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Chronic obstructive pulmonary disease (COPD)

Expert reviewer, Dr Richard Russell, Respiratory Consultant
Next review due August 2024

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that makes you feel breathless. It’s the name for a group of conditions that affect how well your lungs and airways work — including chronic bronchitis and emphysema.

About COPD

If you have COPD, your airways and lungs become inflamed and narrower. This is usually caused by cigarette smoking, although if you’re exposed to other toxic substances, they can also damage your lungs. Most people with COPD aren’t diagnosed until they’re in their 50s or older.

COPD is an umbrella term that covers several different types of lung damage, but the two main types of COPD are:

  • chronic bronchitis — this is when the airways in your lungs become narrower and produce more mucus than normal
  • emphysema — this is when the tiny air sacs (alveoli) at the end of your airways become damaged and break down, which causes them to work less well

The damage to your lungs in COPD reduces how well your lungs can bring air into your lungs and thus get oxygen into your blood. This makes it harder for you to breathe.

Image showing the changes to the bronchioles and alveoli in COPD

Causes of COPD

The biggest cause of COPD is cigarette smoking. Most people with COPD are smokers or ex-smokers — but if you stop smoking, your risk of developing COPD will begin to fall. Although cigarette smoking is the biggest risk for getting COPD, smoking in any form (including pipes and cigars) and smoking marijuana can also increase your risk.

Other things that can increase your risk of developing COPD, include:

  • passive smoking
  • exposure to certain chemicals or fumes at work
  • air pollution
  • having an inherited condition called alpha-1 antitrypsin deficiency

If you smoke, the impact of these other risks is increased.

Symptoms of COPD

COPD usually gets worse slowly over time. The main symptoms you may notice at first include:

  • a persistent cough — this is usually a phlegmy (chesty) cough that you’ve had for some time
  • getting out of breath when you’re active (you may start to get breathless most of the time as the condition gets worse)
  • wheezing

You might notice these problems affect you more during the winter.

Other symptoms that can be signs of COPD getting worse include:

  • losing weight without trying
  • feeling very tired
  • waking up at night because you’re breathless or coughing
  • swollen ankles

These symptoms can be caused by other conditions, not just COPD. Whatever the cause, it’s important to see your GP if you have any new or persistent symptoms.

If you have COPD, you might have flare-ups, also known as exacerbations. This is when your symptoms get worse than normal for a period of time. You may be able to manage a flare-up yourself by taking more of your normal treatment (as advised by your doctor) but if it’s particularly bad, you may need to seek medical help.

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Diagnosis of COPD

Seeing your GP

To diagnose COPD, your GP will ask about your symptoms and examine you. They’ll ask if you smoke (or used to) and about other things that could increase your risk of COPD, such as any exposure to dust or fumes at work. Your GP may listen to your chest to see if you have any wheezing or crackling sounds when you breathe.

Your GP may ask you to do a test called a spirometry. This measures how well your lungs are working. First, your GP will ask you to take a medicine called a bronchodilator, which helps to widen your airways. Then, after 15-20 minutes, your doctor will ask you to take a deep breath and blow into a small device (called a spirometer) as hard as you can. The measurement will tell your GP if your symptoms are likely to be due to COPD.

Your GP will also arrange for you to have:

  • a chest X-ray to see if your lungs show signs of COPD and to rule out other lung diseases
  • a blood test to look for anaemia, or signs of an infection

Further tests

If you’re diagnosed with COPD, you may be asked to have further tests. These may include:

  • full lung function tests — a set of tests, including peak flow measurement (how hard you can breathe out), that assess how well your lungs are working
  • a CT scan to check the condition of your lungs in more detail
  • an ECG or echocardiogram to check on your heart
  • a blood test to check whether or not you’re deficient in alpha-1 antitrypsin
  • a test on any phlegm that you’re coughing up, to check for infection

Self-help for COPD

There are things that you can do yourself to manage your condition and keep well. When you’re first diagnosed with COPD, your doctor will put together a self-management plan which will include advice specific to you. It’s likely to include some of the following points

Give up smoking

If you smoke, the most important thing you can do is to stop. Giving up smoking can relieve your symptoms and slow down the progression of COPD, even if you’ve had it for a long time. Your GP will discuss ways in which they can help you to give up. These may include nicotine replacement therapy or medicines to help you stop smoking, and support programmes you can join.

