reliever across most steps (replacing as-needed SABA in adults and adolescents) and broadens the role of biologics for severe asthma. The 2025 ATS/IDSA community-acquired pneumonia guideline updates antibiotic stewardship recommendations and refines decisions around diagnostic testing and duration of therapy.

This article is intended for general medical information only. It is not a substitute for evaluation by a pulmonologist, primary care clinician, or emergency clinician.

Causes and Symptoms

A practical map of respiratory diseases. Respiratory conditions are usually grouped by the main structure they affect and by whether they are acute (days to weeks) or chronic (months to years).

Airway diseases (most common): - Asthma: chronic airway inflammation with variable, reversible airflow obstruction - COPD: persistent, often progressive airflow obstruction from bronchitis, bronchiolitis, and/or emphysema - Bronchiectasis: permanently dilated, inflamed airways with chronic sputum production - Acute bronchitis: a self-limited (usually viral) airway infection - Cystic fibrosis: an inherited disease of chloride channels with thick mucus, recurrent infection, and progressive lung damage

Lung parenchymal diseases: - Pneumonia (community-acquired, hospital-acquired, aspiration) - Interstitial lung disease (ILD), including idiopathic pulmonary fibrosis (IPF) and hypersensitivity pneumonitis - Sarcoidosis - Pneumoconioses (silicosis, asbestosis, coal workers' lung)

Pulmonary vascular diseases: - Pulmonary embolism (PE) - Pulmonary hypertension (PH) - Pulmonary edema

Sleep-related breathing disorders: - Obstructive sleep apnea (OSA) - Central sleep apnea - Obesity hypoventilation syndrome

Pleural diseases: - Pleural effusion, pneumothorax, malignant pleural disease

Cancers: - Lung cancer (non-small cell and small cell), pleural mesothelioma

Causes and risk factors for chronic respiratory disease.

Tobacco smoke (the leading modifiable risk factor): - Active smoking: causes 80% of COPD and at least 80% of lung cancers; doubles asthma risk; worsens severity in nearly every respiratory condition - Secondhand smoke: increases asthma incidence in children by 30% to 40%, contributes to COPD and lung cancer in non-smokers - E-cigarettes and vaping: associated with EVALI (e-cigarette or vaping product use-associated lung injury), bronchiolitis-like changes, and worsened asthma control

Air pollution: - Outdoor: PM2.5 (particles under 2.5 micrometers), nitrogen dioxide (NO2), ozone, sulfur dioxide - Indoor: biomass cooking and heating fuels (a major COPD cause in low- and middle-income countries), secondhand smoke, mold, dust mites, cockroach, pet dander - Even short-term spikes in PM2.5 increase asthma attacks, COPD exacerbations, hospital admissions, and acute cardiac events

Occupational exposures: - Silica (mining, sandblasting, stone work, denim sandblasting) - Asbestos (construction, shipyards, brake linings, insulation; latency 20 to 40 years) - Coal dust, grain dust, isocyanates, hardwood dust, latex - Welding fumes - Approximately 15% of adult-onset asthma is occupational

Infections (especially in childhood): - Severe respiratory syncytial virus (RSV) bronchiolitis raises asthma risk later - Recurrent childhood pneumonia is associated with lower adult lung function - COVID-19 infection has been linked to persistent breathlessness, post-COVID interstitial changes, and worsening of pre-existing asthma and COPD

Genetic factors: - Atopy (allergic predisposition) for asthma; HLA associations and several gene variants - Alpha-1 antitrypsin deficiency (SERPINA1 mutations) for early-onset emphysema and liver disease; recognized as a treatable cause of COPD - Cystic fibrosis transmembrane conductance regulator (CFTR) mutations for cystic fibrosis

Other factors: - Premature birth and low birth weight (reduced peak lung function) - Recurrent severe lower respiratory tract infections in early childhood - Poor childhood nutrition - Climate change and extreme heat (now recognized by GOLD 2025 as relevant to COPD) - Mental health comorbidity (anxiety and depression are common and worsen outcomes)

Symptoms by major condition.

Common respiratory symptoms (the building blocks): - Cough (acute under 3 weeks, subacute 3 to 8 weeks, chronic over 8 weeks) - Sputum production (clear, white, yellow, green, blood-tinged, frank blood) - Wheezing (musical, expiratory more than inspiratory in airway disease) - Stridor (inspiratory, upper airway origin, always concerning) - Shortness of breath at rest, on exertion, or lying flat (orthopnea) - Chest tightness, chest pain - Hemoptysis (coughing blood) - Fatigue, exercise intolerance - Cyanosis (bluish lips or fingertips, late sign) - Clubbing of fingers (chronic lung disease, congenital heart disease, lung cancer)

Asthma: - Variable wheezing, chest tightness, cough, shortness of breath - Triggers: allergens, exercise, cold air, infections, irritants, emotions, NSAIDs in some - Nighttime or early morning symptoms - Symptom variability is the hallmark

COPD:

• Progressive shortness of breath, especially on exertion
• Chronic cough with sputum production, often morning sputum
• Recurrent lower respiratory infections
• Symptoms tend to be persistent and progressive, not variable

Pneumonia: - Fever, chills, productive cough with yellow or green sputum - Pleuritic chest pain (sharp, worse with breathing) - Shortness of breath - Tachypnea, tachycardia - In older adults: often subtle - confusion, falls, decreased appetite, decompensation of underlying disease

Acute bronchitis: - Cough lasting 1 to 3 weeks, often with sputum - Low-grade fever in early days - No or minimal shortness of breath - Usually viral, antibiotics rarely indicated

Pulmonary embolism (PE): - Sudden shortness of breath - Pleuritic chest pain - Tachycardia, tachypnea - Sometimes hemoptysis, syncope - Always consider in unexplained acute dyspnea, especially with risk factors

Pulmonary fibrosis (ILD): - Progressive, dry cough - Slowly worsening exertional dyspnea - Finger clubbing - Bibasilar "Velcro" crackles on auscultation

Asthma vs COPD Compared

Asthma and COPD are both chronic airway diseases with shortness of breath, cough, and airflow obstruction, but they differ in mechanism, age of onset, reversibility, treatment, and prognosis. The table below summarizes the most useful distinguishing features (asthma-COPD overlap, ACO, is a recognized intermediate phenotype).

