Respiratory Health 279

Respiratory Health

If you have had a cold or suffered from allergies, you know 

what it feels like to have trouble breathing. For women with 

respiratory diseases such as asthma, breathing troubles can 

become a permanent, rather than temporary, problem. If you have 

a respiratory disease, the right medical treatment—and learning 

how to manage your condition—can help you breathe easier.

Throat

Windpipe

Right lung

Nasal cavity

Mouth

Left lung

Ribs

Diaphragm

Sinus

Voice box

How the respiratory system works

Your respiratory system is made up of 

your nose, sinuses, mouth, throat, voice 

box, windpipe, lungs, diaphragm, and 

blood vessels. Breathing is the process of 

inhaling and exhaling. When you inhale, 

you bring oxygen-rich air into your body. 

When you exhale, you release carbon dioxide into the air from your body.

You breathe about 25,000 times during a 

normal day. If you are healthy, this process is easy. But for the millions of women with chronic, or long-term, respiratory 

diseases, breathing is not that simple.
280 The Healthy Woman: A Complete Guide for All Ages

Symptoms of respiratory disease

Because respiratory diseases affect your 

lungs, symptoms are related to how well 

you can breathe. In the early stages of 

respiratory disease, you might just feel 

tired. Other symptoms include:

l	 feeling short of breath, especially during physical activity or activities such 

as climbing stairs or carrying groceries

l	 feeling as though you cannot get 

enough air

l	 a cough that won’t go away

l	 coughing up blood or mucus 

(MYOO-kuhss), a thick, sticky substance, making it hard for air to get in 

and out of the lungs 

l	 uncomfortable or painful breathing

l	 a feeling of tightness in the chest

l	 wheezing, or a squeaky sound when 

you breathe

Your symptoms depend on your illness—

how advanced it is—and your overall 

health. For instance, having another 

chronic illness or being overweight could 

make your symptoms worse.

How respiratory disease is 

diagnosed

A doctor will identify the cause of your 

breathing problems based on your symptoms, medical history—including your 

family history—and a checkup. Several 

tests can also help diagnose respiratory 

illness. You might get one or more of the 

following tests, depending on your condition and the test results:

l	 Pulmonary function tests. These are 

a series of tests that measure how well 

your lungs take in and release air and 

how well they transfer oxygen into the 

blood.

l	 Blood gases test. This test measures 

how much oxygen and carbon dioxide 

are in your blood. If the results of this 

test are not normal, it may mean your 

body is not getting enough oxygen or 

is not getting rid of enough carbon 

dioxide.

l	 Bronchoscopy (brong-KOSS-kuhpee). This test allows your doctor to 

see your airways using a tube passed 

through your mouth or nose into your 

lungs.

l	 Chest x-ray. A chest x-ray lets your 

doctor see your lungs. It takes pictures 

of your heart, lungs, airways, blood 

vessels, and bones in your spine and 

chest. A chest x-ray is the most commonly performed diagnostic x-ray 

exam.

l	 Computed tomography (tuh-MOGruh-fee) (CT) scan of the chest. Your 

doctor might perform a CT scan of 

your chest if a mass or tumor is suspected or to look for bleeding or fluid 

in your lungs or other areas.
Respiratory Health 281

l	 Electrocardiography (ih-lek-trohkar-dee-OG-ruh-fee) (ECG or 

EKG). This test checks to see if heart 

disease is causing your symptoms. An 

ECG measures how fast and steadily 

your heart beats, whether there is heart 

damage, and the effects of drugs or devices that regulate the heart, such as a 

pacemaker.

Common respiratory diseases in 

women

The most common respiratory 

diseases in women are asthma; 

chronic obstructive pulmonary disease 

(COPD), which includes chronic 

bronchitis (brong-KEYE-tuhss) and 

emphysema (em-fuh-ZEE-muh); and 

lung cancer.

Asthma

Asthma is a chronic disease that makes 

the airways leading to the lungs very 

sensitive and swollen, making it hard to 

breathe. Viruses, mold, pollen, dust, air 

pollution, animal dander, smoke, cold 

weather, stress, and some medicines can 

cause the airways to swell. Things that 

cause airways to swell and asthma to 

flare up are called triggers.

