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Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease, or COPD, is a disease that causes airflow blockage and breathing-related problems and is included in the same group as emphysema and chronic bronchitis. The lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of the body, and COPD causes them to lose their elasticity and over-expand, leaving air trapped in the lungs. Chronic bronchitis is the inflammation and narrowing of the bronchial tubes and increased mucus production, resulting in a chronic cough. Emphysema is when the small airways collapse during exhalation, impairing airflow out of the lungs.

 

Although COPD is a progressive disease that gets worse over time, it can be managed. With proper management, most people with COPD can achieve reasonable symptom control and quality of life, as well as reduced risk of other associated conditions.

Symptoms 

People with COPD are likely to experience episodes called exacerbations when symptoms become worse and persist for several days or more. Immediate medical care should be sought if someone cannot catch their breath, experiences severe blueness of the lips or fingernail beds, has a rapid heartbeat, or is having difficulty concentrating.

COPD Symptoms include:

  • Frequent coughing or wheezing

  • A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish

  • Excess phlegm, mucus, or sputum production

  • Trouble taking a deep breath or tightness in the chest

  • Shortness of breath, especially during physical activities

  • Frequent respiratory infections

  • Lack of energy

  • Unintended weight loss (in later stages)

  • Swelling in ankles, feet, or, legs

Causes and Risk Factors 

The following factors contribute to the risk of developing COPD:

  • Cigarette smoke, as well as cigar, pipe, and marijuana smoke

  • Exposure to air pollutants, including smoke, chemicals, dust, and fumes

  • Genetic factors such as low levels of the protein alpha-1-antitrypsin

  • People with a history of asthma

  • Women are more likely to have COPD than men and have more deaths from COPD.

  • Age: risk increases in those 65 and older

 

Prevention

The majority of cases are directly related to cigarette smoking, and the best way to prevent COPD is never to smoke or to stop smoking. Using respiratory protective equipment when exposed to chemical fumes and dust can also reduce the risk. 

 

Diagnosis

COPD is commonly misdiagnosed, and many people may not be diagnosed until the disease is advanced. To diagnose COPD, a doctor will review signs and symptoms, discuss family and medical history, and discuss any exposure to lung irritants. The following tests may be ordered to assist with the diagnosis:

  • Lung or pulmonary function tests measure the amount of air a person can inhale and exhale and whether the lungs deliver enough oxygen to the blood. The most common test, spirometry, involves blowing into a large tube connected to a small machine. Other tests include measuring lung volumes and diffusing capacity, the six-minute walk test, and pulse oximetry.

  • Chest X-rays can show emphysema and rule out other lung problems or heart failure.

  • CT scans can help detect emphysema, screen for lung cancers, and determine if surgery would be beneficial.

  • Arterial blood gas analysis is a blood test that measures how well the lungs are bringing oxygen into the blood and removing carbon dioxide.

  • Laboratory tests aren't used to diagnose COPD but may be used to determine the cause of symptoms or rule out other conditions. 

 

Treatment

For many with mild forms of the disease, little therapy is needed other than smoking cessation. For more advanced stages of disease, effective treatment can control symptoms and slow progression, reduce the risk of complications and exacerbations, and improve the ability to lead an active life. Treatment options may include:

  • Quit smoking and avoid second-hand smoke.

  • Medications used to treat symptoms such as coughing or wheezing include short—and long-acting bronchodilators, inhaled steroids, combination inhalers, oral steroids,  phosphodiesterase-4 inhibitors, theophylline, and antibiotics. Learn more here. 

  • Oxygen therapy or supplemental oxygen from a portable oxygen tank

  • Pulmonary rehabilitation is a personalized program that combines education, exercise training, nutrition advice, and counseling.

  • In-home noninvasive ventilation therapy such as bilevel-positive airway pressure (BiPAP)

  • Surgery is an option for some people with some forms of severe emphysema and may include lung volume reduction surgery, lung transplant, or bullectomy (removal of large air spaces from the lungs).

 

Complications

  • Respiratory infections. People with COPD are more likely to catch colds, the flu, and pneumonia, which can make it even more difficult to breathe and cause additional damage to the lungs.

  • Heart problems, including heart attack as well as stroke

  • Lung cancer

  • High blood pressure in lung arteries or pulmonary hypertension

  • Depression. Difficulty breathing can limit activities and contribute to the development of depression.

  • Increased confusion and memory loss 

  • Reduced activity due to difficulty walking, climbing stairs, or inability to work 

  • Special equipment like portable oxygen tanks is needed.

 

Lifestyle Changes

These steps can help someone with COPD feel better and slow damage to the lungs:

  • Control breathing including energy conservation and relaxation techniques

  • Clear airways through controlled coughing, drinking plenty of water and using a humidifier

  • Exercise regularly to improve overall strength and endurance 

  • Eat healthy foods to maintain your strength and manage weight

  • Avoid smoke and air pollution

  • Get regular checkups and discuss symptoms and treatment options with a physician. 

 

Get Support 

The American Lung Association has several support programs for people with COPD as well as their caregivers.  

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