A few practical points. First, the diagnosis of COPD requires post-bronchodilator spirometry showing FEV1/FVC under 0.7. The diagnosis of asthma is built from history plus documented variable airflow obstruction (positive bronchodilator response, peak flow variability, FeNO, or methacholine challenge). Second, smokers in their 50s and 60s can have both diseases (asthma-COPD overlap). Third, the GOLD 2025 strategy now also recognizes "pre-COPD" (chronic respiratory symptoms with normal spirometry but structural changes or risk factors) and PRISm (preserved ratio with impaired spirometry: FEV1 under 80% predicted but FEV1/FVC at or above 0.7), as precursor states that warrant early intervention.

Diagnosis

Diagnosis of respiratory disease relies on history, examination, and a targeted set of objective tests. Spirometry is the foundation, but the right diagnostic strategy depends on whether the picture is acute or chronic.

1. History and physical examination: - Symptom pattern: onset, duration, variability, triggers, response to treatment - Smoking history quantified in pack-years (packs/day x years; 10 pack-years is a threshold for COPD screening) - Occupational and environmental exposures (silica, asbestos, biomass cooking, mold, birds, pet exposure) - Allergy and atopy history - Family history (asthma, alpha-1 antitrypsin deficiency, cystic fibrosis, lung cancer) - Vital signs: respiratory rate, oxygen saturation, blood pressure, heart rate, temperature - Examination: respiratory rate and pattern, use of accessory muscles, chest expansion, percussion, auscultation, clubbing, cyanosis, peripheral edema

2. Pulmonary function tests (PFTs):

Spirometry, the foundational test: - FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), FEV1/FVC ratio - Bronchodilator reversibility: repeat after 400 mcg salbutamol; a rise in FEV1 of 12% and at least 200 mL is positive (asthma) - A post-bronchodilator FEV1/FVC less than 0.7 confirms COPD (GOLD 2025/2026) - Pre-bronchodilator spirometry can screen for COPD in primary care; post-bronchodilator spirometry is required for definitive diagnosis

Additional PFTs: - Lung volumes by plethysmography or helium dilution (total lung capacity, residual volume): elevated in COPD/emphysema, low in restrictive disease - Diffusion capacity (DLCO): low in emphysema, ILD, pulmonary vascular disease - Bronchial provocation testing (methacholine, mannitol, exercise): for suspected asthma with normal baseline spirometry - FeNO: elevated in eosinophilic asthma, guides ICS responsiveness - Peak expiratory flow (PEF) monitoring: home use for asthma diagnosis and control

3. Laboratory tests: - Complete blood count (eosinophilia in asthma; high WBC in pneumonia) - C-reactive protein and procalcitonin in suspected pneumonia - Arterial blood gas in severe disease (oxygenation, ventilation, acid-base) - Sputum for Gram stain and culture in selected pneumonia cases - Blood cultures in severe community-acquired pneumonia - Influenza/RSV/SARS-CoV-2 PCR when circulating - Legionella urinary antigen in severe CAP, travel, or outbreak - Alpha-1 antitrypsin level once in every patient diagnosed with COPD (per GOLD) - Allergy testing (specific IgE, skin prick testing) for atopic phenotype - Sweat chloride and CFTR genotyping if cystic fibrosis is suspected

4. Imaging: - Chest X-ray: first-line for suspected pneumonia, pneumothorax, effusion, mass; usually normal in asthma; may show hyperinflation, flattened diaphragms, or bullae in COPD - Chest CT (high-resolution, HRCT, for ILD; standard or low-dose for nodules and cancer screening): essential when interstitial disease, bronchiectasis, emphysema phenotyping, or lung cancer is considered - CT pulmonary angiography: the test of choice for pulmonary embolism - Lung cancer screening (USPSTF 2021): annual low-dose CT in adults 50 to 80 with 20+ pack-year history who currently smoke or quit within the last 15 years

5. Other targeted tests: - Bronchoscopy with biopsy or BAL: for ILD work-up, suspected malignancy, persistent infection - Sleep study (polysomnography or home sleep testing) for suspected OSA - Six-minute walk test for functional capacity in chronic disease - Echocardiography for suspected pulmonary hypertension

6. Severity scoring (community-acquired pneumonia):

The 2019 ATS/IDSA guidelines (updated 2025) recommend using a validated rule plus clinical judgment for site-of-care decisions: - CURB-65 (Confusion, Urea over 7 mmol/L, Respiratory rate at least 30, Blood pressure low, age at least 65): score 0 to 1 often outpatient, 2 typically inpatient, 3+ ICU consideration - Pneumonia Severity Index (PSI): more accurate but more complex; preferred per ATS/IDSA - ICU criteria: 1 major (mechanical ventilation, septic shock requiring vasopressors) or 3+ minor criteria

7. Key diagnostic principle: Do not start chronic respiratory therapy (e.g., long-term ICS, LAMA, LABA) without objective confirmation of the diagnosis with spirometry. Empirically treating "presumed asthma" with inhaled corticosteroids without confirmation contributes to over-diagnosis and unnecessary medication exposure.

Treatment

Treatment is tailored to the specific diagnosis. The cornerstone in chronic disease is to confirm the diagnosis, remove modifiable causes (especially smoking), use the right inhaler with correct technique, vaccinate, and add targeted therapies based on severity, phenotype, and comorbidities.