An asthma attack can happen quickly. It 

can be mild or very serious. In a severe 

asthma attack, the airways can close so 

much that your body’s main organs do 

not get enough oxygen. People can die of 

severe asthma attacks.

Physical activity can trigger a problem 

called exercise-induced asthma. Asthma 

Rare Lung Diseases

Several rare lung diseases that also affect women include:

Lymphangeiomyomatosis (lim-fan-jee-oh-meye-oh-muh-TOH-suhss): In this disease, 

known as LAM, an unusual type of cell grows out of control in the lungs and other 

parts of the body. This slowly blocks airways and destroys normal lung tissue. LAM 

primarily affects women in their mid-40s.

Sarcoidosis (sar-coi-DOH-suhss): This disease disproportionately affects African 

American women between the ages of 20 and 40, as well as people in this age group 

of Asian, German, Irish, Puerto Rican, and Scandinavian descent. It causes tiny lumps 

of cells to grow in the lungs. These lumps affect how the lungs work.

Cystic fibrosis (SISS-tik feye-BROH-suhss): In cystic fibrosis, a mutated gene causes 

mucus in the body to become thick and sticky. The mucus builds up in the lungs, 

blocking airways. Repeated lung infections from a buildup of bacteria can seriously 

damage the lungs.

Pulmonary arterial hypertension: This disease causes continuous high blood pressure in the pulmonary arteries, or the blood vessels that carry oxygen-poor blood from 

the heart to the small blood vessels in the lungs. It can be inherited or occur for no 

known reason. The disease also may result from another condition, such as heart 

disease or chronic lung disease. Twice as many cases of the inherited form of the disease occur in women, most often in their 30s.
282 The Healthy Woman: A Complete Guide for All Ages

symptoms are usually triggered by cold, 

dry air during physical activity. For 

some women, symptoms such as coughing, wheezing, and shortness of breath 

can occur within minutes of beginning 

physical activity and get worse afterward. 

Other women have symptoms only once 

they finish exercising.

Although the exact cause of asthma is 

unknown, you are more likely to have the 

disease if it runs in your family. Asthma is 

also closely linked to allergies. Although 

asthma affects women of all ages, the disease is more likely to start in childhood.

Women are more likely than men to 

have asthma. More than 12.6 million 

women in the United States had the disease in 2005, compared with 8.7 million 

men. The number of women—especially 

young women—in the United States 

with asthma is growing.

Asthma: Differences between men and 

women

Studies have shown that asthma can affect men and women differently, and 

medical researchers want to know more 

about why this is the case.

Scientists are studying how changing 

hormone levels in women might cause 

or affect asthma. One study found that 

men with asthma were less likely than 

women to report severe and frequent 

symptoms and limits on their activity. 

Another study found that female hormones may contribute to adult women 

getting asthma.

Asthma treatments

Asthma can’t be cured, but you can work 

with your doctor or nurse to treat, manage, and control your illness. Most asthma medicines open the airways to your 

lungs and reduce swelling. These include:

l	 Corticosteroids (KORT-ih-kohSTAIR-oidz). These medicines can 

prevent and decrease swelling in the 

airways and reduce the amount of mucus you have. They are available in pill 

or inhaled form and are often taken 

over a long period of time.

l	 Bronchodilators (brong-koh-DEYElay-turs). These fast-acting medicines 

prevent or stop an asthma attack once 

it has started. Two common, inhaled, 

fast-acting medicines are albuterol (alAirway in Person with Asthma Normal Airway

Muscle

Lining

Tight Muscles

Swelling

Mucus
Respiratory Health 283

BYOO-tur-ol) and pirbuterol (purBYOO-tur-ol). They can relieve symptoms in minutes by quickly relaxing 

tightened muscles around the airways. 

Long-acting bronchodilators, which 

are often combined with antiswelling 

medicines, help relieve asthma symptoms over time. 

