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Chronic obstructive pulmonary disease (COPD)

Key points

  • Chronic obstructive pulmonary disease (COPD) is a term used to describe a number of long-term lung conditions.
  • Symptoms vary but often start with a persistent, phlegmy cough or breathlessness.
  • The main cause of COPD is smoking.
  • Stopping smoking is the most effective way of treating your symptoms and preventing COPD from getting worse.

Chronic obstructive pulmonary disease (COPD) describes a number of long-term lung conditions that cause breathing difficulties.

Animation – how COPD develops

About COPD

It’s estimated that about one million people in the UK have COPD and that there are many more who haven’t been diagnosed. It’s the fifth most common cause of death in England and Wales with about 28,000 people dying as a result of it every year. You’re more likely to develop the condition as you get older. COPD is usually caused by smoking and tends to get progressively worse over time.

A chronic illness is one that lasts a long time, sometimes for the rest of the affected person’s life. When describing an illness, the term ‘chronic’ refers to how long a person has it, not to how serious a condition is.

The term COPD describes a number of conditions but the most common are chronic bronchitis and emphysema.

  • Chronic bronchitis is caused by inflammation of your bronchi – these are the main airways that lead from your windpipe (trachea) to your lungs. This inflammation can lead to excess mucus that may block your airways.
  • Emphysema is the term used to describe damage to the walls of your alveoli. These are tiny air sacs in your lungs where oxygen passes into your blood.

The damage to your lungs means that less oxygen passes into your blood to be transported around your body to your tissues, including your brain. This contributes to symptoms such as having difficulty breathing and tiredness.

Illustration showing the changes to the bronchioles and alveoli in COPD

Symptoms of COPD

At first, you may not have any symptoms of COPD or they may be very mild. The condition may start with either a persistent, phlegmy cough or breathlessness. Many people don’t see their GP at this early stage, but the earlier you get advice and treatment the better.

As COPD progresses symptoms can vary but may also include:

  • persistent cough
  • breathlessness with physical exertion
  • regularly coughing up phlegm
  • wheezing
  • weight loss
  • extreme tiredness
  • waking up at night as a result of breathlessness
  • swollen ankles

You may find your symptoms are worse in the winter months.

These symptoms aren’t always caused by COPD but if you have them, see your GP.

It isn’t usual to get chest pains or cough up blood if you have COPD. If this happens, you may either have something other than COPD or another condition as well as COPD.

Causes of COPD

The biggest single cause of COPD is smoking. If you stop smoking, your risk of developing COPD begins to fall. If you already have COPD, stopping smoking means your symptoms progress more slowly.

Other less common causes of COPD include:

  • passive smoking
  • being exposed to certain chemicals or fumes
  • environmental factors, such as air pollution

There are likely to be a number of genetic factors that may increase your risk of COPD but more evidence is needed. It’s known that inheriting a shortage of a protein called alpha-1 antitrypsin, which helps protect your lungs, can increase your risk of COPD. However, fewer than one in 100 people with the condition have this shortage.

Smoking also exacerbates the effect of other causes on your risk of developing COPD.

Diagnosis of COPD

Your GP will ask about your symptoms and will ask to examine you. He or she is likely to ask you if you smoke and if there are any other reasons why you may be at risk of COPD. Your GP may ask to listen to your chest with a stethoscope to see if you have any wheezing or crackling sounds when you breathe.

There is no single test that can confirm COPD. If your GP thinks you may have it, he or she may advise you to have a lung spirometry test. This tests how well your lungs are working. Your GP will ask you to blow into a device that measures how much and how quickly you can force out air from your lungs. Different lung problems produce different results so this helps to separate COPD from other chest conditions. For more information see our frequently asked questions.

Other tests you may be offered are listed below.

  • A chest X-ray to see if your lungs show signs of COPD, and to exclude other lung diseases.
  • A blood test to look for anaemia or signs of infection.

If you’re diagnosed with COPD, your doctor may advise you to have further tests. These will help to determine the best treatment for you.

  • A CT (computed tomography) scan to produce three-dimensional images of your lungs.
  • An ECG (electrocardiogram) to measure the electrical impulses from your heart to see how well it’s working.
  • An echocardiogram to look at the structure and function of your heart.
  • Pulse oximetry to monitor the amount of oxygen in your blood to see if you need oxygen therapy.
  • An alpha-1 antitrypsin test to see if you have a lack of this protein. You may need this if your COPD developed when you were 40 or younger, or if you don’t smoke.

