Everything You Need to Know About Chronic Obstructive Pulmonary Disease (COPD)

What is COPD?

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that includes emphysema and chronic bronchitis. Many people diagnosed with COPD have both conditions.

Emphysema gradually damages the lung’s air sacs, making it harder to exhale. Chronic bronchitis causes swelling and narrowing of the bronchial tubes, leading to mucus buildup.

The main cause of COPD is long-term tobacco use, but ongoing exposure to chemical irritants can also contribute. It develops slowly, often over many years.

Doctors diagnose COPD using lung function tests, imaging scans, and blood tests.

There is no cure, but treatment can help manage symptoms, reduce complications, and improve overall quality of life. Medications, oxygen therapy, and surgery are common treatment options.

If left untreated, COPD can worsen quickly, increasing the risk of heart disease and severe respiratory infections.

An estimated 30 million people in the U.S. have COPD, but nearly half don’t realize they have it.

What are the symptoms of COPD?

COPD makes breathing difficult. Symptoms often start mild, with occasional coughing and shortness of breath. Over time, these issues can become constant, making it harder to breathe.

You may experience wheezing, chest tightness, or increased mucus production. Some people have flare-ups, where symptoms suddenly get worse.

Early signs of COPD can be mistaken for a cold. These include:

• Shortness of breath, especially after exercise
• A mild but persistent cough
• Frequent throat clearing, especially in the morning

As the disease progresses, symptoms become more noticeable. With lung damage, you may develop:

• Breathlessness, even after mild activity
• Wheezing, especially when exhaling
• Chest tightness
• Chronic cough, with or without mucus
• Frequent colds or lung infections
• Low energy levels

In later stages, symptoms may also include:

• Fatigue
• Swelling in the feet, ankles, or legs
• Weight loss

Seek immediate medical attention if you experience:

• Blue or gray lips and fingernails (low oxygen levels)
• Difficulty breathing or speaking
• Confusion, dizziness, or a rapid heartbeat

Symptoms are often more severe if you smoke or are exposed to secondhand smoke.

What causes COPD?

In countries like the U.S., cigarette smoking is the leading cause of COPD. Around 90% of those with the disease are either current or former smokers.

Among people who smoke for years, 20 to 30% develop COPD, while others may experience lung issues or reduced lung function.

Most cases occur in people over 40 with a history of smoking. The longer you smoke or use tobacco products, the higher your risk. Cigarettes, cigars, pipes, and secondhand smoke all contribute to the disease.

The risk increases if you have asthma and smoke.

COPD can also result from workplace exposure to chemicals, fumes, and dust, and long-term air pollution exposure can play a role.

In some developing regions, poor ventilation forces families to inhale smoke from cooking or heating fuels, increasing their risk of COPD.

Genetics may also play a role. About 5% of cases are linked to a deficiency in alpha-1-antitrypsin, a protein that protects the lungs. This deficiency can also impact the liver. Other genetic factors might contribute as well.

COPD is not contagious.

Diagnosing COPD

There isn’t a single test to diagnose COPD. Doctors confirm the condition based on symptoms, a physical exam, and test results.

When discussing your health, be sure to mention:

• If you smoke or have smoked before
• Any exposure to lung irritants at work
• Frequent secondhand smoke exposure
• A family history of COPD
• Existing asthma or other respiratory issues
• Any medications, prescription or over-the-counter

During a physical exam, your doctor will listen to your lungs using a stethoscope. Based on your symptoms and risk factors, further tests may be needed, including:

• Spirometry: A simple lung function test where you breathe into a tube attached to a spirometer.
• Imaging Tests: A chest X-ray or CT scan to examine the lungs, blood vessels, and heart.
• Arterial Blood Gas Test: A blood sample from an artery to measure oxygen, carbon dioxide, and other important levels.

These tests help determine if COPD is the issue or if another condition, such as asthma, restrictive lung disease, or heart failure, is causing symptoms.

Treatment for COPD

Treatment can help manage symptoms, reduce complications, and slow down the disease. A healthcare team may include a lung specialist (pulmonologist) along with physical and respiratory therapists.

Medication

Bronchodilators relax the muscles around the airways, making breathing easier. These are usually taken through an inhaler or nebulizer. In some cases, glucocorticosteroids are added to help reduce airway inflammation.