A. Asthma (GINA 2025):

Adults and adolescents 12 and older, Track 1 (preferred): - The single most important change in modern asthma care is that as-needed inhaled corticosteroid plus formoterol (ICS-formoterol) is now the preferred reliever at every step in the GINA strategy, replacing reliance on as-needed short-acting beta-agonist (SABA) alone - Step 1 to 2: as-needed low-dose ICS-formoterol - Step 3: low-dose maintenance ICS-formoterol plus as-needed ICS-formoterol (MART, also called SMART) - Step 4: medium-dose maintenance ICS-formoterol plus as-needed ICS-formoterol - Step 5: refer to a specialist; consider high-dose ICS-LABA, LAMA add-on, or biologics

Severe asthma biologics (specialist prescription): - Omalizumab (anti-IgE): allergic asthma - Mepolizumab, reslizumab, benralizumab (anti-IL-5/IL-5R): eosinophilic asthma - Dupilumab (anti-IL-4Ra): type 2 inflammation, eosinophilic, also approved for nasal polyps and eczema - Tezepelumab (anti-TSLP): broad applicability across phenotypes

Other essential elements of asthma care: - Written asthma action plan - Vaccinations: annual influenza, age-appropriate pneumococcal, COVID-19 boosters, RSV in adults 60+ - Trigger avoidance (allergens, smoking, occupational) - Treat comorbidities: allergic rhinitis, GERD, obesity, OSA, mental health

B. COPD (GOLD 2025/2026):

Smoking cessation is the most important intervention, full stop. It slows lung function decline more than any medication and reduces mortality.

Initial pharmacological therapy by GOLD groups (A, B, E): - Group A (low symptoms, low exacerbation risk): a bronchodilator - Group B (high symptoms, low exacerbation risk): LABA + LAMA combination - Group E (frequent or severe exacerbations regardless of symptoms): LABA + LAMA, with ICS added if blood eosinophils are at least 300 cells/microL, or 100 cells/microL with exacerbations

Single-inhaler triple therapy (LABA + LAMA + ICS): - For patients with recurrent exacerbations despite dual bronchodilator therapy and eosinophil-supportive phenotype - Examples: fluticasone/umeclidinium/vilanterol, budesonide/glycopyrrolate/formoterol

Newer therapies (GOLD 2025 highlights): - Ensifentrine (Ohtuvayre): nebulized PDE3/4 inhibitor approved by FDA in June 2024, the first new drug class for COPD in 30 years - Dupilumab (Dupixent): FDA-approved in September 2024 for adults with uncontrolled COPD and type 2 inflammation (eosinophil-high phenotype); first biologic for COPD - Itepekimab and other anti-IL-33 agents under investigation

Non-pharmacological care: - Pulmonary rehabilitation: structured 6 to 12 week program of exercise, education, breathing techniques; improves dyspnea, exercise capacity, and quality of life more than most drugs - Vaccinations: annual influenza, COVID-19 boosters, pneumococcal (PCV20 or PCV15 + PPSV23), RSV (adults 60+), pertussis if not boosted - Long-term oxygen therapy: PaO2 at or below 55 mmHg (or 88% saturation) at rest, on ABG; 15+ hours per day, improves survival - Non-invasive ventilation (NIV): for selected patients with chronic hypercapnia - Lung volume reduction (surgical or bronchoscopic valves): for selected severe emphysema - Lung transplantation: end-stage disease in eligible candidates

Cardiovascular risk in COPD (new GOLD emphasis): After an acute exacerbation, the risk of severe cardiovascular event or all-cause death is 20-fold higher in the first 7 days. Address CV risk factors (BP, cholesterol, smoking, glucose) aggressively in every COPD patient.

C. Community-acquired pneumonia (ATS/IDSA 2025):

Outpatient adults without comorbidities: - Amoxicillin 1 g three times daily, OR - Doxycycline 100 mg twice daily, OR - A macrolide (azithromycin, clarithromycin) where local pneumococcal resistance to macrolides is under 25%

Outpatient adults with comorbidities (chronic heart, lung, liver, or kidney disease, diabetes, alcoholism, malignancy, asplenia): - Combination therapy: amoxicillin-clavulanate or a cephalosporin PLUS a macrolide or doxycycline, OR - Monotherapy with a respiratory fluoroquinolone (levofloxacin, moxifloxacin)

Inpatient non-severe: - Beta-lactam (ceftriaxone, ampicillin-sulbactam) PLUS a macrolide, OR - Respiratory fluoroquinolone

Inpatient severe: - Beta-lactam PLUS a macrolide, OR - Beta-lactam PLUS a respiratory fluoroquinolone - Add anti-MRSA and antipseudomonal coverage only in patients with risk factors (prior MRSA isolation, recent hospitalization with IV antibiotics, severe immunosuppression)

Duration: 5 days is usually sufficient if the patient is clinically stable at day 5 (afebrile, vital signs normalizing, eating); longer courses for severe disease, immunocompromise, or specific pathogens

Influenza: add oseltamivir if influenza is suspected or confirmed and within 48 hours of symptom onset (or longer in severe or hospitalized cases)

Corticosteroids: not routinely recommended in non-severe CAP; consider in severe CAP with shock (recent data support hydrocortisone)

D. Acute bronchitis: - Most cases are viral; antibiotics are NOT indicated - Supportive care: hydration, rest, antipyretics - Cough usually lasts 1 to 3 weeks - Antibiotic prescribing for uncomplicated acute bronchitis is one of the most overused and inappropriate antibiotic uses in primary care

E. Asthma and COPD exacerbations: - Short-acting bronchodilator (salbutamol/albuterol via MDI with spacer or nebulizer) - Oxygen to keep saturation 88% to 92% in COPD, 93% to 95% in asthma - Systemic corticosteroids: prednisone 40 to 50 mg daily for 5 days (asthma) or 30 to 40 mg daily for 5 days (COPD) - Antibiotics in COPD exacerbations with increased sputum purulence, sputum volume, or dyspnea - Magnesium sulfate IV in severe asthma - Non-invasive ventilation in COPD with acute respiratory acidosis (pH 7.25 to 7.35) - ICU admission for impending respiratory failure

Multisystem Impact

Respiratory diseases are seldom isolated. Comorbidities and downstream effects shape outcomes as much as the lung disease itself.

