COPD for Patients

How is COPD Diagnosed?

There is no home-based test available for COPD. See your doctor if you think you might have COPD. Based on your symptoms and risk factors, your doctor may refer you to a pulmonary specialist or hospital pulmonary function lab to get tested for COPD. If you don't have access to a doctor, contact NHServiceLink for assistance.

The breathing test used to diagnose COPD is spirometry. You will probably also be tested for Alpha-1 Antitrypsin Deficiency (Alpha-1) with a simple blood draw or finger stick test. Alpha-1 is a genetic condition that can cause COPD. Consult with your health insurance provider to determine if your plan covers the cost of these tests. Breathe New Hampshire sometimes hosts free spirometry testing events.

Spirometry is a simple, non-invasive, outpatient test. A device called a spirometer is used to measure the amount of air you can blow out of your lungs and how fast you can blow it out. Spirometry can detect COPD, even in its early stages. The test is also used to differentiate between diseases like asthma and COPD. Stage of COPD is based on severity of airflow limitation: mild, moderate, severe, or very severe. After initial diagnosis, spirometry may be used again later when you are undergoing treatment to check how well medicines are working.

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Newly Diagnosed. Now What?

You have taken the first step by being aware of your symptoms and seeing your doctor for testing and diagnosis. Know that while COPD cannot be cured, you can take steps to make breathing easier and live a longer and more active life.

  1. Quit Smoking. Tobacco smoke makes COPD symptoms worse. If you or someone you know is a smoker, get help to quit. Call the State of New Hampshire Quitline at 800-QUIT-NOW (784-8669) or visit for free help to help you quit and stay quit. Avoid secondhand smoke and other sources of smoke like burning wood and vehicle exhaust.
  2. Keep track of your symptoms and use of medicines in a journal. Discuss your symptoms with your primary care provider. Start a COPD Action Plan.
  3. Take medicine as directed by your doctor to help treat symptoms like coughing and wheezing. Make sure your healthcare provider shows you proper inhaler use.
  4. Get a flu shot. People with COPD are more likely to have symptoms or flare ups when they have the flu. It may also lead to pneumonia or other acute lung diseases. Protect yourself by getting a flu shot every year. During flu season, carry anti-bacterial wipes and a mask to use when others are coughing around you. Learn more about seasonal nfluenza here.
  5. Talk to your doctor about using oxygen therapy as well as joining a pulmonary rehabilitation program.

Are you a caregiver for someone newly diagnosed with COPD? Visit our caregiver information page for tips.   Caregiver Info

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What is Alpha-1?

Alpha-1 Antitrypsin Deficiency (Alpha-1) is a condition that is passed from parents to their children through their genes.  This condition may result in serious lung and/or liver disease at various ages in life.   People with Alpha-1 have received two defective alpha-1 antitrypsin genes. One defective gene came from their mother and one from their father.  The most common abnormal genes are called S and Z. Normal genes are called M. A person who does not have Alpha-1 will have two M genes (MM). People identified with Alpha-1 most commonly have two Z genes (ZZ).  Another deficient gene combination is SZ, although people with this gene combination are less likely to get lung or liver problems than those with two Z genes.

Alpha-1 occurs when there is a lack of a protein in the blood called alpha-1 antitrypsin or AAT that is produced by the liver. The main function of AAT is to protect the lungs from inflammation caused by infection and inhaled irritants such as tobacco smoke. The low level of AAT in the blood occurs because the AAT is abnormal and cannot be released from the liver at the normal rate. This leads to a build up of abnormal AAT in the liver that can cause liver disease and a decrease of AAT in the blood that can lead to lung disease.

The most common signs and symptoms of disease caused by Alpha-1 are:

  • Shortness of breath, wheezing, chronic cough and sputum (phlegm) production
  • Recurring chest colds, chronic bronchitis
  • Eyes and skin turning yellow (jaundice)
  • Swelling of the abdomen (ascites) or legs
  • Vomiting blood (from enlarged veins in the esophagus or stomach)
  • Decreased exercise tolerance
  • Non-responsive asthma or year-round allergies
  • Unexplained liver problems or elevated liver enzymes
  • Bronchiectasis

Who Should Be Tested for Alpha-1?