To lower the risk of respiratory infections, ask your doctor if you should get a yearly flu shot, pneumococcal vaccine, or a tetanus booster that includes protection against pertussis (whooping cough).

Oxygen Therapy

If oxygen levels in the blood are too low, supplemental oxygen may be necessary. It can be delivered through a mask or nasal cannula. Portable oxygen units help with mobility.

Surgery

Surgery is considered for severe COPD when other treatments don’t work, especially in cases of advanced emphysema.

• Bullectomy: Removes large, abnormal air pockets (bullae) in the lungs.
• Lung Volume Reduction Surgery: Removes damaged lung tissue, often from the upper lungs.
• Lung Transplant: An option for select patients with severe disease.

Lifestyle Changes

Certain habits can improve symptoms and overall health:

• Quit smoking; a doctor can suggest products or support groups.
• Avoid secondhand smoke and chemical fumes whenever possible.
• Maintain a balanced diet by working with a doctor or dietitian.
• Discuss safe levels of exercise with a healthcare provider.

Medications for COPD

Medications help manage symptoms and reduce flare-ups. Finding the right medication and dosage may take time, as different options work for different people. Here are some common treatments:

Inhaled Bronchodilators

Bronchodilators help relax airway muscles, making it easier to breathe. They are typically used with an inhaler or nebulizer.

• Short-acting bronchodilators provide relief for about four to six hours and are used as needed.
• Long-acting bronchodilators last around 12 hours and are taken daily for persistent symptoms.

Bronchodilators fall into two main categories: beta-2-agonists and anticholinergics. Both types help open the airways and clear mucus. These can be used separately or together.

Corticosteroids

Long-acting bronchodilators are often combined with inhaled corticosteroids to reduce inflammation and decrease mucus buildup. Corticosteroids are also available in pill form.

Phosphodiesterase-4 Inhibitors

These pills help lower inflammation and relax the airways. They are typically prescribed for severe COPD with chronic bronchitis.

Theophylline

This medication can ease chest tightness and shortness of breath while reducing flare-ups. It is available in pill form but is not usually a first-choice treatment due to possible side effects.

Antibiotics and Antivirals

Doctors may prescribe these medications to treat respiratory infections that can worsen COPD symptoms.

Vaccines

COPD increases the risk of respiratory infections. To help prevent complications, doctors may recommend an annual flu shot, the pneumococcal vaccine, or the whooping cough vaccine.

Diet recommendations for people with COPD

There isn’t a specific diet for COPD, but eating well is essential for overall health. The stronger your body is, the better it can handle complications and other health issues.

Include a mix of foods from these categories:

• Vegetables
• Fruits
• Grains
• Protein
• Dairy

Drinking enough fluids helps keep mucus thinner, making it easier to clear from the lungs. Aim for six to eight glasses of non-caffeinated liquids daily. Caffeine should be limited since it can interfere with some medications. If you have heart issues, talk to your doctor about how much fluid you should consume.

Too much salt can cause water retention, making breathing more difficult. Cutting back on salty foods may help reduce strain on the lungs.

Breathing with COPD takes extra energy, so some people may need more calories. However, carrying excess weight can put additional stress on the lungs and heart. If you’re underweight, basic body functions can become harder, and a weakened immune system may increase the risk of infections.

A full stomach can make breathing harder. Try these strategies:

• Clear mucus from your airways about an hour before eating.
• Take small bites and chew thoroughly before swallowing.
• Eat five or six smaller meals instead of three large ones.
• Drink fluids after meals rather than during them to avoid feeling too full.

Living with COPD

Managing COPD is a lifelong commitment. This means following medical advice and adopting healthy habits to keep symptoms under control.

Since COPD weakens lung function, it's important to avoid anything that could make breathing harder or trigger flare-ups. The top priority is quitting smoking. If stopping is difficult, ask your doctor about programs that can help. Stay away from secondhand smoke, air pollution, dust, and chemical fumes.

Even a small amount of daily exercise can help maintain strength. Speak with your doctor to determine what level of activity is safe for you. Eating nutritious foods is also essential – cut back on processed foods high in salt and empty calories.

If you have other chronic illnesses like diabetes or heart disease, keeping them under control is just as important. Poorly managed conditions can worsen COPD symptoms.