Cardiovascular: - COPD doubles the risk of myocardial infarction, stroke, heart failure, and arrhythmias - After an acute COPD exacerbation, the risk of severe cardiovascular event or all-cause death is 20-fold higher in the first 7 days and remains elevated for over a year - Asthma, especially uncontrolled, is associated with increased cardiovascular risk - Pulmonary embolism causes right ventricular strain and acute cor pulmonale - Chronic hypoxemia drives pulmonary hypertension and right heart failure

Metabolic and weight: - Obesity worsens asthma control and is independently associated with sleep apnea, hypoventilation, GERD, and increased COPD severity - Cachexia and unintentional weight loss in advanced COPD predict mortality - Inhaled corticosteroids in high doses can contribute to weight gain and hyperglycemia - Oral corticosteroid courses worsen glucose control in patients with diabetes

Bone and muscle: - Skeletal muscle dysfunction is common in COPD, contributes to exercise intolerance, and improves with pulmonary rehabilitation - Osteoporosis is more common in COPD (chronic inflammation, inactivity, corticosteroids, smoking) - Vertebral fractures impair lung mechanics

Mental health: - Anxiety and depression affect 20% to 40% of adults with COPD and severe asthma - Mental health worsens adherence, exacerbations, and quality of life - Smoking cessation success increases when mental health is addressed

Sleep: - Obstructive sleep apnea coexists with COPD ("overlap syndrome") and dramatically worsens cardiovascular risk and mortality - Nocturnal hypoxemia in COPD even without OSA worsens pulmonary hypertension - Asthma symptoms are commonly worst at night

Renal and electrolytes: - Chronic hypoxia and cor pulmonale increase the risk of acute kidney injury - Repeated corticosteroid courses contribute to hypertension and metabolic changes

Gastroesophageal: - GERD is more common in asthma and COPD; treating reflux can improve respiratory symptoms in some patients - Aspiration risk increases with neurological disease and reduced cough strength

Immune and infectious: - Recurrent respiratory infections accelerate decline in COPD and worsen asthma control - Inhaled corticosteroids in COPD slightly increase pneumonia risk (most pronounced with high-dose fluticasone) - Vaccination significantly reduces hospitalization in chronic lung disease

Cancer: - Lung cancer risk is 4 to 7 times higher in COPD than in smokers without COPD - Annual low-dose CT screening for eligible smokers reduces lung cancer mortality by about 20%

Quality of life and disability: - Severe asthma and moderate-to-severe COPD substantially reduce ability to work, exercise, sleep, and socialize - Pulmonary rehabilitation produces some of the largest health-related quality of life gains in medicine

A multidisciplinary team (pulmonology, primary care, pulmonary rehabilitation, smoking cessation counseling, dietetics, mental health, sleep medicine, cardiology) is the modern standard for moderate-to-severe chronic respiratory disease.

Warning Signs

Most respiratory symptoms are manageable in the community. Some, however, signal a serious or life-threatening process and need urgent or emergency care.

Emergency signs (call 101 in Israel, 911 in the United States, 112 in Europe):

• Severe shortness of breath at rest, inability to speak full sentences, gasping
• Bluish lips, fingertips, or face (cyanosis)
• Drowsiness, confusion, agitation, or inability to stay awake during a respiratory attack (signals impending respiratory failure)
• Silent chest in a known asthmatic (the absence of wheezing despite severe distress is a sign of life-threatening obstruction)
• Sudden severe chest pain with shortness of breath (suspect pulmonary embolism, pneumothorax, or acute coronary syndrome)
• Coughing up large amounts of blood (more than a teaspoon)
• Sudden onset of severe shortness of breath with leg swelling (suspect pulmonary embolism)
• High fever with shortness of breath in an older adult or immunocompromised person
• Stridor (high-pitched inspiratory sound), especially with drooling or inability to swallow (suspect upper airway obstruction or epiglottitis)
• Persistent peak expiratory flow below 50% of personal best despite reliever inhaler

Asthma exacerbation red flags requiring immediate emergency care: - Reliever inhaler needed more than every 4 hours, or not working - Symptoms worsening despite oral corticosteroids - Peak flow less than 50% of personal best - Difficulty speaking, walking, or lying down - Mental status change

COPD exacerbation red flags: - Significantly increased breathlessness at rest - New cyanosis or peripheral edema - New mental status change - Fever with sputum changes - Increased oxygen requirement on home oxygen

Pneumonia red flags: - Respiratory rate over 30 per minute - Oxygen saturation under 92% on room air - Confusion - Hypotension (systolic BP under 90) - Severe pleuritic chest pain - Inability to keep down oral medications or fluids - Failure to improve after 48 to 72 hours of antibiotics

Same-day or next-day medical care for: - Persistent cough with fever or chills - New or worsening shortness of breath on usual activity - Wheezing that does not respond to usual reliever - New chest pain on breathing - Cough lasting more than 3 weeks - Blood-tinged sputum (even small amounts) - Recurrent respiratory infections - New voice changes or hoarseness lasting over 3 weeks (rule out laryngeal pathology)

Routine clinic care for: - Stable chronic respiratory disease with worsening exercise tolerance - Annual review of asthma control, COPD severity, and inhaler technique - Smoking cessation counseling - Vaccinations - Sleep concerns suggesting OSA

When to Call Emergency Services

Call emergency services (101 in Israel, 911 in the United States, 112 in Europe) immediately for:

1. Severe shortness of breath at rest, especially with inability to speak in full sentences
2. Bluish or grayish lips or fingertips (cyanosis)
3. Confusion, drowsiness, or unresponsiveness during a respiratory attack
4. Sudden onset of severe chest pain combined with shortness of breath
5. Coughing up large amounts of blood (more than a teaspoon)
6. Stridor or noisy breathing with drooling or inability to swallow
7. Severe asthma attack with peak flow under 50% personal best, not improving with reliever
8. Suspected pulmonary embolism: sudden breathlessness, chest pain, fast heart rate, especially after recent surgery, immobility, or long flight
9. Suspected pneumothorax: sudden one-sided chest pain with shortness of breath, especially in tall thin young adults or COPD patients
10. Severe pneumonia symptoms in older adults or immunocompromised patients: high fever, confusion, low BP, RR over 30

Same-day or next-day medical care for: - Worsening shortness of breath without obvious trigger - Fever, productive cough, and pleuritic chest pain (rule out pneumonia) - Asthma attack improving but not fully resolved after reliever doses - COPD with new green or yellow sputum and increased breathlessness - Cough lasting more than 3 weeks - New blood streaks in sputum - Persistent voice change or hoarseness over 3 weeks - Wheezing without prior history in an adult (rule out new asthma, COPD, or other airway pathology)

Routine clinic appointment for: - Stable chronic respiratory disease for routine review - Smoking cessation support and pharmacotherapy - Annual flu, pneumococcal, COVID-19, RSV vaccination - Concerns about new exposures (occupational, mold, indoor pollution) - Sleep concerns (snoring, witnessed apneas, daytime sleepiness) - Discussion of pulmonary rehabilitation - Inhaler technique review

A useful rule for chronic lung disease patients: if you cannot finish a sentence in one breath, or if your reliever inhaler is needed more often than every 4 hours, that is an emergency. Confusion or drowsiness during a respiratory attack is also an emergency.