Early diagnosis and adherence to the proper health management plan are important elements to attaining an optimal quality of life.

The World Health Organization (WHO), the American Thoracic Society (ATS), the European Respiratory Society (ERS), and the Alpha-1 Foundation’s Medical and Scientific Advisory Committee (MASAC) recommend that individuals diagnosed with the following diseases should be tested for Alpha-1:

  1. Chronic Obstructive Pulmonary Disease (COPD)
  2. Emphysema
  3. Bronchiectasis
  4. Chronic bronchitis
  5. Asthma that is incompletely reversible after aggressive treatment
  6. Chronic liver disease
  7. Unexplained liver disease in infants and children
  8. The skin disease panniculitis

How Do You Know If You Have Alpha-1?

Alpha-1 can not be diagnosed by symptoms or by a medical examination. It can only be diagnosed through a blood test. Contact your doctor and discuss if testing for Alpha-1 is appropriate for you. If you agree to be tested, your doctor will write a prescription for the test.

Testing for Alpha-1 is simple, quick and highly accurate. Testing can be conducted on a blood sample (blood draw or finger stick test). Consult with your health insurance provider to determine if your plan covers the cost of this test. The Alpha-1 Foundation offers some free alpha-1 testing options.  

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COPD Medication

COPD has no cure yet, but lifestyle changes and treatments can help you feel better, stay active, and slow the progress of the disease. 

Many types of medicines are available for COPD. You may be on several medicines. You may take daily medicines and use others only when needed. It’s important to know the names of your medicines and how they work so that you can manage your COPD. 

Medicines for COPD can:

  • Reduce and relieve your symptoms
  • Help you move and exercise more easily
  • Reduce “flare-ups” or exacerbation and complications
  • Help you breathe and feel better

Talk with your doctor or health care provider about which medicines are best for you. Ask them to show you the correct way to take your medicine so your body gets the medicine it needs. Remember to ask your doctor or your local pharmacist about possible side effects and tips for dealing with them.

Use Your COPD Action Plan to track medications and chart dosages, time of day, symptoms and side effects. This record can help your doctor to fine-tune your medication regimen for best results. Take medicines as directed by your doctor. 

Common Medicines/Therapies


  • Bronchodilators (most are inhaled): To help relax and open your airways
  • Steroids (inhaled or pills): To reduce swelling and inflammation in your lungs
  • Combination medicines (inhaled): To open your airways and reduce swelling in your lungs
  • Antibiotics: To prevent or control infections that can make your COPD worse
  • Oxygen Therapy:  To make sure your body gets enough oxygen so you can feel better and stay active. A low blood oxygen level (called hypoxemia) can cause shortness of breath and damage to your organs. Your doctor may use a pulse oximeter, which clips onto your finger, and/or a blood draw to check your blood oxygen level. If you have low blood oxygen, your doctor may prescribe oxygen therapy. (see more below under cannula)

Common Delivery Devices

An inhaler is a portable drug delivery device. Many COPD medications (in powder or liquid form) are breathed in using an inhaler. Ask your healthcare provider or pharmacist to show you proper inhaler use for your specific inhaler type. If you're not using your inhaler correctly, your medications may not be able to work properly. There are many different types of inhalers and they all work a bit differently. You may have more than one type of COPD inhaler. Some inhalers (controllers or long-acting medicines) are used to prevent COPD symptoms, so you may need to take them every day, even when you’re feeling okay. Others (fast or short-acting medicines) give you quick relief from your COPD symptoms.

A nebulizer is a drug delivery device that turns liquid medication into a mist for inhalation. Nebulizers are not portable and are commonly used for taking medicine when you are at home. You may use a nebulizer instead of an inhaler, or with an inhaler.

How to use Inhalers
For more information on how to properly use inhalers, visit

Oxygen Therapy

If your COPD has progressed, and your blood oxygen levels are low, getting more oxygen can help you breathe better, improve your quality of life and live longer. oxygen-cart.jpg

If your doctor prescribes oxygen therapy, you will purchase oxygen and supplies from a durable medical equipment (DME) company. The company will deliver supplies to your home. You will use a tube, called a cannula, to breathe in oxygen through your nose. The tube will connect to a tank, a concentrator or a container depending on the type of oxygen you use (gas or liquid.)

