Chronic Obstructive Pulmonary Disease (COPD)

Severe or rapidly worsening breathlessness is an emergency. Use the person’s written COPD action plan and prescribed rescue treatment. Call the local emergency service for breathlessness that makes normal speaking difficult, blue or grey lips or skin, new confusion or unusual drowsiness, chest pain, fainting, or symptoms that are worsening despite the prescribed plan. Do not drive yourself if you are severely unwell.

What is COPD?

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition in which airflow is persistently restricted. Changes can affect the breathing tubes, the small airways and the air sacs. Chronic bronchitis describes a pattern of long-lasting cough with mucus, while emphysema describes damage to air-sac walls; a person with COPD may have features of either or both, but these are not rigid subtypes.

COPD is not contagious. It is not currently curable, but stopping harmful exposures, using appropriate treatment and taking part in rehabilitation can improve symptoms and daily function and reduce the risk of flare-ups.

Causes and risk factors

Tobacco smoking is an important cause, including exposure to second-hand smoke, but not everyone with COPD has smoked. Other contributors include household smoke from cooking or heating fuels, outdoor air pollution, long-term workplace exposure to dusts, fumes or chemicals, and impaired lung growth or lung injury earlier in life. Childhood respiratory illness and asthma can also influence later risk.

A small proportion of cases are related to inherited alpha-1 antitrypsin deficiency, which reduces a protein that helps protect lung tissue. A clinician may consider testing when COPD occurs at a younger age, follows an unusual pattern or has a relevant family history. Risk factors raise probability; they do not mean that COPD is inevitable.

Symptoms

Symptoms often develop gradually and may initially be noticed only during activity. They can include:

• shortness of breath, especially during exertion;
• a persistent cough, with or without mucus;
• wheezing or chest tightness;
• recurrent chest infections; and
• tiredness or reduced ability to carry out usual activities.

Unintentional weight loss, ankle swelling, coughing blood or a marked change in symptoms needs medical assessment because it may reflect advanced COPD, a complication or another condition. Similar symptoms can arise from asthma, heart disease, infection, anaemia and other illnesses, so symptoms alone cannot confirm COPD.

How COPD is diagnosed

A clinician considers the pattern of symptoms, tobacco and other exposures, previous illnesses, medicines and physical findings. Persistent airflow obstruction is confirmed with post-bronchodilator spirometry, a breathing test performed after an inhaled bronchodilator. The result must be interpreted alongside symptoms and clinical context rather than used as a stand-alone self-diagnosis.

A chest X-ray or CT scan can help assess another diagnosis, emphysema or a complication, but imaging does not by itself confirm COPD. Oxygen saturation, blood tests, an electrocardiogram, exercise testing or an arterial blood gas may be appropriate for selected people. Treatment planning combines spirometry with symptom burden, previous flare-ups, other health conditions and the person’s goals; one number does not capture the whole illness.

Treatment and ongoing care

Treatment is individualized and should be reviewed when symptoms, flare-ups or health circumstances change. Do not start, stop or alter an inhaler, steroid, antibiotic or oxygen treatment on the basis of a general article.

Reducing harmful exposures

For someone who smokes, stopping is one of the most effective ways to slow further lung damage. Behavioural support and approved stop-smoking medicines can improve the chance of success; a healthcare professional can help choose an option. Reducing second-hand smoke, household air pollution and workplace exposure also matters. Appropriate respiratory protection and occupational-health advice should be matched to the actual exposure.

Inhaled treatment

Bronchodilators relax muscles around the airways and can reduce breathlessness. Short-acting inhalers may be prescribed for relief, while long-acting bronchodilators are used regularly by many people. Some people need two types of long-acting bronchodilator. Device choice, correct technique, adherence, benefit and side effects should be checked in person by a clinician, nurse or pharmacist.

An inhaled corticosteroid is not universal COPD treatment. A clinician may include one for selected people based on factors such as repeated flare-ups, blood eosinophil results or coexisting asthma features. Potential harms, including pneumonia risk, need discussion. Mucus management is separate from bronchodilation and may include hydration advice, airway-clearance teaching or other treatment when clinically appropriate.

Rehabilitation and self-management

Pulmonary rehabilitation combines supervised, individually adapted exercise with education and support. It can improve breathlessness, exercise capacity and quality of life, including after some hospital-treated flare-ups. A wider plan may include physical activity within ability, nutritional support, help with anxiety or low mood, and management of other conditions.

A written action plan should explain the person’s usual treatment, how to recognize a flare-up, which prescribed steps to take and when to seek help. Vaccination against infections such as influenza, COVID-19 and pneumococcal disease should follow local recommendations for age, health and vaccine availability.

Other medicines and procedures

Clinicians may prescribe a short course of systemic corticosteroid for a significant flare-up and antibiotics when clinical features suggest a bacterial infection or another defined indication. Long-term antibiotics, roflumilast, theophylline and other add-on treatments have narrower roles and require individual risk assessment and monitoring. They should not be used as general home remedies.

Bronchoscopic procedures, bullectomy, lung-volume-reduction treatment or lung transplant are considered only for a small, carefully selected group after treatment has been optimized and a multidisciplinary specialist team has assessed likely benefits and risks.

Oxygen treatment

Oxygen is a prescribed treatment, not simply a remedy for feeling breathless. During an acute illness, clinicians monitor oxygen and carbon-dioxide levels and set an individualized oxygen target. Too much uncontrolled oxygen can be harmful in some COPD flare-ups.

Long-term oxygen treatment is considered for selected people with severe, stable low blood oxygen after specialist assessment while receiving optimized care. It is different from oxygen used during an emergency. Home oxygen equipment, flow rate and safety instructions must be prescribed and reviewed; never change the flow rate or use another person’s oxygen.

Recognizing a flare-up

A COPD exacerbation, or flare-up, is an acute worsening beyond usual day-to-day variation. Breathlessness, cough, amount or colour of mucus, wheeze and ability to carry out normal activities may change. Infection, smoke and air pollution are common triggers, but heart failure, a blood clot in the lung and other emergencies can look similar.

Follow the written action plan and contact a healthcare professional promptly when symptoms worsen. Do not rely on a home “mild, moderate or severe” score or wait for fever before seeking help. Emergency warning signs are listed at the top of this article.

Complications and outlook

COPD can increase the risk of respiratory infections, low blood oxygen, high carbon-dioxide levels, loss of muscle strength, osteoporosis, anxiety or depression, heart and blood-vessel disease and lung cancer. These problems are not inevitable. Regular review can identify treatable symptoms, inhaler problems, nutritional needs and other health conditions.

The course varies greatly. It depends on lung impairment, ongoing exposures, flare-up history, other illnesses, access to care and response to treatment. Risk reduction before COPD includes avoiding tobacco, cleaner household air and effective workplace protection. After diagnosis, stopping smoking, taking prescribed treatment, pulmonary rehabilitation, relevant vaccination and a usable action plan can help protect health and independence.