Other ways of controlling asthma require 

that you change or manage your behavior, such as avoiding secondhand smoke, 

stopping your own tobacco use, limiting 

your contact with triggers, and managing 

other health problems that could affect 

your asthma, such as stress and sleep apnea (AP-nee-uh), a disorder caused by 

repeated interrupted breathing during 

sleep. (See page 287 for more information on managing respiratory disease 

triggers.)

Asthma and pregnancy

Asthma can be one of the most serious medical conditions to interfere with 

pregnancy, so it is very important to 

manage your symptoms if you become 

pregnant. Uncontrolled asthma during 

pregnancy can increase the risk of preeclampsia (pree-ee-CLAMP-see-uh), a 

condition that could lead to seizures in 

the mother or baby; preterm birth; low 

birth weight; and even infant death. The 

most likely time for a pregnant woman 

to have asthma-related problems is in 

the late second or early third trimester. 

Asthma is hardly ever a problem at delivery. Continuing your asthma medicines 

and controlling triggers will help prevent 

an attack and help ensure your baby gets 

enough oxygen.

Inhaled medicines are less likely to be 

passed on to the baby than medicines 

you take by mouth, but you should speak 

with your doctor or nurse about the best 

way to control your asthma while you 

are pregnant. You also should ask about 

getting a flu shot, because the flu can be 

serious for pregnant women with asthma.

Pregnant women with other conditions that can make asthma worse, such 

as allergic rhinitis (reye-NEYE-tuhss), 

sinusitis (SEYE-nyoo-SEYE-tuhss), 

and gastroesophageal (GASS-troh-uhSOF-uh-JEE-uhl) reflux (GER), should 

bring those to the attention of a doctor 

or nurse. These illnesses often get worse 

during pregnancy. 

For more information about GER, see 

the Digestive Health chapter on page 265.
284 The Healthy Woman: A Complete Guide for All Ages

Pregnancy and Asthma

Some women may see their symptoms 

improve during pregnancy, whereas 

others’ symptoms may worsen. A National Institutes of Health study found 

that asthma got worse in about 30 

percent of women who had mild asthma at the beginning of their pregnancy 

and improved in 23 percent of pregnant women who already had moderate or severe asthma.

Chronic obstructive pulmonary disease 

(COPD)

COPD is a lung disease that has two 

forms: emphysema and chronic bronchitis. Many people with COPD have both 

forms.

COPD is the fourth leading cause of 

death in the United States and throughout the world. More than 12 million 

people in the United States have COPD 

and another 12 million may have the 

disease and not know it.

Emphysema

Emphysema is a chronic disease that 

weakens lung tissue and destroys the 

walls between the air sacs, or alveoli (alVEE-uh-leye). Because oxygen passes 

into the blood through these sacs, emphysema reduces the amount of oxygen 

in the blood. In 2005, 1.5 million women 

and 2.1 million men had emphysema. 

The most common cause of emphysema 

is smoking.

Chronic bronchitis

Smoking is also the most common cause 

of chronic bronchitis, which is a swelling 

of the bronchial tubes. The swollen tubes I

produce a buildup of mucus. About 5.3 

million women and 2.8 million men had 

chronic bronchitis in 2005.

Emphysema: Differences between men 

and women

A 2007 study found notable differences 

between men and women who had 

severe emphysema. Even though the 

women in the study hadn’t smoked as 

long as the men, they had more trouble 

with breathing and physical activity. They 

also reported feeling more depressed and 

scored lower on a test measuring overall 

mental health.

COPD treatments

Like asthma, COPD cannot be cured. 

But you can slow the disease down by 

not smoking and avoiding secondhand 

smoke. If you smoke, quitting will reduce 

future damage to your lungs.

Medicines to help you feel better if 

you have COPD are similar to those 

for asthma: inhaled corticosteroids and 

bronchodilators. Your doctor also might 

prescribe medicines called antibiotics if 

LLuSTRATION uSeD WITH PeRMISSION fROM THe 

NATIONAL HeART, LuNG, AND BLOOD INSTITuTe.
Respiratory Health 285

your lungs are infected. Other treatments 

include:

l	 Supplemental oxygen. Getting extra 

oxygen some or all of the time, depending on how bad your illness is, 

can help you breathe better. Extra oxygen, which you inhale through a mask 

or tube connected to an oxygen tank, 

can help you sleep better, stay more 

alert during the day, and live longer. 

l	 Pulmonary rehabilitation. A pulmonary rehabilitation program teaches 

you how to control your disease by being physically active, eating right, setting goals, managing your symptoms, 

and getting proper medical care. A 

team of health care providers will work 

together to create a program just for 

you.

