Healthy California

The Breath of Life - COPD

Linda Brown, MPT Season 2 Episode 41

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Today we're diving into a condition that affects more than 15 million Americans and remains one of the most underdiagnosed chronic diseases: Chronic Obstructive Pulmonary Disease (COPD). Once labeled a "smoker's disease," COPD is now understood as a complex inflammatory condition, and according to the WHO and ALA, it's the 4th leading cause of death worldwide and 6th in the U.S.

The new GOLD 2026 guidelines shift the conversation toward disease activity, emphasizing inflammation, early detection, and strategies to move patients into a low‑disease‑activity state. Because at its core, COPD is not just about damaged lungs, it's about systemic inflammation and the body's ability to exchange the breath of life.

We break down the why and the how: from emphysema and chronic bronchitis to the leading causes, tobacco, vaping, environmental exposures, and the often‑missed genetic condition Alpha‑1 antitrypsin deficiency. We explore the ripple effects of COPD, including hyperinflation, CO₂ retention, cardiovascular risk, and the emotional toll of "air hunger."

You'll learn the essentials of prevention, physical therapy, pulmonary rehab, and lifestyle strategies that truly move the needle. From anti‑inflammatory nutrition and Mediterranean‑style eating to the surprising benefits of higher‑fat, lower‑carb patterns for CO₂ reduction, we cover the tools that help lungs and lives function better.

References

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2026). Global Strategy for the Diagnosis, Management, and Prevention of COPD.
  2. U.S. Pharmacist. (2025). Updated GOLD 2026 Report Broadens COPD Treatment Guidance.
  3. American Lung Association. (2026). Nutrition and COPD: Guidelines for Lung Health.
  4. Chest Physician. (2026). The link between exacerbations and cardiovascular health.
  5. Mayo Clinic. (2024). COPD: Diagnosis, Treatment, and Lifestyle Management.
  6. www.copdfoundation.org

Thank you for listening to Healthy California.

If you have tried all my suggestions and are still having trouble with your health, and would like an appointment with me, please email me, text, or call me via the contact information below.

My contact:

Linda Brown, MPT, Doctoral Candidate Functional Nutrition

916-426-2543

linda@heal-throughfood.com

www.heal-throughfood.com

Okay, welcome back, everyone.

00:01:16

This is Linda Brown, your physical therapist, functional nutritionist, coach, educator, and host of Healthy California.

00:01:25

Today, we are diving into a topic that affects over 15 million people in the U.S. alone.

00:01:32

It remains one of the most underdiagnosed conditions.

00:01:36

We are talking about chronic obstructive pulmonary disease, COPD.

00:01:41

It's no longer just a smoker's disease or just a diagnosis of bad lungs.

00:01:46

According to the World Health Organization and the American Lung Association, it is the 4th leading cause of death worldwide and the 6th most leading cause of death in the U.S.

00:01:58

That's huge.

00:02:00

And it's the leading cause of cancer worldwide.

00:02:04

The latest 2026 GOLD report, GOLD stands for Global Initiative of Obstructive Lung Disease.

00:02:13

The latest GOLD report, 2026, now views COPD through the lens of disease activity.

00:02:21

This means we aren't just looking at how your lung functions today, but also at the level of inflammation and how we can proactively move you into a low disease activity state.

00:02:35

I like this because we're being proactive.

00:02:37

We're not waiting for the symptoms and then doing something about it.

00:02:40

We're going to be proactive.

00:02:42

This says also the level of inflammation and how we can proactively move you into a low disease activity state.

00:02:48

Remember, most chronic diseases are inflammatory diseases.

00:02:53

I've said that multiple times.

00:02:54

Most chronic disease or inflammatory diseases, and this is one of them.

00:02:58

We'll go into that in a minute.

00:03:00

So we're talking about our lungs, the breath of life.

00:03:04

We shouldn't take it for granted.

00:03:05

So how do we get COPD?

00:03:08

Why do we get it? How do we get it?

00:03:11

To manage COPD, we have to understand what it is, actually.

00:03:17

COPD is an umbrella term that usually covers emphysema and chronic bronchitis.

00:03:23

So emphysema and bronchitis fall under the umbrella COPD.

00:03:29

Emphysema affects the little tiny air sacs in our lungs.

00:03:34

These little air sacs are very, very delicate, and when we have emphysema, those air sacs are destroyed.

00:03:42

And with bronchitis, It's a long-term inflammatory process of our airways.

00:03:49

So the airways are like the duct system.

00:03:52

It's before you get to these little alveoli sacs, it's the duct system of air as it gets to those alveoli.

