Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease, commonly known as COPD, is a serious lung condition that makes it progressively harder to breathe. It is one of the leading causes of death worldwide, yet with the right treatment and lifestyle changes, people with COPD can manage their symptoms and maintain a better quality of life.

What is chronic obstructive pulmonary disease?
Types of COPD
Symptoms and warning signs
Causes and risk factors
Complications
How is COPD diagnosed?
Treatment options
Living with COPD
Prevention

What is chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease, or COPD, is a term used to describe certain types of lung and airway damage that make it hard to breathe^[1]. The condition causes restricted airflow and breathing problems that develop slowly and worsen over time^[3]. In people with COPD, the lungs can get damaged or clogged with a thick, slimy substance called mucus (also called phlegm or sputum)^[3].

COPD is an ongoing lung condition caused by damage to the lungs. This damage results in swelling and irritation, also called inflammation, inside the airways that limit airflow into and out of the lungs^[1]. The term “obstructive” means that the airways are blocked or obstructed, making it difficult for air to move in and out freely^[2].

Changes that occur in the lungs and airways of people with COPD include loss of elasticity in the airways and air sacs, inflammation and scarring of the airways, thick mucus buildup, and destruction of the walls between tiny air sacs^[2]. These changes trap air in the lungs and make breathing increasingly difficult.

Although COPD is a condition that worsens over time, it is both preventable and treatable. With proper management, most people with COPD can control symptoms and improve their quality of life^[1]. However, the damage to the lungs caused by COPD is permanent and cannot be reversed^[5].

Types of COPD

COPD includes two main types of lung conditions: emphysema and chronic bronchitis^[1]. Most people with COPD have a mixture of both conditions in different proportions, and how serious each condition is varies from person to person^[4].

Emphysema develops when there is damage to the walls between many of the air sacs in the lungs. These air sacs are called alveoli. Normally, the alveoli are elastic or stretchy. When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sacs deflate and the air goes out. In emphysema, the alveoli become damaged and enlarged, and it becomes harder for your lungs to move air out of your body^[4]. The most common symptom of emphysema is shortness of breath^[2].

Chronic bronchitis is inflammation of the lining of the tubes that bring air into the lungs. These tubes are called bronchi. The inflammation prevents good airflow into and out of the lungs and causes the airways to make extra mucus^[1]. Chronic bronchitis is defined as a long-term cough with mucus that you’ve had for three months or longer at a time for at least two years^[2]. The main symptom is a persistent cough that produces mucus.

Symptoms and warning signs

COPD symptoms often don’t appear until a lot of lung damage has occurred, and they usually worsen over time, especially if smoking or other irritating exposure continues^[1]. Common symptoms of COPD develop from mid-life onwards^[3].

The most common symptoms include:

Trouble catching your breath or shortness of breath, particularly when you’re active or performing daily activities^[1]
A persistent chesty cough with mucus or phlegm that you’ve had for a long time. Some people may dismiss this as just a “smoker’s cough”^[5]
Frequent coughing or wheezing (a whistling or squeaky sound when you breathe)^[1]
Difficulty taking a deep breath^[2]
Chest tightness^[1]
Feeling tired or having extreme tiredness^[3]
Frequent respiratory infections such as colds and the flu^[7]

In more advanced stages, some people with COPD may experience weight loss, weakness in their lower muscles, and swelling in their ankles, feet, or legs^[7]. Some people may also have a barrel-shaped chest or bluish skin, called cyanosis^[2].

As COPD progresses, people find it more difficult to carry out their normal daily activities, often due to breathlessness^[3]. COPD symptoms can get worse quickly. These sudden worsening episodes are called flare-ups or exacerbations, and they usually last for a few days and often require additional medicine^[3]. You might need to go to the hospital for severe exacerbations^[2].

If you have persistent symptoms of COPD, particularly if you’re over 35 and smoke or used to smoke, see a doctor. Do not ignore the symptoms. If they’re caused by COPD, it’s best to start treatment as soon as possible, before your lungs become significantly damaged^[5].