Keeping your home organized and clutter-free can make everyday tasks easier and reduce unnecessary strain. If COPD is severe, consider getting assistance with household chores.

Plan ahead for emergencies by keeping a list of your medications, dosages, and emergency contacts on your fridge and phone.

Connecting with others who understand can be reassuring. Consider joining a COPD support group to share experiences and get advice. The COPD Foundation offers a range of resources for those living with the condition.

What are the stages of COPD?

One way to measure COPD severity is through spirometry grading. Different systems exist, but one commonly used method is the GOLD classification. This system helps determine how advanced COPD is and assists doctors in planning treatment and predicting outcomes.

The GOLD classification uses spirometry results to assign a severity grade:

• Grade 1: Mild
• Grade 2: Moderate
• Grade 3: Severe
• Grade 4: Very Severe

These grades are based on FEV1, which measures how much air a person can forcefully exhale in one second. The lower the FEV1 score, the more serious the condition.

Beyond spirometry, COPD symptoms and a history of flare-ups help refine the classification. A doctor may assign a letter group to further define the disease stage and guide treatment options.

As COPD worsens, the risk of other health problems increases, including:

• Respiratory infections (colds, flu, pneumonia)
• Heart disease
• Pulmonary hypertension (high blood pressure in lung arteries)
• Lung cancer
• Depression and anxiety

Understanding COPD classification allows for better disease management and helps prevent complications.

Is there a connection between COPD and lung cancer?

COPD and lung cancer are both serious diseases affecting people worldwide. These conditions are closely connected in several ways.

Both diseases share common risk factors, with smoking being the leading cause. Exposure to secondhand smoke, chemicals, or harmful fumes at work also increases the likelihood of developing either condition.

Genetics may also play a role in making some individuals more prone to these diseases. Additionally, age is a significant factor, as the risk of developing COPD or lung cancer increases over time.

A 2009 study estimated that between 40% and 70% of lung cancer patients also have COPD, confirming that COPD itself is a risk factor for lung cancer. Research from 2015 suggests that COPD and lung cancer could actually be connected aspects of the same disease, with COPD possibly contributing to the development of lung cancer.

In some cases, people only learn they have COPD after being diagnosed with lung cancer. However, having COPD does not guarantee that lung cancer will develop—just that the risk is higher. This is yet another reason why quitting smoking can have major health benefits.

COPD statistics

Globally, around 65 million people are estimated to have moderate to severe COPD. In the United States, approximately 12 million adults have been diagnosed with the condition, while another 12 million may have it without knowing.

Most individuals with COPD are 40 years or older. The majority are current or former smokers, as smoking is the biggest modifiable risk factor. About 20–30% of long-term smokers develop symptomatic COPD.

However, not all COPD patients have smoked. Around 10–20% of cases occur in individuals who never smoked. In up to 5%, a genetic disorder linked to a deficiency of alpha-1-antitrypsin is the underlying cause.

COPD is one of the leading causes of hospital admissions in developed countries. In the U.S., it accounts for a large number of emergency room visits and hospital stays. In 2000, there were over 700,000 hospital admissions and 1.5 million emergency visits due to COPD. Additionally, between 40–70% of lung cancer patients also have COPD.

Each year, 120,000 people die from COPD in the U.S., making it the third leading cause of death. More women than men succumb to the disease annually.

The number of COPD diagnoses is projected to rise by over 150% between 2010 and 2030, largely due to an aging population.

What’s the outlook for people with COPD?

COPD progresses gradually, often going unnoticed in the early stages. Many people don’t realize they have it until symptoms become more noticeable.

Once diagnosed, regular medical checkups become essential. Managing the condition requires lifestyle adjustments to help maintain overall well-being. Early symptoms can usually be controlled, allowing many to maintain a decent quality of life.

As the disease advances, symptoms become more restrictive. Those in severe stages may need assistance with daily activities. They are at greater risk of respiratory infections, heart disease, and lung cancer. Mental health challenges like anxiety and depression are also more common.

COPD typically shortens lifespan, but the extent varies. Non-smokers with COPD may experience only a slight reduction in life expectancy, while smokers and former smokers tend to have a more significant decrease.

Beyond smoking history, treatment response, and complication prevention influence prognosis. A healthcare provider can assess overall health and provide insight into what to expect based on individual circumstances.