Lung cancer

Lung cancer kills more women in the 

United States than any other kind of 

cancer. Lung cancer causes unhealthy 

cells in the lungs to divide and spread. 

These cells invade nearby tissue and 

spread to other parts of the body. 

In 2003, lung cancer accounted for more 

deaths than breast cancer, prostate cancer, and colon cancer combined. During that year, 105,508 men and 84,789 

women got lung cancer, and 89,906 men 

and 68,084 women died of it.

Although nonsmokers do get lung cancer, smoking leads to 87 percent of all 

lung cancer cases.

For more information on lung cancer, 

see the Cancer chapter on page 51.

Lung cancer: Differences between men 

and women

Researchers are studying the effects of 

hormones, such as estrogen, on the development of lung cancer in nonsmoking 

women and on drug treatments for cancer. A 2006 study reported that women 

who were recently diagnosed with lung 

cancer had lungs that functioned normally. These patients also had better 

results on lung tests than men who were 

recently diagnosed. The study also found 

that many more men than women with 

lung cancer also developed COPD.

Studies have shown that women with 

lung cancer respond better than men to 

some types of therapy and that women 

with lung cancer live longer than men 

with the disease.
286 The Healthy Woman: A Complete Guide for All Ages

Lung cancer treatments

Treatment for lung cancer includes surgery, radiation treatment, and chemotherapy 

(drug treatment) or a combination of these.

Respiratory Diseases, Symptoms, Tests, and Treatment

Asthma

Symptoms • Coughing

• Wheezing

• Chest tightness

• Trouble breathing

Tests • Spirometry (spuh-ROM-uh-tree)—measures how much air you can blow out of your lungs 

and how quickly

• Allergy and sinus

• Chest x-ray

• electrocardiography

Treatment • Corticosteroids

• fast-acting and long-term control bronchodilators

• Managing your disease, such as controlling triggers and using a peak flow meter to 

check how your lungs are working. A peak flow meter measures how fast you blow air 

into it.

COPD

Symptoms • Coughing

• Producing mucus

• Shortness of breath, especially with physical activity

• Wheezing

• Chest tightness

Tests • Spirometry

• Bronchodilator reversibility—repeats a spirometry test, adding a bronchodilator medicine 

to measure how the medicine affects your breathing; the bronchodilators relax muscles 

around the airways to make it easier to breathe.

• Diffusion capacity testing—measures how well your lungs transfer oxygen from the air 

into your blood

• Chest x-ray

• Blood gases test

Treatment • Corticosteroids

• Bronchodilators

• Antibiotics

• Pulmonary rehabilitation

• Supplemental oxygen
Respiratory Health 287

Respiratory Diseases, Symptoms, Tests, and Treatment

Lung cancer

Symptoms • Coughing that gets worse or does not go away

• Trouble breathing

• Constant chest pain

• Coughing up blood

• Hoarse voice

• feeling very tired all the time

• Lung infections, such as pneumonia (noo-MOH-nyuh)

• Losing weight

Tests • Blood tests

• Chest x-ray

• CT scan

Treatment • Surgery

• Radiation

• Chemotherapy

Sleep Apnea

Sleep apnea, or sleep-disordered 

breathing, is a common breathing 

disorder that can be very serious. 

Sleep apnea causes breathing to stop 

or become very shallow for 10 to 20 

seconds or longer many times throughout the night. One of 50 middle-aged 

women has sleep apnea. It is more 

common in African Americans, Hispanics, and Pacific Islanders than in 

Caucasians. A doctor can recommend 

changes in daily activities or treatments for sleep apnea.