Practical Tips

1. Stop smoking. This single change beats every other respiratory intervention. Smoking cessation slows COPD lung function decline more than any medication, halves the lung cancer risk within 10 years, improves asthma control, and reduces the risk of pneumonia and exacerbations. Combine pharmacotherapy (nicotine replacement, varenicline, bupropion) with behavioral counseling for the best success.

2. Avoid secondhand smoke and indoor pollution. - No smoking inside the home or car, ever - Use exhaust ventilation when cooking, especially with gas or biomass fuels - Vent dryers, gas stoves, and bathrooms outside - HEPA air purifier in the bedroom for allergic or sensitive individuals - Control dust mites: mattress and pillow encasings, weekly bedding wash at 60°C - Reduce mold: fix leaks, maintain humidity below 50%

3. Pay attention to outdoor air quality. - Check daily air quality index (AQI) during pollution or wildfire season - On high-pollution days, exercise indoors and limit outdoor exposure - Wear an N95 or KN95 mask in wildfire smoke or sandstorms - Asthma and COPD patients should pre-medicate before exposure when possible

4. Build a vaccination plan. For adults with asthma or COPD: annual influenza, age-appropriate pneumococcal (PCV20 alone or PCV15 followed by PPSV23), updated COVID-19 boosters, RSV at age 60+ (or earlier in COPD), pertussis if not boosted within 10 years, and shingles after age 50. For all adults: hepatitis B if at risk.

5. Use your inhaler correctly. Most people do not. Up to 70% of users have at least one inhaler technique error. Common pitfalls: not exhaling first, not holding breath for 10 seconds, not rinsing the mouth after ICS, breathing too fast through DPIs. Have your inhaler technique checked at every clinic visit. Use a spacer with metered dose inhalers.

6. Know your asthma action plan, and use it. Three zones: green (symptom-free, full activity, peak flow 80% to 100% of personal best), yellow (symptoms, reliever needed, peak flow 50% to 80%), red (severe, peak flow under 50% or distress). Each zone has specific actions and medications, written in advance with your clinician.

7. Exercise regularly, but smartly. - 150 minutes per week of moderate aerobic exercise plus 2 to 3 sessions of resistance training - Pre-medicate (reliever inhaler 10 to 15 minutes before exercise) for exercise-induced bronchoconstriction - Warm up gradually - Swimming, walking, cycling are excellent - Pulmonary rehabilitation programs are highly effective for COPD and severe asthma

8. Maintain a healthy weight. Obesity worsens asthma control, increases OSA, raises cardiovascular risk, and reduces exercise tolerance. Weight loss of 5% to 10% measurably improves asthma symptoms.

9. Eat for your lungs. A Mediterranean-style diet rich in fruits, vegetables, whole grains, fish, olive oil, and nuts is associated with better lung function and lower respiratory disease risk. Avoid sulfite-rich foods if you are sulfite-sensitive (some asthmatics).

10. Treat comorbidities. - Allergic rhinitis with intranasal corticosteroids (improves asthma) - GERD with proton pump inhibitors if symptomatic - Anxiety and depression with appropriate therapy - OSA with CPAP

11. Know when to escalate. Reliever inhaler more than 2 days per week, nighttime awakenings from asthma, peak flow under 80% personal best, or 2 or more exacerbations per year requiring oral steroids all signal poor control and need a step-up in treatment.

12. Test for alpha-1 antitrypsin deficiency once. GOLD recommends testing every patient with COPD at least once. Identification allows family screening, lifestyle counseling, and (in selected cases) augmentation therapy.

13. Consider lung cancer screening if eligible. Adults 50 to 80 with a 20+ pack-year smoking history who currently smoke or quit in the last 15 years should be offered annual low-dose CT screening (USPSTF 2021 and updated 2024 recommendations).

14. Mind your mental health. Anxiety can trigger hyperventilation that mimics or worsens asthma; depression reduces adherence and self-care. Treat them as part of your respiratory care, not separately.

FAQ

What are the most common symptoms of a respiratory disease?

The most common respiratory symptoms are cough (acute, subacute, or chronic depending on duration), sputum production, wheezing, shortness of breath (at rest, on exertion, or lying flat), chest tightness, hemoptysis (coughing up blood), fatigue, and reduced exercise tolerance. The pattern often points to the underlying condition: variable, episodic wheezing with chest tightness in response to allergens, exercise, or cold air suggests asthma; progressive shortness of breath with chronic productive cough in a smoker over 40 suggests COPD; fever, productive cough, and pleuritic chest pain suggest pneumonia; sudden shortness of breath with pleuritic pain raises concern for pulmonary embolism or pneumothorax. Less specific symptoms include nighttime cough, snoring with daytime sleepiness (sleep apnea), and finger clubbing (chronic lung disease or lung cancer). Any new persistent cough lasting over 3 weeks, blood in sputum, or unexplained shortness of breath warrants medical evaluation.

What is the difference between asthma and COPD?

Asthma and COPD are both chronic airway diseases with airflow obstruction, but they differ in mechanism, age of onset, reversibility, and treatment. Asthma is a chronic airway inflammation, usually allergic or eosinophilic, with variable, reversible bronchoconstriction; it typically starts in childhood, often comes with eczema or allergic rhinitis, and has variable symptoms triggered by allergens, exercise, cold air, or infections. Lung function tests usually show significant reversibility (FEV1 improves by 12% and 200 mL or more after a bronchodilator). COPD is persistent, usually progressive airflow obstruction from chronic small-airway inflammation plus alveolar destruction (emphysema); it almost always starts after age 40 in a person with a long smoking history (10+ pack-years) or significant biomass exposure; symptoms are persistent and progressive rather than variable; lung function does not return fully to normal after a bronchodilator (post-bronchodilator FEV1/FVC remains under 0.7). Treatment differs accordingly: asthma is controlled primarily with inhaled corticosteroid plus formoterol (ICS-formoterol, GINA 2025 Track 1), while COPD is treated with long-acting bronchodilators (LABA or LAMA, often both) with ICS added based on eosinophil count and exacerbation history. Some patients (especially older smokers with childhood asthma) have both conditions, known as asthma-COPD overlap.