Keep as active as you can

Although it can be hard to imagine if you’re very breathless, exercise can really help people with COPD. If you’re able to move around, going for a regular walk is a good place to start. Or you could try something like yoga and Qigong to help improve your symptoms. It’s ok to get a little bit out of breath, but don’t overexert yourself and always take things at your own pace. Build it up gradually if you need to.

If you can’t move around, keep active by stretching out your arms and twisting your upper body. If you’re really limited in what you can do, your doctor may refer you to a pulmonary rehabilitation programme. For more information, see our Treatment section.

Eat a healthy, balanced diet

It’s important to eat a healthy diet and maintain a healthy weight if you have COPD. If you’re overweight, it can make it even harder for you to breathe and move around. If you struggle to eat or prepare food, you may lose weight and start to lack certain nutrients. Try to eat little and often. Your GP may recommend that you take nutritional supplements or refer you to a specialist for advice on your diet.

Vaccinations

Make sure you have all recommended vaccinations, including an annual flu jab and vaccination against pneumonia. This can help to prevent flare-ups of your COPD.

Managing flare-ups

Your healthcare team will give you advice on how to recognise if you’re having a flare-up and how to deal with it. They may give you certain medicines to keep at home for use when your symptoms are worse. This is sometimes called a rescue pack.

They may also give you advice on breathing techniques that can help when you feel breathless. Breathing techniques include:

  • relaxed, slow, deep breathing
  • pursed-lips breathing — having your lips pursed as if you were whistling when you breathe out
  • blowing out when you’re doing something that requires effort
  • paced breathing — where you time your breathing to a particular activity

Treatment of COPD

There isn’t a cure for COPD and you can’t reverse damage to your lungs. But treatments for COPD can manage your symptoms, help you feel as well as possible and help to stop your COPD from getting worse.

A team of healthcare professionals will care for you and advise you on the right treatments to help you.

Inhalers

Inhalers for COPD usually include a type of medicine called a bronchodilator. Bronchodilators open your airways so air flows through them more easily to relieve wheezing and breathlessness. There are two main types of bronchodilator – beta-2 agonists and antimuscarinics.

To start with, you’ll probably have a short-acting bronchodilator. If you still get breathless, your GP may add one or two types of long-acting bronchodilator to your treatment, sometimes with a steroid medicine.

Devices for inhaled medicines

Different devices can help you to take your inhaled medicines. The main types are listed below.

  • Metered dose inhalers (MDIs). These are the most common type of inhaler. You press the top of these inhalers to release the medicine in a short sharp puff and breathe in slowly and steadily. They’re often used with a spacer – a plastic tube with a mouthpiece – which you attach to your inhaler. This can help make it easier for you to breathe in the medicine.
  • Dry-powder inhalers. The technique for these differs depending on the particular device you have. But it always involves breathing in firmly and deeply to release the medicine.
  • Nebulisers. These are small machines that turn liquid medicine into an aerosol or fine mist, which you breathe in through a mouthpiece or mask. They can deliver higher doses of medicine than you’d get through an inhaler. Your doctor may suggest a nebuliser if your breathlessness is severe and stops you going about your daily life.

Mucolytics

Mucolytics break down phlegm and mucus that your lungs produce and make 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. As well as helping with your cough, mucolytics may help to reduce the number of flare-ups you have.