You do not have to stay at home or be in a hospital to use oxygen.  Oxygen systems are portable and you can use them throughout your day inside or outside the home. Oxygen therapy contains little risk as long as you follow your provider's instructions. However, oxygen is a fire hazard, so it should not be used around lit cigarettes, open flames (furnaces, candles) or flammable materials.

It is important to have a safety plan if you use oxygen therapy:

  • Be prepared in case of a power outage. Talk to your medical supply company representative to create an emergency power plan for your oxygen therapy. In addition, notify your power utility so that they are aware of your medical needs.
  • Before traveling with oxygen, talk to your supplier to make sure that you have enough oxygen for travel time to, use during, and travel time home. Medical supply companies also offer a number of accessories, like travel bags or carts, to help make it easier to get out and about. If you book transportation services for your trip, call ahead to inquire if they have any restrictions for portable oxygen (ex. FAA-approved POCs) and to make the operator aware of your medical condition.

What to do during an a Power Outage (additional information)

Cost of Medicines

Insurance coverage for COPD medical services and prescriptions may vary depending upon the company and your specific health plan. Consult with your health insurance provider to determine if your plan covers the cost of your COPD medicines and related medical services. Your health plan may also offer a COPD management program, so be sure to ask. If you are not able to afford your medications, contact your doctor right away. Pharmaceutical companies may offer coupons or financial assistance for their branded medications. If you do not have health insurance, you may benefit from using the NH Rx Card - Prescription Assistance Program (PAP).

Additional Resources

  1. Insurance/Medication Form (writable)
  2. NH Health Cost - Web site created to compare Health Costs and Quality of Care in NH. 
  3. NH Insurance Department - List of Licensed Insurance Companies 
  4. NH Public Utilities Commission - Utility Service Questions & Answers
  5. Ready NH, Emergency Preparedness Website
  6. Federal Aviation Administration - Approved Portable Oxygen Concentrators (POCs) 

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Exercise and Pulmonary Rehabilitation

Aerobic exercise and breathing exercises are good for your lungs and the rest of your body.  Overall fitness and strengthening of the diaphragm can help make breathing easier. Did you know that regular exercise can improve your sleep, too? Set goals and keep track of what you eat and your activity level. If you are web savvy, you might want to try calorie and activity tracking at

Always consult with your doctor before beginning an exercise routine.

Pulmonary Rehabilitation (PR)

PR is a program of exercise and education for people living with COPD and other lung diseases. Usually conducted in a group format at a hospital or health care facility, a pulmonary rehabilitation program gives you a chance to interact with others living with lung disease. The initial program runs about 6-8 weeks. Usually, a maintenance program is available there after. Many participants say that PR is the best thing they could have done to live better with COPD! PR also offers you training and support on the following:

  • understanding your diagnosis
  • oxygen therapy
  • breathing techniques and energy conservation
  • using medicines and/or oxygen therapy
  • dealing with family stress and emotional issues, such as depression and loneliness
  • healthy eating
  • relaxation skills     

Ask your doctor or health care provider if you could benefit from a pulmonary rehabilitation program. Check with your health insurance plan representative to find out what to expect for covered versus out-of-pocket expenses before registering for a PR class. Pulmonary Rehabilitation is not a cure for COPD or other lung diseases, but it can help you breathe easier and live a longer and more active life. If your doctor refers you, Medicare covers many PR programs.

Additional Resources
  1.  List of Pulmonary Rehab Programs
  2.  Map of Pulmonary Rehab Programs

Team Orange .JPGTeam Orange COPD Challenge

Team Orange is a program of Breathe NH to help motivate participants to meet their pulmonary rehabilitation goals. Team Orange members track their exercise and log their minutes or miles for a Team Orange Challenge kicking off in March during Pulmonary Rehabilitation Week and ending in May.


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Breathing Techniques

You can retrain yourself in breathing to help your airways stay open longer as you breathe out. If you empty more of the old "stale" air out of your lungs, you will have more room for "fresh" air when you breathe in. This also takes less energy to get air in and out. 