Causes and risk factors

COPD happens when the lungs become inflamed, damaged, and narrowed. The most common cause is smoking, although the condition can sometimes affect people who have never smoked^[5]. Tobacco smoking accounts for over 70% of COPD cases in high-income countries, while in low- and middle-income countries, tobacco smoking accounts for 30 to 40% of cases^[3].

The likelihood of developing COPD increases the more you smoke and the longer you’ve smoked^[5]. In the United States, cigarette smoke is the main cause of COPD. Pipe, cigar, and other types of tobacco smoke can also cause COPD, especially if you inhale them^[7].

Other causes and risk factors include:

Secondhand smoke: Exposure to other people’s cigarette smoke can contribute to COPD^[7]
Air pollution: Long-term exposure to air pollution at home or work, including household air pollution, can cause COPD^[3]
Occupational exposure: Exposure to dust and fumes from your job or hobbies, including chemical fumes and industrial dusts, may cause COPD^[2]
Respiratory infections: Many respiratory infections during childhood may play a role in developing COPD^[3]
Alpha-1 antitrypsin deficiency: This is a rare, inherited genetic disorder that can lead to lung damage and COPD, even in people who don’t smoke^[2]

While smoking is the biggest risk factor for COPD, not everyone who smokes will develop it. You may be at higher risk if you are female, are over the age of 65, have been exposed to toxins in the air, have worked with chemicals, dust or fumes, have alpha-1 antitrypsin deficiency, or had many respiratory infections during childhood^[2]. People with a history of asthma are also at higher risk of developing COPD than people who don’t have asthma^[7].

Complications

COPD is one of the leading causes of death worldwide. It was the fourth leading cause of death globally in 2021, causing 3.5 million deaths, which represents approximately 5% of all global deaths^[3]. In the United States, COPD is one of the top 10 causes of death^[8].

COPD can trap bacteria in your lungs, leading to infections. It can also prevent oxygen from getting into your body and carbon dioxide from getting out. This can lead to serious complications^[2], including:

Pneumonia and other lung infections like the flu^[2]
High levels of carbon dioxide in your blood, called hypercapnia^[2]
Low levels of oxygen in your blood, called hypoxemia^[2]
Respiratory failure^[2]
Lung cancer^[3]
Heart problems, including pulmonary hypertension (high blood pressure in the lungs) and right-sided heart failure^[2]
Collapsed lung, called pneumothorax^[2]
Making too many red blood cells, called polycythemia^[2]
Weak muscles and brittle bones^[3]
Depression and anxiety^[3]

People with COPD are more likely to have difficulty working or doing usual activities, walking or climbing stairs, and concentrating, remembering, or making decisions. They are also more likely to have other chronic diseases like asthma, heart disease, and diabetes, as well as depression or mental health conditions^[8].

Nearly 90% of COPD deaths in those under 70 years of age occur in low- and middle-income countries^[3]. There may be a considerable financial burden due to limitation of workplace and home productivity, and costs of medical treatment^[3].

How is COPD diagnosed?

To diagnose COPD, a healthcare provider will perform an exam and ask about your symptoms, your family and medical history, and any exposure you’ve had to lung irritants, especially cigarette smoke^[11]. They will ask questions like whether you smoke or have ever smoked, and about your breathing difficulties^[2].

The provider will do a physical exam that includes listening to your lungs. You may also have several tests to diagnose your condition^[11].

The main test used to diagnose COPD is called spirometry. This is a simple breathing test that measures how well your lungs work^[5]. During the test, you breathe out quickly and forcefully through a tube connected to a machine called a spirometer. The machine measures how much air the lungs can hold and how quickly air moves in and out of the lungs^[11]. Spirometry can diagnose COPD and tell how much airflow is limited.