Antibiotics

If you have a flare-up of symptoms and your doctor thinks it might be due to a bacterial chest infection, they may give you antibiotics. Sometimes, your doctor may give you a course of antibiotics to keep at home so you can start them as soon as you think you’ve got an infection. In certain circumstances, if you keep getting flare-ups, your doctor may recommend you take regular antibiotics.

Steroid tablets

If you have a flare-up of COPD, your doctor may suggest a short course of steroid tablets. You only take these for a short time because they can cause side-effects. If you’re used to managing your COPD, your doctor may give you a course of steroid tablets to keep at home, so that you can start them as soon as you notice the signs of a flare-up.

Other medicines

If you still have symptoms despite using inhalers, your GP may refer you to a specialist. They may offer you other medicines in addition to your inhalers. Other medicines may include:

  • theophylline
  • roflumilast

Pulmonary rehabilitation

This is a specialised programme of exercise and education about COPD, which is individually tailored to you. Your doctor may refer you if your COPD is starting to stop you doing things or if you’ve recently been admitted to hospital following a flare-up.

The programme includes physical training in a safe environment and can help you to increase the amount of exercise you can do. It aims to help you understand and manage your condition better, and to give you any support you need with nutrition or mental wellbeing. Sessions are usually held two times a week for six to eight weeks.

Oxygen therapy

If you’re still getting COPD symptoms despite taking other medicines, your GP may refer you to specialist services to see if oxygen therapy can help you.

Oxygen therapy can make it easier for you to do things that you’re finding difficult. Your doctor may recommend that you use it continuously or sometimes only when you exercise. But it’s something that you’ll need to take continuously, over the long term.

If you would benefit from oxygen therapy, your nurse or therapist will talk through the best type of equipment for you. You may have oxygen cylinders or a machine called an oxygen concentrator to use at home, which you’ll need to use for 15 hours or more a day. You inhale the oxygen through a face mask or through small tubes that continuously deliver the gas into your nostrils (nasal cannulae). You can get portable concentrators to use when you’re out and about.

You can’t smoke if you have oxygen therapy, because there’s a serious fire risk. You may not be prescribed oxygen therapy if you haven’t given up smoking.

You might also have oxygen in hospital if you’re admitted due to a flare-up of COPD.

Surgery

If you have severe COPD and have tried all other treatments, your doctor may recommend a review to assess if surgery on your lungs may help. There are several different options, depending on the particular problem in your lungs.

  • Lung volume reduction surgery such as an operation called a bullectomy removes the most damaged section of each lung.
  • Endobronchial valve insertion stops air from going into the worst affected sections of your lungs.
  • A lung transplant completely replaces your diseased lung with a donor’s lung.

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Related information


  • Discover other helpful health information websites.

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    • Chronic obstructive pulmonary disease (COPD). BMJ Best Practice. bestpractice.bmj.com, last reviewed 22 June 2021
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    • Chronic obstructive pulmonary disease in over 16s: Diagnosis and management. National Institute for Health and Care Excellence (NICE), last updated 26 July 2019. www.nice.org.uk
    • Chronic obstructive pulmonary disease. Patient. patient.info, last edited 31 January 2019
    • Personal communication, Dr Richard Russell, Respiratory Consultant, 18 August 2021
    • Smoking cessation. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2020
    • Keeping active with a lung condition. British Lung Foundation. www.blf.org.uk, last medically reviewed August 2020
    • Breathlessness. British Lung Foundation. www.blf.org.uk, last medically reviewed November 2020
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    • Use of metered dose inhalers, spacers, and nebulizers. Medscape. emedicine.medscape.com, updated 12 April 2020
    • Home oxygen therapy. British Lung Foundation. www.blf.org.uk, last medically reviewed February 2021
    • Hardinge M, Annandale J, Bourne S, et al. British Thoracic Society guidelines for home oxygen use in adults. Thorax 2015; 70:i1–i43. doi:10.1136/thoraxjnl-2015-206865
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2021
    Expert reviewer, Dr Richard Russell, Respiratory Consultant
    Next review due August 2024

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