Pursed lip breathing creates back pressure on your airways and helps keep them open. This will allow more of the stale air in your lungs to get out and create room for fresh air to get in. You will be able to catch your breath faster and easier and will feel less short of breath. Practice pursed-lip breathing when you are short of breath. 

Steps to Follow

  1. Breathe in or inhale through your nose at a normal rate and depth.  Feel your lungs fill with air.
  2. Purse your lips together as if you are going to whistle or play the flute or harmonica.
  3. Breathe out or exhale slowly and gently through your mouth, keeping your lips pursed.  The time it takes to exhale should be 2 to 3 times longer than the time you inhale.  Do not force air out.  

Adjust your breathing rhythm and the amount your purse your lips to increase your comfort.  Use this technique during exercise or activities that cause you to be short of breath.  However, this technique can be practiced anytime.

The diaphragm is the main muscle for breathing and is located between the chest and the abdomen. The diaphragm moves down as you breathe in, making the chest size larger so that air can flow into the lungs. When you breathe out the diaphragm moves upward and reduces the chest size so that the air is pushed out of the lungs. 

Most people breathe using their diaphragm. Other people, because of certain lung diseases, such as asthma and COPD don't use their diaphragm to the fullest extent. Exercising the diaphragm can improve its function. Learning how is a part of re-teaching yourself to breathe.

Steps to Follow

  1. Lie on your back with knees bent. Place one hand on your stomach and one hand on your chest.
  2. Relax your stomach muscles. Now inhale through your nose and feel your abdomen expand as your diaphragm contracts. You should be able to feel this  movement with your hand. The chest hand should move very little or not at all. This type of breathing is often referred to as "diaphragmatic breathing."
  3. Exhale slowly through your mouth while pursing your lips (like whistling). This reduces the tendency for airways to collapse. While exhaling, tighten your  abdominal muscles. This moves the diaphragm up and helps to get all the stale air out. You should be able to feel an inward movement of your abdomen with your hand.
  4. Try to make your exhalation twice as long as inhalation. To do this, try counting silently: Inhale 1, 2. Exhale 1, 2, 3, 4.

While breathing in and out, keep the muscles in your chest and neck as relaxed as possible because using these muscles will increase tension and waste energy.

Making it Work for You

The only way to retrain yourself to breathe is by practicing. Begin by going through the steps a few times an hour when you are relaxed. When you feel comfortable doing the exercises lying down, then begin practicing them while standing, walking, and sitting. You will find eventually these breathing exercises will decrease your episodes of shortness of breath. You will actually be able to do more activity.

Don't become discouraged if breathing exercises don't seem to be helping. Remember you are retraining your muscles and that takes time. The more you practice, the more natural and automatic it will become. When you become tense or short of breath then slow down, concentrate, relax, and do your breathing retraining exercises. This will help you catch your breath.

Help Yourself Move

Coordinate diaphragmatic and pursed lip breathing with your activity.

  • When walking inhale for two steps, then exhale for four steps.
  • When walking up stairs, exhale as you step up, then inhale and rest before the next step.
  • Pushing or pulling should be done when exhaling.
  • Exhale while lifting.
  • Exhale when you move from lying to sitting.
  • Exhale when you move from sitting to standing.

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What to Avoid/COPD Triggers

You can help manage your COPD by avoiding triggers or things that can make your COPD worse.  It’s important to be aware of these common triggers so you can take steps to protect yourself and prevent a flare-up of COPD symptoms:

Avoid Tobacco Smoke

Quit SmokingTobacco smoke (from cigarettes, pipes, cigars) makes symptoms worse. Do not smoke and avoid secondhand smoke. If you have COPD and currently smoke, you are not alone. Many people with COPD find it hard to quit. But, quitting is the most important step you can take to prevent more damage to your lungs. 

Quitting smoking will:

  • Improve your lung function and your ability to breathe
  • Improve your body’s response to medicines
  • Lessen COPD symptoms


Prevent Infections

Any type of infection, like the common cold or seasonal flu, can make your COPD symptoms worse.

Tips for reducing your risk from an infection from a virus, bacteria or other organism:

  • Wash your hands often, especially after being in public places
  • Avoid being around anyone who has a cold or the flu
  • Get a flu shot each year
  • Talk to your doctor about a pneumonia vaccination
  • Drink water to keep your body hydrated
  • Avoid crowds, especially during the flu season

Avoid Strong Odors

Strong smells can make you cough and irritate your airways, increasing your chance of having a COPD flare-up.