00:04:01

So the bronchi get inflamed, and that would be bronchitis.

00:04:06

And so how do we get that? How do we get COPD?

00:04:10

I said just a second ago that it's not just a smoker's disease.

00:04:15

However, smoking is 90% of the causes.

00:04:19

So smoking is a thing. And this includes secondhand smoking.

00:04:23

Smoke itself contains a toxic mix of thousands of chemicals that damage these little delicate alveoli in the lungs by breaking down elastin.

00:04:35

Elastin is a protein in those alveoli that helps keep its shape.

00:04:42

So it helps those little cells to expand and recoil with each breath, expand and recoil.

00:04:47

And that's important because we need that to be pliable so the air can go in and carbon dioxide can come out.

00:04:54

That's the whole purpose of those alveoli.

00:04:56

Air comes in, oxygen comes in, CO2 comes out.

00:05:00

And when that doesn't happen, the whole system can break down.

00:05:03

So smoke damages the elastin, which damages the recoil of each of those air sacs.

00:05:11

And then nicotine itself, nicotine in cigarettes, paralyzes the cilia in the airways.

00:05:17

So the nicotine paralyzes the cilia.

00:05:19

So cilia is these fine little hairs, and they help remove things out of the air.

00:05:26

So as air comes in, the cilia trap the dusts and the pollens, and it traps it in the cilia, these little hairs, and then it moves it out.

00:05:35

And that's why we cough sometimes, because the cilia is moving things out.

00:05:40

And so when nicotine paralyzes that, we don't have a filtration system, and we get more bad air into our lungs.

00:05:50

So we don't have a filter system when the nicotine paralyzes the cilia.

00:05:55

And then from the cigarettes, we also have tar.

00:05:58

So tar coats the inside of the lungs and physically damages the alveoli.

00:06:03

And this promotes chronic inflammation.

00:06:06

There's that word inflammation again, because anytime something in the body is damaged, it sends an inflammatory process to try to heal it.

00:06:16

So tar, promotes chronic inflammation and impaired exchange.

00:06:22

So think about air coming in, CO2 leaving, and that being coated with tar.

00:06:29

Well, how is air going to come in and how is CO2 going to leave?

00:06:33

It doesn't, or it has a very difficult time.

00:06:36

So, you know, we don't get enough air and then we don't get rid of our CO2 either.

00:06:40

And not getting rid of our CO2 puts us at risk for lots of disease processes.

00:06:45

It makes our blood acidic, actually.

00:06:49

So tar coats the alveoli, coats the inside of the lungs, promoting inflammation and impairing oxygen CO2 exchange.

00:06:59

Let's talk about vaping for a second.

00:07:01

2026 guidelines emphasize that vaping and e-cigarettes are not recommended as safe alternatives, and that's because it is chemicals being delivered straight to our lungs as well, causing damage.

00:07:15

So there's a lot of research now on vaping because it's been around a little while at this point.

00:07:21

And so there's a lot more research on the long-term damage of vaping.

00:07:24

Vaping used to be considered a better alternative than smoking, but it's actually not.

00:07:30

So that's how it's caused, the smoke, the nicotine, the tar, and then vaping.

00:07:34

And then we also have environmental factors.

00:07:37

Environmental factors like air pollution.

00:07:40

Air pollution can come from dust, chemicals, things at your workplace.

00:07:44

We know that childhood infections or delayed lung maturation can set the stage for COPD later.

00:07:52

So even though you're not exposed to that right now, if you were as a child, that could stick with them throughout their life.

00:08:02

And they may not see the effects of it until later in their life.

00:08:06

So I'm saying that because children nowadays can be protected from the things in the air.

00:08:12

And that includes environmental things like smoke from forest fires, right?

00:08:17

Because that's a thing here in California now is the fire season.

00:08:21

So we need to protect ourselves.

00:08:24

We need to protect our children from these long-term effects.

00:08:27

And then another cause is genetics.

00:08:30

there is a rare condition called alpha-1 antitrypsin deficiency.

00:08:35

It's rare, but it's still important.

00:08:38

According to the COPD Foundation and the COPD Foundation podcast, 1% of COPD patients have this genetic deficiency.

00:08:49

However, 10% of people with COPD are undiagnosed.

00:08:55

So there's still people out there that don't have the diagnosis.

00:08:58

And so this 1% of those people that have this deficiency, this gene deficiency, are also undiagnosed.

00:09:07

So why is this important?

00:09:08

It's just like 1% of people who have COPD.

00:09:12

Well, it's important because it's a once in a lifetime test. It's a gene test.