Other tests that may be done include:

Lung volume test: This measures the amount of air the lungs hold at different times when breathing in and out^[11]
Lung diffusion test: This shows how well the body moves oxygen and carbon dioxide between the lungs and the blood^[11]
Pulse oximetry: A simple test that uses a small device placed on one of your fingers to measure how much oxygen is in your blood^[11]
Chest X-ray or CT scan: Imaging tests to get pictures of your lungs^[2]
Blood tests: To check oxygen and carbon dioxide levels and rule out other conditions^[2]
Exercise stress test or six-minute walking test: To see how physical activity affects your breathing and oxygen levels^[11]

Getting diagnosed early allows you to manage and treat COPD, so you can prevent it from getting worse^[8]. Many people do not realize they have COPD until significant lung damage has occurred. In the United States, COPD affects more than 14 million adults, and many others do not know they have it^[4].

Treatment options

There is currently no cure for COPD, but treatment can help slow the progression of the condition and control symptoms^[5]. Although the damage to the lungs is permanent, treatments can help with symptoms, slow the progress of the disease, and improve your ability to stay active^[7].

Stopping smoking

If you smoke, stopping is the most effective way to prevent COPD from getting worse. This is the most important thing you can do^[5]. Although any damage already done to your lungs and airways cannot be reversed, giving up smoking can help prevent further damage^[12]. About 8 out of 10 deaths from COPD are caused by smoking^[6].

A healthcare provider can help by recommending programs and products that can help you quit. Treatment, including medications, can double or triple your chances of quitting for good^[6]. Joining a support group with other people who are quitting smoking can also be very helpful.

Inhalers and medications

If COPD is affecting your breathing, you’ll usually be given an inhaler. This is a device that delivers medicine directly into your lungs as you breathe in^[12]. A doctor or nurse will advise you on how to use an inhaler correctly and how often to use it.

The main types of inhalers include:

Bronchodilators: These medicines relax the muscles around your airways, which helps to open the airways and make breathing easier. They can be short-acting (used when needed, lasting about 4 to 6 hours) or long-acting (used once or twice daily)^[12]
Steroid inhalers: These contain corticosteroid medicines that can help reduce inflammation in your airways. They are normally prescribed as part of a combination inhaler^[12]

For symptomatic COPD, combination therapy with a long-acting beta agonist (LABA) and a long-acting muscarinic antagonist (LAMA) is recommended over using just one medicine. This combination results in fewer exacerbations and hospitalizations, with improvements in breathlessness^[15].

If patients are still symptomatic despite combination therapy, adding an inhaled corticosteroid (ICS) can be considered. This reduces exacerbations but increases the risk of pneumonia^[15].

Other medications that may be prescribed include:

Theophylline tablets: A type of bronchodilator taken as tablets or capsules^[12]
Mucolytic medicines: Such as carbocisteine, which make the mucus in your throat thinner and easier to cough up^[12]
Antibiotics: To treat respiratory infections^[8]

Pulmonary rehabilitation

Pulmonary rehabilitation is a specialized program of exercise and education that can help people with COPD feel better and improve their ability to do daily activities^[5]. These personalized programs teach you how to manage your COPD symptoms, including how to breathe better, conserve your energy, and choose what types of food and physical activities are right for you^[8].

Oxygen therapy

Long-term oxygen therapy of at least 15 hours a day is recommended for patients with severe resting hypoxia, which means very low oxygen levels with an oxygen saturation of 88% or less. In these patients, oxygen therapy reduces mortality significantly^[15]. Portable oxygen can help you breathe easier if your blood oxygen levels are low^[8].

Vaccinations

Lung infections can cause serious problems for people with COPD. Respiratory disease vaccines can help prevent illness. Everyone with COPD is encouraged to stay up to date with vaccinations, including COVID-19, flu (influenza), and pneumococcal vaccines^[8].

Surgery

Surgery or a lung transplant may be an option for a very small number of people with severe COPD who do not improve with other treatments^[5].

Living with COPD

Although living with COPD can be challenging at times, there are steps you can take to improve your quality of life and better manage your symptoms.