Treatment options for COPD

There are a number of treatment options for COPD, as described below. Which treatments you are offered will depend on your personal circumstances. Your doctor will discuss these with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

There isn’t a cure for COPD and it isn’t possible to reverse the damage to your lungs. However, there are ways to treat the symptoms and prevent COPD from getting worse. If you smoke, the most important thing you can do is stop. Giving up smoking can relieve your symptoms and slow down the progression of COPD, even if you have had it for a long time. Speak to your GP about ways to give up smoking.

Treatment for COPD will vary depending on how severe your condition is. You may be able to manage your condition with self-help measures. However, if it’s more severe or progresses, you may be offered medicines or oxygen therapy.

Self-help

There are other steps you can take to try to prevent COPD from getting worse and to ease your symptoms. Some examples are listed below.

  • Make sure you drink enough fluid as this can help to reduce the thickness of mucus that your lungs produce.
  • Try to exercise regularly, even if you feel tired. Walking for 20 to 30 minutes at least three times a week is recommended. If you can’t move around, exercise by stretching out your arms and twisting your upper body. See our frequently asked questions for more information.
  • Make sure you eat a healthy, balanced diet. It’s important that you eat enough as this will help to prevent your symptoms from getting worse. Your GP may recommend that you take nutritional supplements. See our frequently asked questions for more information.
  • Have a flu vaccination each year, and have the vaccination for the Streptococcus pneumoniae bacterium that causes pneumonia.

Pulmonary rehabilitation

This is a scheme that involves exercise, education about COPD, advice on nutrition and psychological support. Pulmonary rehabilitation aims to help reduce your symptoms and make it easier for you to do everyday activities. It’s a good idea to ask your GP about pulmonary rehabilitation and whether there is a programme in your area.

Medicines

There are various medicines that may help to ease your symptoms or control flare-ups. Discuss with your GP which medicine is best for you. You may be advised to take more than one. Some of these medicines are also used to treat asthma.

Bronchodilators

These medicines are commonly used to treat COPD. They widen your airways so air flows through them more easily and can relieve wheezing and breathlessness. They are available as short-acting or long-acting inhalers. There are many different types of bronchodilators – examples include salbutamol, salmeterol and tiotropium.

Steroids

Steroid medicines may help if you have more severe COPD or if a bronchodilator hasn’t helped. Steroids work by reducing inflammation of your airways. They are available as inhalers or tablets. You’re likely to be offered an inhaler if you need to take steroids frequently. Generally you will only be advised to take these tablets for a limited period of time, for example to treat a flare-up. This is because they can cause side-effects if taken regularly.

You’re unlikely to be offered a steroid inhaler if your condition is mild. This is because they may increase the risk of pneumonia in some people.

Mucolytics

Mucolytics break down the phlegm and mucus produced by your lungs, making it easier for you to cough it up. Your GP may advise you to take a mucolytic if you develop a persistent, phlegm-producing cough.

Oxygen therapy

If your COPD becomes severe, you may develop a low blood oxygen level. Oxygen therapy can help to relieve this and improve symptoms in some people. You inhale oxygen through a mask or small tubes (nasal cannulae) that sit beneath your nostrils.

The oxygen is provided in cylinders for you to use at home or in smaller, portable versions for outside the home. If you need oxygen for long periods of the day (over eight hours), you may be offered an oxygen concentrator. This is a machine that filters out oxygen from the air in the environment and stores it for you to use.

You must not smoke if you have oxygen therapy for COPD because there is a serious fire risk. You may not be prescribed oxygen therapy if you haven’t given up smoking. Oxygen therapy can be short-term, long-term (you use it all the time at home) or ambulatory (you use it for exercise or when you’re outdoors). You will probably only be offered oxygen after an appointment with a doctor who specialises in respiratory medicine (identifying and treating conditions of the lungs).

You may also need additional oxygen if you travel by air. It’s important to speak to your GP if you have COPD and are considering travelling by plane.

Surgery

If you have severe COPD, your doctor may recommend surgery to remove diseased areas of your lungs. This can help your lungs to function better. However, it’s only carried out in certain circumstances – speak to your doctor for more advice.

Prevention of COPD

You have the best chance of preventing COPD if you don’t smoke.

If your job exposes you to dust or fumes, it’s important to take care at work and use any relevant protective equipment. For example, you may need to wear a face mask to help prevent you from inhaling any harmful substances.


Reviewed by Polly Kerr, Bupa Health Information Team, November 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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