00:09:19

So why not take the test? It's inexpensive.

00:09:23

If you have family members that have had COPD, then just get checked for it.

00:09:30

If your doctor orders it, will be covered by your insurance because it is inexpensive.

00:09:35

And if you know that you have the gene, even if you don't have symptoms, if you know you have the gene, you can start doing prevention measures right now, today, because you do not want to get COPD.

00:09:47

It's literally the breath of life.

00:09:50

And then the other thing that causes COPD is environmental triggers.

00:09:54

Like I said, air pollution and secondhand smoke, I mentioned those chemicals, if you live near farming that sprays their fields, construction, there's all sorts of things in the environment that can trigger COPD, especially if you have the gene for it.

00:10:14

And then another thing is indoor cooking fuels. So if you cook meat or you burn things or you like things a little bit burnt, that indoor cooking fuel can trigger a COPD event.

00:10:28

or it can trigger a bronchitis that can lead to COPD, or it can trigger inflammation in the lungs, which could contribute to COPD later.

00:10:36

So that's just something to think about.

00:10:39

So if you're living with COPD, or you don't know if you have it, some physical symptoms beyond just the smoker's cough is shortness of breath during activity, chest tightness, excess mucus.

00:10:52

So it's more than just a cough. But if you do have a chronic cough, that would be something to get checked out because a chronic cough is not normal.

00:11:00

If you have a chronic cough, please get it checked out. A chronic cough is never normal.

00:11:05

So COPD causes airflow obstruction because that's what the OPD, right, the chronic obstructive pulmonary disease.

00:11:13

So it's an obstruction of the airflow.

00:11:16

So it makes it hard to expel the carbon dioxide, not just take in the oxygen, but to expel the carbon dioxide.

00:11:25

When you can't expel carbon dioxide, this leads to hyperinflation of your lungs.

00:11:30

So your lungs kind of stay puffed up and you get that big barrel chest.

00:11:34

And it makes it harder to take the next breath.

00:11:36

If your lungs are already expanded, how do you get another breath in there?

00:11:41

And then your systemic effects is crucial, meaning system-wide.

00:11:47

If you can't get rid of the CO2, the body becomes acidic because that's what CO2 does in the blood.

00:11:54

The body becomes acidic, and when your body is acidic, it affects your brain, it affects your heart, and your nervous system.

00:12:01

In addition to not getting the oxygen the body needs affects everything, because every cell in the body needs oxygen.

00:12:08

So if you're not getting the oxygen in and the CO2 out, that's a whole systemic effect of your body, not getting the oxygen in, and then the CO2 causing your body to be acidic, causing all sorts of brain, heart, and nervous system damage.

00:12:25

Even one moderate flare-up or exacerbation significantly increases your risk for heart attacks or strokes, like even within 30 days.

00:12:33

So this is something to pay attention to.

00:12:36

Early symptoms of COPD may be headaches, being tired, shortness of breath, difficulty concentrating, or mild confusion.

00:12:44

And then more higher levels of COPD might be dizziness, rapid breathing, right, because we're trying to get the oxygen in and the CO2 out, flushed skin, elevated heart rate, high blood pressure, muscle twitches, that could all be COPD.

00:13:01

And then severe CO2 buildup can cause severe confusion or disorientation, hallucinations even, paranoia, seizures, loss of consciousness, loss of consciousness, respiratory failure, or coma.

00:13:15

That's something you don't want to get to.

00:13:17

You don't want to get to that severe CO2 buildup.

00:13:20

So if you have unexplained headaches, tiredness, shortness of breath, go get that checked out.

00:13:25

And then if you do think you have a history of COPD, make sure you go get a genetic test for that. And that genetic test would be the alpha-1 antitrypsin deficiency.

00:13:38

So once you have symptoms of COPD, there's kind of a downward spiral, unfortunately, because you get breathless and that leads to inactivity because it's not fun to be breathless.

00:13:50

And then that inactivity leads to muscle weakness. And muscle weakness, you know, if we don't have muscle on us, we are more prone to accidents, but muscle on our body is a determiner of longevity. So the more muscle we have on us, the longer we will live.

00:14:10

And if we have muscle weakness and that muscle wasting away, then we kind of go into this downward spiral.

00:14:17

And then if we're weak, it makes breathing even harder because it takes muscles to breathe.

00:14:22

And then there's this, the mental health, right?

00:14:24

There's a high correlation between COPD and anxiety and depression, and that's due to like air hunger, but it's also due to the fact that your brain isn't getting oxygen.