How to decrease respiratory 

disease triggers

Reducing your contact with triggers that 

can make your breathing problems worse 

is a must for managing your illness. Here 

are some things you can do:

l	 Quit smoking. The best thing you 

can do for your overall health is quit. 

Also avoid secondhand smoke—only 

smoke-free environments will ensure 

your safety from tobacco chemicals 

that irritate your lungs.

l	 Avoid breathing chemicals. Stay 

away from strong cleaning or chemical agents whenever possible or wear 

a mask and use them in well-aired 
288 The Healthy Woman: A Complete Guide for All Ages

Feel Great: Quit Smoking

20 minutes after quitting

• Your heart rate drops.

12 hours after quitting

• The carbon monoxide 

(a gas that can be 

toxic) in your blood 

drops to normal.

2 weeks to 3 months 

after quitting

• Your heart attack 

risk begins to drop.

• Your lungs are 

working better.

1 to 9 months after quitting

• Coughing, sinus congestion, fatigue, and 

shortness of breath decrease.

• Your lungs start to function better, lowering your risk of lung infections.

1 year after quitting

• Your risk of heart disease 

is half that of a smoker’s. 

5 years after quitting

• Your risk of having a stroke 

is the same as someone 

who doesn’t smoke.

10 years after quitting

• Your risk of dying of lung 

cancer is half that of a 

smoker’s.

• Your risk of cancer of the 

mouth, throat, esophagus, bladder, kidney, and 

pancreas also decreases.

15 years after quitting

• Your risk of heart disease is now 

the same as someone who doesn’t 

smoke.

spaces. Avoid dust, dry-cleaning and 

cosmetic chemicals, asbestos, coal dust, 

soot, paint and chemicals used in construction, and wood and furniture 

refinishing products.

l	 Plan outdoor time carefully. Avoid 

being outdoors as much as possible 

during allergy season—spring and 

fall. Keep your house and car windows 

closed, and wash your clothes and 

vacuum once you come inside.

l	 Watch when and where you get physical activity. Try to walk or be physically active early in the morning or 

later in the evening (before and after 

rush hour traffic). Fewer cars on the 

roads will help you avoid car fumes. 

Consider finding an area to be physically active that is less crowded but not 

so empty as to be unsafe.

 Another option is to be physically active indoors. Fitness equipment and 
Respiratory Health 289

indoor tracks, tennis, basketball, volleyball, and racquetball courts allow 

you to exercise without going outside. 

Being indoors also helps you control 

the air temperature so you can avoid 

cold, dry air.

 If you have exercise-induced asthma, 

you might start to have trouble breathing within 5 to 20 minutes after physical activity. Warming up with short 

bursts of activity might help relieve 

your asthma symptoms. Physical activity that involves only short bursts of 

activity or activity that you stop and 

start again, such as walking, volleyball, 

basketball, gymnastics, or baseball, 

tend to be better for people with exercise-induced asthma. Swimming is 

also good because you are breathing 

warm, moist air instead of cold, dry air. 

You can get medicine to take several 

minutes to an hour before you begin 

physical activity to prevent an asthma 

attack.

l	 Manage stress and prevent panic attacks. Panic attacks brought on by 

stress can cause trouble breathing. 

Prevent panic attacks by managing 

stress: lighten your load, learn to say 

no, share tasks with coworkers or family members, make time for yourself, 

get enough sleep, and manage your 

time better. (See pages 208–210 of the 

Mental Health chapter for more information about stress.)

l	 Prevent the flu and pneumonia by 

getting vaccinated. Influenza, or 

the flu, and pneumonia are respiratory infections that can cause serious 

problems in people with respiratory 

diseases. Getting flu and pneumonia 

shots can greatly reduce your risk of 

these problems.

Asthma, COPD, and lung cancer are 

the most common respiratory diseases in 

women. If you have any of these diseases 

and smoke, quit now. With the help of 

your doctor, you can learn to manage the 

symptoms of asthma and COPD and 

improve your quality of life. If you have 

lung cancer, appropriate treatment, especially when started early, can prolong 

life. n
290 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

I

t was a typical August day in Michigan, hot and humid. I sat in our basement family 

room watching my three kids play and wondering if I could somehow pull it together 

to walk upstairs and make dinner. My chest felt tightly wrapped up, and I was so tired. 

