Chronic Obstructive Pulmonary Disease (COPD)

What is COPD?

Chronic obstructive pulmonary disease (COPD) is a chronic lung condition that causes airflow problems and makes it hard to breathe.

You may have heard other names for COPD, such as chronic bronchitis or emphysema. These terms describe two sorts of lung damage seen in smoking-related lung disease. COPD is the collective term that includes both chronic bronchitis and emphysema: 

• Chronic bronchitis: This is swelling — or inflammation — of the airways. It causes a cough and excess mucus (phlegm) in the chest. It also causes tightening of the airways, which makes it hard to breathe.

• Emphysema: This is damage to the alveoli, the little air sacs at the end of the breathing tubes in the lungs. Your body uses these sacs to take in oxygen and get rid of carbon dioxide. When the alveoli are damaged, this vital exchange of oxygen and carbon dioxide is disrupted. The result is low oxygen levels in the body, which causes breathlessness.

Some people with COPD have mainly chronic bronchitis and a cough. Some have mainly emphysema and shortness of breath. Many people have some of both conditions. 

COPD affects 14 million people in the U.S. But the real number of people affected is probably much higher. It helps to understand what causes it and to recognize the symptoms. Getting a diagnosis of COPD early — and starting treatment — may help improve your outcome.

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What causes COPD?

COPD is caused by inhaling irritating gases and particles over many years. These irritate the breathing tubes in the lungs (the airways) and damage the air sacs (alveoli). Over time, these changes make breathing more difficult.

Risk factors for COPD include:

• Smoking: The most common irritant is active or passive smoke from cigarettes. About 3 in 4 people with COPD have a history of smoking. 

• Vaping: Studies show a link between e-cigarette use and COPD.

• Other inhalants: Other irritants — such as those from open fires, air pollution, or work-related exposure — can also be a factor.

• Genetics: Some people are more likely than others to get lung damage from smoking because of their genes. 

• Airway hyper-responsiveness: About 1 in 4 people with COPD have abnormal sensitivity to irritants inhaled from the environment. 

In rare cases, COPD is due to a rare genetic condition called alpha-1 antitrypsin (AAT) deficiency. This condition causes liver disease and emphysema. People with AAT deficiency lack a protein that protects the lungs. Experts recommend that all adults with symptoms of COPD get tested for it.

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Symptoms of COPD

COPD usually starts in middle age and often gets worse over time. 

In the early stages of COPD, there may be no symptoms at all. As COPD progresses, symptoms worsen and can start to interfere with everyday life. Some common symptoms of COPD include: 

• Coughing

• Spitting up phlegm (mucus) 

• Noisy breathing (wheezing)

• Shortness of breath 

• Tiredness

People with COPD also commonly experience exacerbations, when symptoms flare and require treatment for a few weeks. Sometimes, an exacerbation can make people with COPD very sick. They may need treatment in the hospital with oxygen, nebulizers, and IV medication. 

COPD can impact all areas of life. People with COPD can experience some or all of the following: 

• Limitations in everyday activities, such as exercising, working, moving around, and even eating

• Disturbed sleep

• Social isolation

• Depression, anxiety, and even problems with memory

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Stages of COPD

COPD staging is a little complicated. You can look at COPD in a few different ways: 

• How well do the lungs work? 

• How much is the person affected every day? 

• What’s a person’s risk of becoming very unwell? 

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies COPD based on level of airflow restriction:

• Stage 1 (mild)

• Stage 2 (moderate)

• Stage 3 (severe)

• Stage 4 (very severe)

An additional “ABCD” scoring system uses symptoms for classification:

• Group A: very few COPD symptoms, with one or fewer exacerbations per year that don’t require hospitalization 

• Group B: moderate or severe COPD symptoms, but one or fewer exacerbations per year that don’t require hospitalization

• Group C: very few COPD symptoms, but two or more exacerbations per year with at least one requiring hospitalization

• Group D: moderate or severe COPD symptoms, with two or more exacerbations per year and at least one requiring hospitalization

Within the ABCD scoring system, there are other scoring systems for symptoms. These are the:

• mMRC Dyspnea Scale

• COPD Assessment Test (CAT)

• Clinical COPD Questionnaire (CCQ)

Like we said, it’s complicated.

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How is COPD diagnosed?