00:14:36

That's where the confusion comes in and some of the headaches and your body and your mind being hungry for air, even at a low level, we don't even realize it, even at a low level is detrimental.

00:14:48

So the other thing you can do is go see your physical therapist, right?

00:14:51

I'm a physical therapist. I'm always going to say go see your physical therapist.

00:14:55

A physical therapist can show you energy conservation, lung expansion, deep breathing, general prevention, purslip breathing.

00:15:04

There's a lot of things your physical therapist can do to get you on the road to prevention or to more activity or to COPD management if you already have it or if you think you have it.

00:15:16

Of course, prevention is always the best medicine.

00:15:19

It's always going to be the best medicine in everything.

00:15:21

So your primary prevention, of course, if the number one cause of COPD is smoking, then your primary prevention would be to stop smoking.

00:15:31

That's the gold standard. It's never too late to stop the clock.

00:15:35

It's the only intervention proven to slow the decline of lung function.

00:15:40

Even in 2026, with all our new drugs, quitting is still the gold standard.

00:15:45

Prevention is still the gold standard.

00:15:48

And then you can shield yourself from the environment, right, using masks if you are in a high-risk job or the air quality is bad.

00:15:57

You can get HEPA filters for indoor air.

00:16:00

So let's say you have the gene for COPD, the alpha-1, then these prevention strategies are something you want to do now before you get symptoms.

00:16:14

So the indoor air filters, wearing the masks. So this is the primary prevention.

00:16:21

You can get your flu shots, pneumonia vaccines, so that you stay strong and healthy and prevent flare-ups. You don't want to get pneumonia.

00:16:33

Anti-inflammatory diet.

00:16:35

Now, remember, inflammation is the cause of most chronic diseases. So if you are an anti-inflammatory diet, you can put things into your body that can help you heal.

00:16:48

Because that's what the body does with food.

00:16:50

It takes it and it builds, it takes the food, it breaks it down, it builds things, it repairs things, it grows things. That's the intention of it.

00:16:57

So if you have something in your body that is trying to heal, it's not going to heal on soda and cheese puffs.

00:17:08

I promise you that, is not going to help you heal.

00:17:12

So you need to be on an anti-inflammatory diet.

00:17:15

And also, like a Mediterranean diet has been shown to improve all sorts of inflammatory processes.

00:17:22

So look that up.

00:17:23

Anti-inflammatory diet, you can look that up on the web. You can look up Mediterranean diet.

00:17:27

And then of course, exercise. Exercise is something that is good for everything.

00:17:32

And exercise will help increase oxygen flow, but also it will also increase your rib cage to expand so that you can get more air into the lungs.

00:17:41

So exercising, not even to just expand the lungs, but to get your blood pumping and because exercise is anti-inflammatory.

00:17:53

So there's many different reasons why exercise is good for the body.

00:17:57

Exercise. If you don't know what you can do, go to your physical therapist.

00:18:01

And then if you already have COPD, you can go to a pulmonary rehab. You can go to your physical therapist as well. But a specialist pulmonary rehab, this is kind of a non-negotiable if you already have COPD, whether it's in person or telehealth. Everything can be telehealth nowadays.

00:18:21

So exercise training helps your muscles use the oxygen more efficiently so your lungs don't have to work as hard.

00:18:28

And then there's also inhalers.

00:18:31

Oxygen is usually used for more advanced stages. So don't get to that.

00:18:36

You can use inhalers, which manage daily symptoms if you already have symptoms.

00:18:41

And it's never too late to quit. Quitting at any stage can improve lung function.

00:18:48

And it can also just stop it from progressing because COPD is a progressive disease.

00:18:55

So you want to stop that progression.

00:18:58

And I can't say this enough, the best medicine is prevention.

00:19:03

Always, always.

00:19:05

And then, me as a functional nutritionist, this is my favorite part, your lungs and your gut are deeply connected because the gut is a lot of times where inflammation starts.

00:19:18

So you can change that.

00:19:19

So COP diet strategy would again include the Mediterranean diet.

00:19:25

can focus on whole grains, lean proteins, healthy fats.

00:19:29

Studies show that this pattern helps preserve lung function, the Mediterranean diet.

00:19:33

I mentioned that a little a minute ago.

00:19:35

Lower the carbs, increase the fats.

00:19:38

This may sound counterintuitive, but when your body metabolizes carbohydrates, it produces more CO2 than what it does when it burns fat.

00:19:48

For someone with COPD who struggles to exhale CO2, A higher fat, low carb diet can actually make breathing easier.