What causes chronic respiratory diseases?

The biggest single cause is tobacco smoke, responsible for around 80% of COPD cases and at least 80% of lung cancers, and a major contributor to asthma severity. Air pollution comes next: outdoor PM2.5, nitrogen dioxide, and ozone; and indoor pollution from biomass cooking and heating fuels (a major COPD cause in low- and middle-income countries), secondhand smoke, mold, dust mites, and cockroach. Occupational exposures cause approximately 15% of adult-onset asthma and a meaningful portion of COPD, pulmonary fibrosis, and lung cancer: silica (mining, stonework), asbestos (construction, shipyards, latency 20 to 40 years), coal dust, grain dust, isocyanates, welding fumes. Severe early-childhood respiratory infections (especially RSV bronchiolitis and recurrent pneumonia) reduce peak adult lung function and raise the risk of later asthma and COPD. Genetic factors include atopy for asthma, alpha-1 antitrypsin deficiency for early-onset emphysema (testable and recognized as a treatable cause of COPD), and CFTR mutations for cystic fibrosis. Other modifiable contributors include obesity (worsens asthma and OSA), uncontrolled GERD, premature birth, low birth weight, and poor childhood nutrition. Climate change and extreme heat are now recognized in the GOLD 2025 strategy as relevant to COPD outcomes.

How are respiratory infections, like pneumonia or bronchitis, treated?

The two are different problems. Acute bronchitis is almost always viral, lasts 1 to 3 weeks, and does not require antibiotics in healthy adults: supportive care (rest, hydration, antipyretics, cough relief) is sufficient. Antibiotics for uncomplicated acute bronchitis are one of the most overused and inappropriate antibiotic uses in primary care. Community-acquired pneumonia (CAP), in contrast, requires antibiotics. Per the 2025 ATS/IDSA guidelines, outpatient adults without comorbidities can receive amoxicillin (1 g three times daily), doxycycline, or a macrolide (where local pneumococcal macrolide resistance is under 25%). Outpatient adults with comorbidities (chronic heart, lung, liver, or kidney disease, diabetes, alcoholism, malignancy, asplenia) receive combination therapy (amoxicillin-clavulanate or a cephalosporin plus a macrolide or doxycycline) or monotherapy with a respiratory fluoroquinolone. Hospitalized patients receive a beta-lactam plus a macrolide or a respiratory fluoroquinolone, with anti-MRSA and antipseudomonal coverage reserved for patients with specific risk factors. Duration is usually 5 days for clinically stable patients. Supportive care includes oxygen for hypoxemia, fluids, and antiviral therapy (oseltamivir) when influenza is suspected within 48 hours of onset.

Can respiratory diseases be prevented?

Many can, partially or fully. The single highest-yield action is never starting to smoke, or quitting if you do: this prevents most COPD, most lung cancer, and reduces severity of asthma and most other lung diseases. Other preventive measures with strong evidence: vaccinations (annual influenza, age-appropriate pneumococcal, COVID-19, RSV in adults 60+ or with chronic disease), avoiding secondhand smoke, reducing exposure to indoor pollution (biomass fuels, mold, dust mites), wearing appropriate respiratory protection at work (especially around silica, asbestos, isocyanates), managing allergies and atopic dermatitis early in childhood, breastfeeding for at least 4 to 6 months (reduces severe respiratory infections), introducing peanut early to reduce allergy risk (which indirectly affects asthma), maintaining a healthy weight, and exercising regularly. For people with severe eczema or family history of allergy, ongoing primary care follow-up reduces progression along the atopic march. Lung cancer screening with annual low-dose CT in eligible smokers (USPSTF 2021) prevents about 20% of lung cancer deaths in the eligible population. Air quality awareness and behavior change on high-pollution days reduce exacerbations.

How does smoking affect the respiratory system?

Smoking damages every level of the respiratory system. Acutely, it paralyzes airway cilia (the hair-like cells that clear mucus and particles), causes airway inflammation, increases mucus production, and constricts small airways. Chronically, smoking causes persistent neutrophilic airway inflammation, hypertrophy of mucus glands (chronic bronchitis), destruction of alveolar walls (emphysema), and progressive loss of lung function at a rate 2 to 3 times faster than non-smokers. Smokers have higher rates of every common respiratory infection (pneumonia, influenza, tuberculosis, COVID-19), worse asthma control, faster decline in lung function with age, and substantially higher cancer risk: smoking causes 80% to 90% of lung cancers and contributes to cancers of the larynx, pharynx, esophagus, bladder, kidney, pancreas, and cervix. Smoking also impairs wound healing, accelerates atherosclerosis, raises the risk of myocardial infarction and stroke 2 to 4 times, and is the leading preventable cause of death worldwide (over 8 million deaths annually per WHO). Crucially, quitting at any age has measurable benefits: blood pressure and circulation improve within weeks, lung function stabilizes and partially recovers over months, and the risk of lung cancer falls by about 50% within 10 to 15 years of quitting.

What are the long-term effects of poorly managed asthma?

