Chronic obstructive pulmonary disease, or COPD, is a long-term lung condition that makes it harder to breathe. It is one of the leading causes of death and disability in the United States, and millions of people have it without a diagnosis. COPD cannot be cured, but the right treatment can ease symptoms, prevent flare-ups and help people stay active for years.
What COPD is
COPD is an umbrella term for lung diseases that block airflow, mainly:
- Chronic bronchitis: long-term inflammation of the airways with a persistent cough and mucus
- Emphysema: damage to the tiny air sacs (alveoli) in the lungs, making it harder to move air in and out
Most people with COPD have features of both. The damage develops slowly over many years.
Causes and risk factors
- Smoking is the main cause in the United States, including past smoking
- Secondhand smoke
- Workplace dust, fumes and chemicals
- Indoor air pollution, such as smoke from burning wood or other fuels for cooking and heating
- Outdoor air pollution
- Alpha-1 antitrypsin deficiency, an inherited condition that can cause COPD at a younger age, even in non-smokers
- Childhood lung problems, such as severe respiratory infections or poorly controlled asthma
Symptoms
- Shortness of breath, especially with activity, that slowly gets worse
- A long-lasting cough, often with mucus
- Wheezing
- Chest tightness
- Frequent chest infections
- Tiredness
- In later stages, weight loss and swelling in the ankles
Many people adapt by doing less, without realizing their breathing is the reason.
How COPD is diagnosed
The key test is spirometry, a simple breathing test in which you blow as hard and fast as you can into a tube. It measures how much air you can exhale in one second (FEV1) compared with the total amount you can exhale (FVC). A low ratio after using a bronchodilator inhaler confirms airflow obstruction.
Your doctor may also order a chest X-ray or CT scan, blood oxygen tests, and an alpha-1 antitrypsin blood test, which is recommended at least once for everyone diagnosed with COPD.
Stages and severity
Doctors describe COPD severity using spirometry results (GOLD grades 1 to 4, from mild to very severe), along with how much breathlessness you have and how many flare-ups you have had in the past year. Together these guide treatment.
Treatment
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Stop smoking
Quitting is the single most effective way to slow COPD. It is never too late. Nicotine replacement, prescription medicines such as varenicline, and counseling greatly improve success rates. You can call 1-800-QUIT-NOW for free support.
Inhalers
- Long-acting bronchodilators relax the airway muscles and are the foundation of treatment. They include LAMAs (such as tiotropium) and LABAs (such as salmeterol or formoterol), often combined in one inhaler.
- Inhaled corticosteroids are added for people with frequent flare-ups, particularly those with higher levels of a white blood cell called eosinophils.
- Rescue inhalers (short-acting bronchodilators such as albuterol) provide quick relief.
Using inhalers correctly makes a big difference. Ask your doctor, nurse or pharmacist to check your technique, and ask about spacers if you use a metered-dose inhaler.
Newer treatments
For some people with frequent flare-ups despite triple inhaler therapy, newer options include biologic injections such as dupilumab (for COPD with raised eosinophils) and an inhaled medicine called ensifentrine. Your lung specialist can advise if these fit your situation.
Pulmonary rehabilitation
Pulmonary rehab is a supervised program of exercise, breathing techniques and education. It is one of the most effective COPD treatments, improving breathlessness, exercise ability and quality of life. Medicare and many insurers cover it for eligible patients.
Oxygen therapy
People with low blood oxygen levels at rest may benefit from long-term oxygen therapy, which can improve survival in severe cases.
Vaccines
Vaccines against flu, pneumococcal disease, COVID-19 and RSV (for eligible adults) help prevent infections that can trigger dangerous flare-ups.
Surgery and procedures
For selected people with severe emphysema, options include lung volume reduction surgery, endobronchial valves that collapse damaged areas of lung, and lung transplant.
Managing flare-ups
A flare-up (exacerbation) is a sudden worsening of breathlessness, cough or mucus. Work with your doctor on a written action plan that may include extra rescue inhaler use, steroid tablets and antibiotics if there are signs of infection.
Seek emergency care if you are very short of breath, have blue lips or fingertips, feel confused or drowsy, or have chest pain.
Living well with COPD
- Stay as active as you can; regular walking helps maintain fitness
- Practice breathing techniques such as pursed-lip breathing
- Eat a balanced diet and maintain a healthy weight
- Avoid smoke, dust and air pollution, and check air quality alerts
- Wash hands often to avoid infections
- Get support for anxiety or low mood, which are common with COPD
The bottom line
COPD is common, often underdiagnosed and largely caused by smoking. If you have a long-lasting cough or get short of breath more easily than before, ask your doctor about a spirometry test. Quitting smoking, using inhalers correctly, pulmonary rehab and vaccines help people with COPD breathe easier and stay out of the hospital.
This article is for general information and does not replace medical advice.