00:19:57

Remember, eating fat doesn't make you fat. It's eating high carbs and sugar that make you fat. So eating fat does not make you fat.

00:20:06

Also, another thing you can do is eat more protein.

00:20:10

COPD often leads to pulmonary cachexia, which just means muscle wasting.

00:20:14

You need at least 20 to 30 grams of high protein a couple times a day, like at two of your main meals. So eggs, lean protein, beans, tofu. Make sure you get good protein.

00:20:27

And this can keep your breathing muscles strong.

00:20:31

And also can just help your muscles from not wasting away, because you need muscle.

00:20:35

So the top foods to embrace might be potassium-rich foods like avocados, dark leafy greens, bananas. There's actually more potassium in a potato than there is a banana.

00:20:49

and potassium is vital for lung function.

00:20:52

Also focus on omega-3s, your SMASH fish. SMASH stands for salmon, mackerel, anchovies, and sardines.

00:21:03

Omega-3s, so your SMASH fish, your walnuts, they all fight systemic inflammation.

00:21:09

And then high fiber. So you want to aim for 30 grams of fiber a day, and this supports that gut-lung axis.

00:21:18

So keeping your gut healthy requires you having a good fiber diet.

00:21:24

And foods to eliminate might be sodium because it causes fluid retention, which puts pressure on your lungs.

00:21:31

But I would say more to increase your potassium because there is that sodium potassium pump in all your cells.

00:21:39

And sometimes we think about decreasing our sodium, but we don't think about increasing our potassium.

00:21:44

There needs to be a good ratio between your potassium and your sodium.

00:21:48

And I more likely see people low in potassium than high in sodium.

00:21:53

Think about increasing your potassium first.

00:21:55

And then limit foods that are gas producers.

00:21:59

Some people get gas in their stomach, not necessarily in their bowels, but in their stomach from onions, cabbage, carbonated drinks.

00:22:08

So bloating in the stomach pushes against the diaphragm, and anything that pushes up against the diaphragm make it harder for your lungs.

00:22:15

So even eating too much food that fills your stomach and pushes up against that diaphragm, that is also going to make your lungs struggle.

00:22:25

Not eating to the point of fullness and eating things that are less gas producing.

00:22:32

So your checklist. Your checklist would be

00:22:37

Early diagnosis.

00:22:39

COPD is a marathon, not a sprint.

00:22:40

So you want to get diagnosed earlier if you feel like you are headed down that road or if you have a family member.

00:22:49

You can go to your doctor or your physical therapist and do a spirometry test.

00:22:55

It's pretty easy.

00:22:56

Spirometry tracks your forced expiratory volume.

00:23:01

So you just breathe into this contraption and you can test what your lung function is.

00:23:06

And then of course, your genetic testing.

00:23:08

If you feel like you need to, again, it's real simple.

00:23:11

And if you have family members, then I would say go do it.

00:23:15

It's a really inexpensive test and you only have to do it once to see if you have the gene or not.

00:23:19

Simple.

00:23:21

Check your lung health if you have a persistent cough.

00:23:25

If you have a persistent cough right now, Put me on pause right now and call your doctor and set up an appointment to get your lungs tested.

00:23:34

Your checklist also would include exercise. Go exercise.

00:23:37

It's beautiful outside right now.

00:23:39

There's no reason why you can't get your heart pumping and your lungs pumping and your muscles moving.

00:23:47

And then get on an anti-inflammatory diet.

00:23:50

So in hydrate, hydrate, drink 6 to 8 glasses of water.

00:23:54

Having more water in your system thins any mucus that might be developing in your lungs, and it makes it easier to clear your airways.

00:24:02

So that's your checklist.

00:24:04

Early diagnosis, call your doctor if you have a cough, exercise, anti-inflammatory or Mediterranean diet, and hydrate.

00:24:13

Easy enough.

00:24:14

And then of course, I like to end on a Bible verse.

00:24:18

This one is from Genesis 2.7.

00:24:20

It says, then the Lord God formed man of the dust of the ground, and breathed into his nostrils the breath of life, and man became a living being.

00:24:30

So this verse reminds me that breath itself is a gift from God. So protect every breath.

00:24:36

Protect every breath.

00:24:38

We only have a numbered amount of breaths in our life, so protect it.

00:24:42

So if you know of someone who is managing COPD, send them this podcast.

00:24:48

It's a, what, 20, it's less than 30 minutes.

00:24:52

And I want to say thank you for breathing with me today.

00:24:56

Stay active, stay nourished, stay informed, and stay healthy, California.

00:25:03

Thank you for joining me today.