Somehow the cooler air in the basement seemed to relieve some of the pressure in my 

chest. When my husband came home, I would go sit in his air-conditioned car, and slowly 

the pressure would ease. 

I decided it was time to see our family doctor. 

We had lived in Michigan for only 4 years, but I 

found I was extremely tired in the late summers 

and felt like I was breathing underwater. I always ...my personal 

blamed it on the humidity from living near Lake 

Michigan, but the tests my doctor sent me for 

proved otherwise.

Asthma Action 

“You have asthma,” he told me. “You’re kidding! 

How could I get asthma at my age?” I responded. Plan to help me 

He smiled and shook his head. “You have two 

children with asthma. Why would you be shocked 

that you have it? It runs in families.” keep asthma 

I was surprised at the diagnosis. Although my 

older daughter had been diagnosed with asthma under control

after being hospitalized and my son diagnosed 

the following year, it never occurred to me that 

the symptoms I was experiencing were the same 

ones my children lived with on a regular basis. My heart went out to them as I thought 

about how terrifying it is when they struggle to take each breath.

I started educating myself about allergies and asthma with an eye toward myself as the 

patient. I learned to avoid irritants that triggered my asthma. I tested positive for allergies 

to mold, dust mites, and grasses and took action to control my environment. I also see my 

doctor annually, monitor my lung function with a peak flow meter, and step up my medications per my personal Asthma Action Plan to help me keep asthma under control.

Ongoing education about asthma and allergies and working with my doctor provide the 

tools I need to stay in control of asthma rather than letting asthma control me. It’s been 

18 years since my diagnosis, and I can count the number of times when asthma has gotten in my way. 

Sandra

Butler, New Jersey
Respiratory Health 291

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/

quitsmoking

www.womenshealth.gov/faq/lung_

disease.htm 

Phone number: (800) 994-9662, 

(888) 220-5446 TDD

Centers for Disease Control and 

Prevention

1600 Clifton Rd

Atlanta, GA 30333 

Web site: www.cdc.gov

Phone number: (800) 232-4636, 

(888) 232-6348

National Cancer Institute, NIH

6116 Executive Blvd, Room 3036A

Bethesda, MD 20892-8322 

Web site: www.cancer.gov

Phone number: (800) 422-6237, 

(800) 332-8615 TTY

National Heart, Lung, and Blood Institute 

Information Center, NIH

PO Box 30105

Bethesda, MD 20824-0105

Web site: www.nhlbi.nih.gov

www.hearttruth.gov

Phone number: (301) 592-8573, 

(240) 629-3255 TTY

National Institute of Allergy and 

Infectious Diseases, NIH

6610 Rockledge Dr, MSC 6612

Bethesda, MD 20892–6612

Web site: www.niaid.nih.gov

Phone number: (866) 284-4107, 

(800) 877-8339 TDD

Office of Women’s Health, FDA

5600 Fishers Ln

Rockville, MD 20857

Web site: www.fda.gov/womens

Phone number: (888) 463-6332

Allergy and Asthma Network Mothers of 

Asthmatics

2751 Prosperity Ave, Suite 150

Fairfax, VA 22031

Web site: www.aanma.org

Phone number: (800) 878-4403

American Academy of Allergy, Asthma, 

and Immunology

555 E Wells St, Suite 1100

Milwaukee, WI 53202-3823

Web site: www.aaaai.org

American Association for Respiratory 

Care

9425 N MacArthur Blvd, Suite 100

Irving, TX 75063-4706

Web site: www.aarc.org

www.yourlunghealth.org

American College of Chest Physicians

3300 Dundee Rd

Northbrook, IL 60062–2348 

Web site: www.chestnet.org/patients/

guides

American Lung Association 

61 Broadway, 6th Floor

New York, NY 10006

Web site: www.lungusa.org

Phone number: (800) 548-8252

COPD Foundation

2937 SW 27th St, Suite 302

Miami, FL 33133

Web site: www.copdfoundation.org

Phone number: (866) 316-2673