Persistently uncontrolled asthma is not just uncomfortable: it causes structural changes ("airway remodeling") including thickening of the airway wall, smooth muscle hypertrophy, subepithelial fibrosis, increased mucus glands, and angiogenesis. These changes contribute to fixed airflow limitation that is partially irreversible even with optimal treatment. People with poorly controlled asthma have lower peak adult lung function, accelerated decline in FEV1 (similar to mild COPD over decades), higher rates of severe exacerbations requiring oral steroids, and increased risk of hospitalization and death (asthma still causes around 1,000 deaths per day globally, most preventable). Chronic systemic corticosteroid use carries its own toll: osteoporosis, fractures, cataracts, glaucoma, diabetes, hypertension, weight gain, adrenal suppression. Quality of life is significantly reduced. Poorly controlled childhood asthma may impair lung growth and reduce peak adult lung function. Mental health is affected: anxiety, depression, and reduced school or work performance are common. The good news: regular use of inhaled corticosteroids (typically as ICS-formoterol in the GINA 2025 strategy), trigger avoidance, comorbidity management, and (for severe disease) biologics dramatically reduce exacerbations and largely prevent these long-term harms.

How does air pollution trigger respiratory issues?

Air pollution causes respiratory harm through several overlapping mechanisms. Fine particulate matter (PM2.5 and PM10) penetrates deep into the lungs and reaches the alveoli, causing airway inflammation, oxidative stress, and impairment of cilia and macrophages. Ozone is a potent oxidant that damages the airway epithelium and lower respiratory tract; even short-term exposure increases asthma attacks and emergency visits. Nitrogen dioxide (from traffic and combustion) increases airway hyperresponsiveness, eosinophilic inflammation, and respiratory infection susceptibility. Sulfur dioxide acutely constricts airways. The clinical effects: increased asthma attacks and emergency department visits within hours of pollution spikes; more COPD exacerbations and hospitalizations; higher rates of pneumonia in children and older adults; reduced lung function development in children; higher lung cancer rates; and accelerated decline in lung function in healthy adults. Indoor pollution (biomass cooking and heating fuels in low- and middle-income countries, secondhand smoke globally, mold, cockroach, dust mites) accounts for a substantial share of childhood asthma and adult COPD. Climate change amplifies this: wildfire smoke contains very high PM2.5; heat waves increase ground-level ozone; longer pollen seasons worsen allergic disease. Practical defenses: monitor air quality, restrict outdoor activity on high-pollution days, wear N95 masks during wildfire smoke or sandstorms, optimize home ventilation, use HEPA air purifiers, and ensure clean cooking fuels.

When should I see a doctor for a persistent cough or shortness of breath?

See a primary care doctor or pulmonologist for: any cough lasting more than 3 weeks (chronic cough by definition); cough with blood (hemoptysis, even small streaks); cough with unexplained weight loss, night sweats, or fever beyond 1 to 2 weeks; new or progressive shortness of breath on usual activities; wheezing that does not respond to over-the-counter inhalers or that is new in an adult without prior asthma; cough that worsens at night and wakes you from sleep (suggests asthma, heart failure, or GERD); chest tightness or pain with breathing; persistent voice changes lasting more than 3 weeks (rule out laryngeal pathology); recurrent respiratory infections (more than 2 in a year); or new finger clubbing. Smokers and former smokers age 50 to 80 with at least 20 pack-years should ask about annual low-dose CT lung cancer screening. Seek emergency care immediately (101 in Israel, 911 in the United States, 112 in Europe) for: severe shortness of breath at rest with inability to speak full sentences; bluish lips or fingertips; confusion or drowsiness during a respiratory attack; severe chest pain with shortness of breath; coughing up large amounts of blood; or sudden onset of breathlessness with a swollen, painful leg (suspect pulmonary embolism). In chronic disease, a useful rule: any new symptom, change in usual symptom pattern, or rescue inhaler use more than every 4 hours is reason to seek help quickly.

What lifestyle changes can improve lung function and respiratory health?

The highest-impact change is to stop smoking and to avoid secondhand smoke; this single step does more for lung function than any medication. After that: exercise regularly (150 minutes per week of moderate aerobic activity plus 2 to 3 resistance training sessions, building exercise tolerance with pulmonary rehabilitation if you have chronic lung disease); maintain a healthy weight (obesity worsens asthma, OSA, and COPD); eat a Mediterranean-style diet rich in fruits, vegetables, whole grains, fish, olive oil, and nuts (associated with better lung function); reduce indoor pollution (no smoking inside the home, exhaust ventilation when cooking, dust mite control, mold remediation, HEPA filtration in the bedroom); monitor outdoor air quality and limit exposure on high-pollution days; vaccinate annually for influenza, COVID-19, and age-appropriate pneumococcal and RSV; learn correct inhaler technique and review it at each clinic visit; treat allergic rhinitis, GERD, and OSA; address mental health (anxiety, depression); get enough sleep (7 to 9 hours); ensure adequate vitamin D; and limit alcohol. For people with chronic lung disease, attend pulmonary rehabilitation if eligible, follow a written action plan, attend regular reviews, and know when to escalate care. Each of these has modest individual effect, but combined they substantially improve symptoms, exacerbations, hospitalizations, quality of life, and life expectancy.

Summary

Respiratory diseases span a wide spectrum from acute infections (pneumonia, acute bronchitis) to chronic disorders (asthma, COPD, interstitial lung disease, lung cancer). Together they are the third leading cause of death globally and one of the largest causes of disability and hospital admissions. The single most modifiable risk factor is tobacco smoke, followed by air pollution (outdoor PM2.5, ozone, NO2; indoor biomass fuels, secondhand smoke, mold, dust mites), occupational exposures (silica, asbestos, isocyanates, coal dust), recurrent severe respiratory infections in childhood, and genetic factors (atopy, alpha-1 antitrypsin deficiency, CFTR mutations).

Modern management is driven by the GOLD 2025/2026 strategy for COPD, the GINA 2025 strategy for asthma, and the 2025 ATS/IDSA community-acquired pneumonia guideline. The most important asthma update is the shift to ICS-formoterol as the preferred reliever across most steps, replacing reliance on as-needed SABA alone. The most important COPD updates are the recognition of pre-COPD and PRISm as treatable precursor states, expanded use of LABA-LAMA dual bronchodilation, biologic therapy (dupilumab approved 2024), the new nebulized PDE3/4 inhibitor ensifentrine (the first new drug class in 30 years), and explicit attention to cardiovascular comorbidity. For community-acquired pneumonia, antibiotic stewardship favors narrow-spectrum agents (amoxicillin, doxycycline) when appropriate, with shorter courses (5 days) for clinically stable patients. Across all conditions, the highest-yield interventions are smoking cessation, vaccination, correct inhaler technique, pulmonary rehabilitation, and management of comorbidities. Severe acute symptoms (chest pain with shortness of breath, blue lips, confusion, silent chest in asthma, hemoptysis) are emergencies and need immediate care.