Common sources of strong odors:

  • Cleaning products, in particular, any products with bleach or ammonia
  • Scented candles and air fresheners
  • Perfumes, colognes, scented lotions, deodorants or hair products
  • Kitchens (cooking fumes)

Tips to help avoid strong smells:

  • use environmentally friendly cleaners
  • avoid aerosol sprays
  • use a mask when cleaning
  • ventilate the area when cleaning or cooking (open windows, use exhaust fans, vent to outside)
  • ask family and friends not to burn candles or use strong smelling products around you 

Watch the Weather

Temperature, humidity, wind conditions and air quality can affect your breathing and make your COPD symptoms worse.

Cold/dry air

During fall and winter months, dry air and sudden changes in temperature, like going in and out of your home, can bring on COPD symptoms. Use a mask or cover your mouth and nose when outside. Use a humidifier inside.

Hot/humid weather

During summer months, heat and humidity can make breathing very difficult. Stay inside and/or use air conditioners or fans.

Keep Indoor Air Clean

Indoor air quality can affect your COPD:

  • Keep it clean, dry, and tobacco free
  • Regularly inspect and repair heating systems (furnaces, wood stoves, water heaters, and fireplaces)
  • Avoid using rugs. If you have rugs, use a vacuum with a HEPA filter
  • Test your home for radon
  • Install an alarm that detects carbon monoxide

Learn more about clean indoor air here.


Avoid Outdoor Air Pollution

Be aware of your air. Check the NH Air Quality Forecast before going outside. Stay inside when air quality is poor. If you have to go out on a bad air day, wear a mask and avoid going out when air pollution levels are highest.

Learn more about outdoor air quality here.

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COPD & Sleep

Do you have trouble getting a good night sleep due to COPD symptoms like coughing or from medication side effects? You are not alone.

Sleeping well is important to your health. During sleep, your body is working to support healthy brain function and maintain your physical health. Duration and quality of sleep also impact daytime sleepiness. It is not uncommon for individuals living with COPD to have trouble with sleep or to have an underlying sleep disorder.

If you have trouble falling asleep, staying asleep, or feeling refreshed after waking up, talk to your doctor. They may refer you for evaluation at an accredited sleep center to determine the cause of your sleep problem and identify appropriate treatment. Check with your insurance plan representative before making an appointment so you know what to expect for covered versus out-of-pocket expenses.

Tips for sleeping better with COPD

  • Never use over-the-counter sleeping aids without talking to your doctor first. Many drugs can further reduce and interfere with your breathing ability.
  • Exercise! Did you know that regular exercise can improve sleep? Consult with your doctor before beginning an exercise routine.
  • Use breathing techniques to help clear your airways before going to bed.
  • If you have a low blood oxygen level at night and have been prescribed nocturnal oxygen therapy by your doctor, make sure to use it as directed. Contact your oxygen supply company to create a safety plan for traveling with oxygen and using oxygen during power outages.
  • Use your COPD Action Plan and talk with your doctor about it. Track your medications, test results, and monitor your overall health - including sleep patterns and any treatments prescribed for sleep.

Practice Good Sleep Hygiene 


  1. Go to bed and wake up at the same time each day—even on the weekends
  2. Do something relaxing, like reading, to unwind at the end of your day
  3. Dim the lights – darkened rooms help you fall asleep
  4. Remove TVs from your bedroom, they can interfere with your ability to sleep
  5. Turn down the temperature – cooler temperatures are better for sleep


  1. Eat a large meal within hours of going to sleep
  2. Drink alcohol or caffeine (coffee, tea, soda) before going to bed
  3. Text or look at a screen (computer, tablet, smart phone) before going to bed
  4. Nap for more than 30 minutes

Additional Resources

  1. Catholic Medical Center New England Sleep Center
  2. Elliot Pulmonary and Sleep Center
  3. NH Hospital Association - List of NH Hospitals
  4. American Academy of Sleep Medicine 


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Food provides essential nutrients and energy we need to stay healthy. Eating well can help you feel more energetic and will help your body to fight off infection. Nutrition is especially important in managing a chronic disease, like COPD. Living with COPD, you may find that you have trouble losing or gaining weight. It’s also easy to get dehydrated due to medication side effects or complications from other health conditions. It can be tricky to know what to eat and what to avoid eating when you need to manage your COPD in addition to other medical conditions and medication side effects. A registered dietician (RD) can help you create a personal meal plan. Contact your local hospital for a referral or to find nutrition classes. Check with your insurance plan representative before making an appointment so you know what to expect for covered versus out-of-pocket expenses.