Getting a COPD diagnosis involves a visit to a healthcare professional. Most likely, they’ll ask you about your: 

• Symptoms

• Medical history

• Smoking history

• Work history 

You’ll get a physical examination. And you’ll need to have some breathing tests to see how your lungs are working. You can do some breathing tests (spirometry) in their office. You may need to do other pulmonary function tests in a specialized lab. 

Additional testing may include:

• A lung X-ray

• CT scan of the chest

• Blood tests, including a test for AAT deficiency and a blood oxygen test

• An exercise test to look at how the heart and lungs react during exercise

Once you’ve had all these tests, the healthcare professional will want to see you again. They’ll help to put all the pieces together to work out whether you have COPD.

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Medications for COPD

Inhalers are the most common medications for COPD. These contain medications that are inhaled through the mouth, straight into the lungs. Inhalers come in all shapes and sizes, and they use different technologies. The most important difference is the medicine inside them. 

Maintenance inhalers

These COPD medications keep COPD symptoms controlled in the long term. They’re usually used once or twice a day, every day — even when you’re feeling well. 

Inhaled bronchodilators relax the muscles around the airways to open them up and let more air pass through. Everyone with COPD should start with a daily, long-acting bronchodilator. Examples include:

• Salmeterol (Serevent)

• Formoterol (Perforomist)

• Tiotropium (Spiriva)

• Umeclidinium (Incruse Ellipta)

Rescue inhalers

Some COPD medications work more quickly to stop symptoms. Most people with COPD have a short-acting inhaler for quick relief, such as:

• Albuterol (Proair, Ventolin, Proventil)

• Levalbuterol (Xopenex)

• Ipratropium (Atrovent) 

Combination inhalers

Combination inhalers contain multiple medications. They can include inhaled corticosteroids (to reduce airway inflammation) and/or bronchodilators. Examples include:

• Budesonide / formoterol (Symbicort) 

• Fluticasone / vilanterol (Breo Ellipta)

• Umeclidinium / vilanterol (Anoro Ellipta)

Oral medications

Antibiotics and corticosteroids can be useful for treating COPD flares. 

There are also some less commonly used COPD pills, reserved for people with difficult-to-treat symptoms: 

• Theophylline (Elixophyllin)

• Roflumilast (Daliresp)

• Azithromycin (Zithromax)

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Treatment for COPD

There’s no cure for COPD. But medications and other treatments can slow or prevent the negative impacts that COPD can have on your life. These treatments will:

• Reduce symptoms and exacerbations

• Improve activity and strength 

• Help prevent the progression of COPD

Here are some recommended treatments for COPD:

• Quitting smoking is the most important thing you can do for your lungs. And it’s never too late to quit. While you can’t undo damage, stopping smoking can slow the progression of COPD. It can also prevent other complications of smoking, such as heart disease, stroke, and lung cancer. 

• Pulmonary rehabilitation (or pulmonary rehab) is a structured program of education, physical therapy, and social support. It improves quality of life, physical activity, and COPD symptoms. Find a pulmonary rehab program near you. 

• Oxygen is a treatment that can improve symptoms of COPD in people who have low oxygen levels. 

• Vaccines protect against certain diseases and stop chest infections (and COPD exacerbations) before they happen. These vaccines include flu, pneumonia, whooping cough (pertussis), and COVID-19.

Whether you need treatment — and which treatment you get — depends on you, your symptoms, and your life. It’s not a one-size-fits-all approach. But your healthcare team will work with you to come up with the best treatment plan for you.

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Living with COPD

In addition to the treatments above, there are several ways to maintain your health when living with COPD. Here are some things to consider:

• Optimize your eating habits. Some people with advanced COPD aren’t able to eat enough because they run out of breath. Malnutrition and being underweight can make COPD worse. But carrying too much weight can also worsen COPD symptoms. The more weight you carry, the harder your lungs have to work. Working with a dietitian or nutritionist can help you manage your weight.

• Make an action plan. Most people with moderate or severe COPD need an action plan. This is a written, personalized plan for what to do when your symptoms get worse. It lists step-by-step instructions for how to best treat your symptoms and when to call for help. 

• Get a peak flow meter. As part of your action plan, you might need to use a peak flow meter. This device measures the strength of your exhale and helps monitor the severity of your symptoms. 

• Practice breathing exercises. These can help you strengthen your breathing muscles, increase blood oxygen levels, feel less short of breath, and relax your mind and body. Breathing exercises include pursed lip breathing and belly breathing. 

Living with COPD can be challenging and require some changes. Don’t be afraid to ask for help and support when you need it.

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