Daily life adjustments

Mornings can be challenging for people with COPD. Pace yourself and go slowly as you move into your daily routine. Keep drinking water by your bed to help thin out mucus production, which can be worse in the morning^[26].

When getting dressed, lay out your clothing the night before. Choose loose clothing that won’t constrict your breathing. Your clothes and shoes should be easy to get on and off^[26].

For meal preparation, keep often-used items on the counter or stovetop so you won’t have to bend, which makes it harder to breathe. Chop and do other food preparation while sitting down. Use a slow cooker or only one large pot or pan to reduce the number of dishes to wash. Make extra portions and refrigerate the rest for later meals^[26].

Breathing techniques

Breathing techniques can help reduce shortness of breath. Practice pursed-lip breathing and coordinated breathing to help move air into and out of your lungs^[22]. Pursed-lip breathing involves breathing gently through your nose and then breathing out slowly through lips that are pursed as if whistling^[25].

If you have a chesty cough that produces a lot of mucus, you may be taught specific techniques to help clear your airways. Practice deep coughing or huff coughing to help clear mucus out of your lungs so you can breathe better^[22].

Physical activity and exercise

Regular physical activity can improve your heart, lungs, and muscles, and it can help you breathe easier and feel better^[22]. Start with gentle exercises like walking or yoga, and gradually increase your activity level. Always consult your doctor before starting any new exercise program^[23].

Physical activity can help strengthen the muscles that help you breathe and improve your overall wellness. Exercising until you’re a little breathless is not dangerous, but do not push yourself too far^[25].

Healthy eating

Talk to your provider about following an eating plan that will meet your nutritional needs. If you have trouble eating enough because of symptoms such as shortness of breath and fatigue, you may not get all the calories and nutrients you need, which can make your symptoms worse and raise your risk for infections^[21].

Your doctor may suggest eating smaller meals more often throughout the day, resting before eating, and taking vitamins or nutritional supplements. Eating a healthy diet with fresh fruits and vegetables, whole grains, and fish may also help protect your lungs^[21]. Drinking plenty of fluids can help keep your mucus thin and easier to clear from your lungs. Aim for at least 8 glasses of water a day unless your doctor advises otherwise^[23].

Avoiding triggers

Identify and avoid things that can worsen your symptoms. There are certain things that should be avoided to reduce COPD symptoms and the chances of a flare-up, including dusty places, fumes such as car exhausts, smoke, air freshener sprays, strong-smelling cleaning products, hairspray, and perfume^[25]. Keep your living space clean and well-ventilated^[23].

Staying healthy

To avoid getting ill, wash your hands thoroughly and frequently with soap and water. Cough or sneeze into your elbow area or a tissue. Don’t touch your nose and mouth until you’ve washed your hands^[22].

Keep your inhaler and nebulizer clean. Clean breathing equipment often and carefully, following the item’s cleaning instructions^[22].

Monitor your symptoms daily. Keep track of any changes in your breathing, energy levels, and medication use. This can help you and your healthcare provider adjust your treatment plan as needed^[23].

Support and resources

Connecting with others who have similar conditions can provide emotional support and practical advice. Look for local or online support groups for people with COPD^[23]. A pulmonary rehabilitation program may also include support services and education to help you learn about COPD and the important role you have in managing it^[6].

Prevention

COPD is largely a preventable condition. You can significantly reduce your chances of developing it by following these steps:

Avoid smoking

If you already smoke, stopping can help prevent further damage to your lungs before it starts to cause troublesome symptoms^[5]. If you’ve never smoked, don’t start. Not smoking is the single most important thing you can do to prevent COPD.

Avoid secondhand smoke

Avoid inhaling cigarette smoke from others. Limit time in places where people are smoking^[8].

Limit exposure to air pollution

Avoid exposure to air pollutants at home and work. Limit time in places with bad air quality^[8]. Improving indoor and outdoor air quality is important for prevention^[3].

Workplace safety

If you work with chemicals, dust, or fumes, use proper protective equipment and follow workplace safety guidelines to minimize exposure to lung irritants.