Tips for Eating Well with COPD

Shopping, preparing and cooking meals can also be challenging if you have COPD. Here are some ideas:

  1. Plan ahead - Prepare snacks and meals when you have energy. Store them so they are easy to reheat when you need them.
  2. Make enough for leftovers - when you cook a meal, make enough so you can freeze some for a time when you’re not up for cooking.
  3. Buy frozen fruits and vegetables - Frozen produce can be a healthy, easy and cost-effective way to get more fruits and vegetables. Look for the USDA "U.S. Fancy" stamp for the most nutritional ones. Steam or microwave for easy preparation.
  4. Eat smaller, nutritious meals throughout the day.
  5. If you have oxygen, use it while you eat.
  6. Ask for help - explain to your family and friends that you need help with grocery shopping, preparing/cooking meals, and cleaning up after meals!
  7. Use your COPD Action Plan. Track your medications, test results and monitor your overall health - including nutrition! Then, talk about your COPD Action Plan with your doctor at your next visit.

General Nutrition Guidelines

Talk with your doctor about your nutritional needs before making any changes to your eating plan. Here are some general guidelines from the Food & Drug Administration (FDA):

  1. Eat a variety of foods, especially fruits, vegetables and whole grains. Find a NH farmers’ market near you for fresh produce.
  2. Eat lean sources of protein (poultry, fish, beans, low-fat cuts of meat, eggs and low-fat dairy products).
  3. Eat healthy fats (monounsaturated and polyunsaturated fats) found in olive oil, nuts, seeds and fish. Avoid trans fats and limit saturated fats (found in butter, cheese, red meat) and partially hydrogenated oils, often found in processed foods.
  4. Drink water and stay hydrated. Talk to your doctor or healthcare provider about how much water intake is right for you given your medical conditions and medications.
  5. Limit sodium. Don’t add extra salt to your foods, limit processed foods and check food labels.

Additional Resources
  1. VeryWell Fit - Recipe Nutrition Analyzer
  2. USDA - Choose My Plate Recipes
  3. US FDA - Using the Nutrition Facts Labels
  4. Hannaford Supermarkets - Free Nutrition Classes
  5. NH Department of Health & Human Services - Healthy Food Outlets 
  6. NH Hospital Association - List of NH Hospitals
  7. NH Academy of Nutrition and Dietetics - Find a Registered Dietician

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Patient Support 

COPD Support Groups - Join a monthly COPD Support Group. In addition to finding support from others, groups provide the opportunity to share new information and strategies, encourage each other to live each day to its full potential and feel empowered to cope with the challenges of living with COPD. Contact: 603.669.2411 or  

NH Lung Health Support Groups pdf

Ask Dr. Mahler of New Hampshire 

COPD Foundation Patient Information Line:  1-866-316-COPD (2673)

National COPD Foundation COPD360Social Online Community  

COPD International International Support Network Online Community 

Depression/Stress Management Support

Call 911 if you or a loved one are in immediate danger.  Notify the operator that this is a psychiatric emergency and ask for an officer trained to help people with a mental health condition.

National Suicide Prevention Lifeline:  1-800-273-TALK (8255) (open 24-hours)

National Alliance on Mental Illness (NAMI) Helpline
1-800-950-NAMI (6264) (open Monday through Friday, 10AM - 6PM, ET)

Community Services Support

NH Health Cost - Compare health costs and quality of care in New Hampshire.  

211 NH - Resources and Support -   Dial 2-1-1 or 866-444-4211, tty Number 603-634-3388

NH ServiceLink - Aging and Disability Resource Center 

 U.S. Department of Veterans Affairs

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