References

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2026 Report. https://goldcopd.org/2026-gold-report/

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of COPD. 2025 Report. https://goldcopd.org/2025-gold-report/

1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2025 Update (released November 2025). https://ginasthma.org/wp-content/uploads/2025/05/GINA-2025_tracked-for-archive-WMSA.pdf

1. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST

1. American Thoracic Society / Infectious Diseases Society of America. Diagnosis and Management of Community-Acquired Pneumonia. 2025 Update. https://www.guidelinecentral.com/insights/nov-2025-atsidsa-cap-guideline-timeline/

1. US Preventive Services Task Force. Screening for Lung Cancer: USPSTF Recommendation Statement. JAMA. 2021;325(10):962-970. https://jamanetwork.com/journals/jama/fullarticle/2777244

1. Bhatt SP, Rabe KF, Hanania NA, et al. Dupilumab for COPD with Type 2 Inflammation Indicated by Eosinophil Counts (BOREAS). N Engl J Med. 2023;389(3):205-214. https://www.nejm.org/doi/full/10.1056/NEJMoa2303951

1. Anzueto AR, Rabe KF, Martinez FJ, et al. Efficacy and Safety of Ensifentrine in COPD (ENHANCE-1 and ENHANCE-2). Am J Respir Crit Care Med. 2023;208(4):406-416. https://www.atsjournals.org/doi/10.1164/rccm.202306-1097OC

1. World Health Organization. Chronic obstructive pulmonary disease (COPD) Fact Sheet. November 2023. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

1. World Health Organization. Asthma Fact Sheet. May 2024. https://www.who.int/news-room/fact-sheets/detail/asthma

1. Reddel HK, FitzGerald JM, Bateman ED, et al. GINA 2019: a fundamental change in asthma management. Eur Respir J. 2019;53(6):1901046. https://erj.ersjournals.com/content/53/6/1901046

1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. Am J Respir Crit Care Med. 2017;195(5):557-582. https://www.atsjournals.org/doi/10.1164/rccm.201701-0218PP

1. National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. https://www.nejm.org/doi/full/10.1056/NEJMoa1102873

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Key Takeaways

• Respiratory diseases include airway disease (asthma, COPD), lung tissue disease (pneumonia, ILD), vascular disease (PE, PH), and cancers; they cause around 3 million COPD deaths and 1,000 asthma deaths per day globally.
• The most common respiratory symptoms are cough, sputum, wheezing, shortness of breath, chest tightness, hemoptysis, and reduced exercise tolerance. The pattern (variable vs persistent, with or without smoking history) points to the diagnosis.
• Asthma is variable, reversible, often allergic, often starts young; COPD is persistent, less reversible, almost always after long smoking history, and starts after age 40. Spirometry confirms both.
• Tobacco smoke is the single largest cause of chronic respiratory disease, responsible for around 80% of COPD and lung cancer. Smoking cessation is the most effective single intervention in respiratory medicine.
• Air pollution (PM2.5, ozone, NO2; indoor biomass, mold, dust mites) and occupational exposures (silica, asbestos, isocyanates) cause large but underrecognized respiratory disease burdens.
• Acute bronchitis is usually viral and does not need antibiotics; community-acquired pneumonia does, with amoxicillin or doxycycline preferred for outpatients without comorbidities (ATS/IDSA 2019/2025).
• GINA 2025 recommends ICS-formoterol as the preferred asthma reliever across most steps, replacing SABA-only reliever use, which doubled mortality risk in observational studies.
• GOLD 2025 recognizes pre-COPD and PRISm as precursor states that warrant early intervention; recommends LABA-LAMA combinations early; and incorporates biologic therapy (dupilumab) and ensifentrine (the first new COPD drug class in 30 years).
• After a COPD exacerbation, the risk of severe cardiovascular event or all-cause death is 20-fold higher in the first 7 days; CV risk factor management is essential.
• Poorly controlled asthma causes airway remodeling, partial irreversibility, and mortality; ICS-formoterol-based regimens dramatically reduce these harms.
• Annual vaccination (influenza, pneumococcal, COVID-19, RSV) reduces hospitalization in chronic lung disease.
• Lung cancer screening with annual low-dose CT in eligible smokers (USPSTF 2021) reduces lung cancer mortality by about 20%.
• Severe shortness of breath at rest, blue lips, confusion during a respiratory attack, silent chest in asthma, hemoptysis, and sudden chest pain with breathlessness are emergencies requiring immediate care.

Medical Disclaimer

This article is intended for general medical information only and does not constitute medical advice, diagnosis, or treatment recommendations. It is not a substitute for consultation with a pulmonologist, primary care clinician, or emergency clinician. Information is based on scientific evidence available as of May 2026, including the GOLD 2026 strategy for COPD, the GOLD 2025 report, the GINA 2025 strategy for asthma (updated November 2025), the 2019 and 2025 ATS/IDSA guidelines for community-acquired pneumonia, and the USPSTF 2021 lung cancer screening recommendation.

Before starting, stopping, or changing any respiratory medication (inhaled corticosteroids, long-acting beta-agonists, LAMAs, biologics, antibiotics, oral corticosteroids), supplement, or oxygen therapy, consult a clinician familiar with your full medical history and current laboratory and lung function data. Do not stop maintenance asthma or COPD medications without medical guidance, even when feeling well. Reliance on a short-acting beta-agonist (SABA) alone without an inhaled corticosteroid for asthma is associated with worse outcomes including increased mortality.

In emergencies, including severe shortness of breath at rest with inability to speak full sentences, bluish lips or fingertips, confusion or drowsiness during a respiratory attack, severe chest pain with shortness of breath, coughing up large amounts of blood, sudden onset of breathlessness with leg swelling (suspect pulmonary embolism), stridor with drooling, or peak flow under 50% of personal best not improving with reliever, seek immediate emergency care: call 101 in Israel, 911 in the United States, or 112 in Europe.