I have been diagnosed with severe COPD for 4 years or so, and probably have suffered from emphysema for much longer. I smoked for about 40 years before quitting in 2000. I quit because my husband had severe COPD and several hospitalizations and crisis . After my second spirometry test two years ago I went to Respiratory rehab classes that included about 50 minutes of exercise. I felt so much better after regularly working out for that amount of time on a regular basis that I chose not to take medication. I joined a health club near my home and am struggling to keep myself going regularly. However, I suffer when I do not go. I am still choosing to avoid medication. I am still able to complete household chores, volunteer as a cat foster mom and cage cleaner at our adoption display site, tow days a week and taking my dog on walks when weather permits. I do yoga breathing exercises on a regular basis, do pursed lip breathing when walking or working out and also do regular yoga meditation. Is there anyone else out there who is choosing to go without medication for as long as possible, and choosing lifestyle modifications instead? I am very fortunate in having a pulmonologist who supports my choice, even when others were and are urging medication use. I am trained as a research psychologist individual organism designs and see no reason to medicate when lifestyle changes that improve my function are working.