Overview
COPD, or chronic obstructive pulmonary disease, covers chronic bronchitis, where the airways are inflamed and full of mucus, and emphysema, where the tiny air sacs are damaged.
Most people have some of each. The airways narrow and air is trapped, so breathing out takes effort. The damage builds over decades and is often put down to age until well advanced.
COPD cannot be cured and the damage does not reverse, but treatment eases symptoms and cuts down flare-ups.
Symptoms
The main symptoms are shortness of breath, at first only when hurrying or climbing stairs, a cough that keeps returning and usually brings up phlegm, wheezing, and frequent chest infections, especially in winter.
Later there may be tiredness, weight loss, swollen ankles and chest tightness. Coughing up blood is not typical of COPD and always needs checking.
Symptoms can suddenly worsen for several days. These flare-ups are common and often follow a chest infection.
When to see a doctor
See a doctor if breathlessness, cough or phlegm has been worsening over weeks, particularly if you are over 35 and smoke or used to smoke. The sooner treatment begins, the less the damage.
Contact your doctor quickly in a flare-up, when breathlessness increases, phlegm changes colour, or the usual inhalers stop helping.
Causes
COPD happens when the lungs become inflamed, damaged and narrowed over years. Tobacco is the largest single cause, smoked or breathed in as second-hand smoke.
It also occurs in people who have never smoked. Smoke indoors from wood, dung or coal burned for cooking is a major cause, as are dusts, fumes and chemicals at work and heavy outdoor pollution. A rare inherited condition, alpha-1 antitrypsin deficiency, causes COPD without smoking.
Risk factors
- Smoking now or in the past, including bidis and hookah
- Living or working around other people's tobacco smoke
- Cooking with wood, dung, crop waste or coal in a poorly aired kitchen
- Dust, fumes, welding smoke, chemicals or grain at work
- Heavy outdoor air pollution
- Alpha-1 antitrypsin deficiency in the family
Complications
COPD affects more than the lungs, and people with it are more likely to have:
- Flare-ups that need emergency treatment or a stay in hospital
- Chest infections, including pneumonia
- Heart disease, heart failure and an irregular heartbeat
- Lung cancer
- Anxiety and depression
Prevention
- Not starting tobacco, and stopping if you already use it
- Using cleaner cooking fuel, and a chimney or open window while cooking
- Using masks and extraction where there is dust or fumes at work
- Having flu, pneumococcal and COVID-19 vaccinations as advised
- Getting a lasting cough or breathlessness checked early
Diagnosis
COPD is confirmed with , a breathing test in which you blow hard into a machine that measures how much air comes out and how fast. It also helps separate COPD from asthma.
A chest X-ray or may be added to look for other causes, along with an oxygen reading and, in younger people or non-smokers, a test for alpha-1 antitrypsin deficiency.
Treatment
Stopping tobacco is the most important part of treatment at every stage, and counselling and medicines help.
Inhalers that open the airways are the mainstay, usually a long-acting one daily and a quick-acting one for bad moments, with an inhaled steroid for some. Flare-ups are treated with steroid tablets and, when infection is likely, .
Pulmonary rehabilitation, a supervised programme of exercise and education, helps people do more with less breathlessness. Home oxygen is used when the blood level stays low, and surgery or a transplant only in severe disease.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Only heavy smokers get COPD.”What is true?
Fact
Tobacco is the biggest cause, but COPD also develops in people who have never smoked. Second-hand smoke, dust and fumes at work, outdoor air pollution and smoke from wood, dung or coal burned indoors for cooking all damage the lungs, and household air pollution is a major cause in many countries.
Myth“The damage is done, so there is no point stopping tobacco now.”What is true?
Fact
Stopping is the most important part of treatment at any stage of COPD. It does not undo the damage already there, but it slows further damage and is the one step that changes how the illness goes from here.
Myth“Getting breathless on the stairs at this age is just old age, not an illness.”What is true?
Fact
COPD develops so slowly that it is often mistaken for growing older or being unfit. A lasting cough, phlegm or breathlessness in someone over 35 who smokes or used to smoke deserves a breathing test, because the earlier treatment starts the less lung damage follows.
Myth“If walking makes me breathless, I should rest as much as possible.”What is true?
Fact
Resting completely makes the muscles weaker and breathlessness worse. Staying physically active is part of treatment, and pulmonary rehabilitation, a supervised programme of exercise and education, is offered exactly so that people can do more with less breathlessness.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is it too late to stop smoking once COPD has started?
No. Stopping is the most important thing anyone with COPD can do, at any stage. It will not repair the damage already done, but it slows further damage, reduces flare-ups and chest infections, and lowers the risk of the heart disease and lung cancer that often go with COPD.
How is COPD different from asthma?
Both narrow the airways, and the symptoms overlap. Asthma often starts in childhood, comes and goes, and breathing can be completely normal in between. COPD usually appears after the age of 35 in people exposed to tobacco, smoke or dust, builds up slowly and does not fully clear. Breathing tests help tell them apart, and some people have both.
I have never smoked, so how can I have COPD?
Anything breathed in over years can damage the lungs. Years of cooking on a wood, dung or coal fire indoors, second-hand smoke at home, dust and fumes at work, and heavy air pollution all cause COPD. Poor lung growth in childhood and a rare inherited condition can too.
Will I need oxygen at home?
Most people with COPD do not. Home oxygen is prescribed only when measurements show the oxygen level in the blood stays low, and it is not given simply because breathing feels hard. Your doctor will measure the level before deciding.
