Chronic obstructive pulmonary disease (COPD) is an incurable illness that makes it increasingly difficult to breathe due to irreversible lung damage. It mainly affects middle-aged and older people who smoke – and many do not realise they have it.
What is COPD?
Several conditions are types of COPD. The most common are chronic bronchitis and emphysema – people with COPD often have both. COPD also includes the less-common condition obstructive bronchiolitis.
Smoking is the main cause of COPD, thought to be responsible for almost 9 in every 10 cases.
COPD is a common condition, globally. The World Health Organization says it caused 3 million deaths in 2015 – 5% of all deaths that year – and that by 2020 it will be the third biggest cause of death worldwide.
In the US, estimates suggest more than 30 million have the condition, with about half of them undiagnosed. The US has upwards of 130,000 COPD deaths a year. In the UK, more than a million people are living with a diagnosis of COPD, though it is estimated that up to 3 million have the disease – about 25,000 die from it each year.
In COPD, airways in the lungs (bronchi) or the tiny air sacs (alveoli) that take in oxygen and remove carbon dioxide are damaged. Chronic bronchitis inflames and narrows the airways, causing a build-up of mucus; emphysema destroys the air sacs and interferes with breathing out.
The first symptoms most people notice are shortness of breath during everyday activities, such as climbing stairs, and a persistent cough, often with a lot of mucus (sputum). In a 2017 survey in the HealthUnlocked COPD online community, 73% of people with the disease said being short of breath was the symptom that had most impact on their lives. Over time, COPD can be fatal, leading to respiratory failure, heart failure, infections and a range of complications.
Which symptom has the most impact on your life?
505 responses from the HealthUnlocked COPD user survey
Though there’s no cure, COPD can be managed - symptoms can be treated and the progression can be slowed. It’s possible to live with COPD for many years, though in many cases it gets gradually worse despite treatment and will limit normal activities.
It’s not possible to say how long someone diagnosed with COPD will live – that depends on a range of things like their general health, whether they have other health problems, their lifestyle and so forth as well as the severity of their symptoms. But it is estimated that people with severe or very severe COPD will die five to six years earlier than if they didn’t have the disease.
Symptoms of COPD
COPD develops over many years. Most people don’t notice any symptoms until they are in their late 40s, 50s or older. Early symptoms of COPD can be mild and people often dismiss them as a ‘cold’ or ‘smoker’s cough’, or as a part of ageing.
- A mild cough that keeps coming back
- Breathlessness, especially after exercise or exertion
- A need to clear your throat often, especially when you wake in the mornings
As COPD progresses, symptoms become more obvious:
- Being short of breath, after even mild activity such as climbing stairs
- A persistent cough
- Tightness in the chest
- Frequent colds, flu, or other respiratory infections
- A lack of energy
In more severe COPD you may also have:
- Swelling of the ankles, feet or legs
- Weight loss
“I woke up in the early hours of the morning unable to breathe, and that worried me immediately.”HealthUnlocked COPD survey response, 2018
In advanced COPD, some people get chest pain and cough up blood but these are not common symptoms and often suggest another condition, such as a chest infection or possibly lung cancer.
Most people with COPD will have times when symptoms get suddenly worse and breathing becomes extremely difficult. These are known as flare-ups or ‘exacerbations’. It's not unusual to have several flare-ups a year, particularly during the winter. Even an ordinary cold can cause a flare-up.
You should seek immediate help if:
- Your lips or fingernails turn bluish or grey – signs of a low oxygen level in your blood
- You have cannot catch your breath to the point where talking is difficult or impossible
- You feel faint or confused
- You have a racing heart
Symptoms are likely to be much worse if you smoke or are regularly exposed to smoke. If you think you have symptoms of COPD, you should see your GP – the sooner you get a diagnosis, the sooner you can get treatment and make changes to your lifestyle that will help prevent further damage to your lungs. See more about symptoms of COPD at Healthline.
Diagnosis of COPD
Diagnosis of COPD is based on symptoms, a physical examination, and tests. There are several conditions that can be mistaken for COPD. These include asthma, bronchiectasis, in which your airways enlarge, and heart failure. There are also rare lung diseases that can be confused with COPD.
The first step in getting a COPD diagnosis is to talk to your GP. The doctor will want to know:
- Whether you smoke or have been a smoker
- If you regularly breathe secondhand smoke
- Whether your job exposes you to irritants such as dust or fumes
- If you have a family history of COPD
- If you have other respiratory conditions, such as asthma.
“When I was told I wasn't sure what to think as the consultant didn't explain much about it. I'm still unsure now and waiting to go on a rehab course.”HealthUnlocked COPD survey response, 2018
The GP will almost certainly listen to your chest using a stethoscope and calculate your body mass index (BMI) to see if you are a healthy weight. You may be asked to take a spirometry breathing test, which can show if your airways are obstructed.
Spirometry involves breathing into a machine called a spirometer. The machine works out how much air you breathe out in a second and how much overall you breathe out. The results will be compared with what’s normal for your age and give a guide to how well your lungs work.
Other tests might be needed to confirm a COPD diagnosis, to gauge its severity, or to rule out other possibilities. These tests may include:
Blood tests – to identify other conditions that can cause similar symptoms to COPD or, occasionally, to see if you have alpha-1-antitrypsin deficiency, a rare genetic problem that increases your risk of COPD. This deficiency is found in around 1 in 100 COPD cases.
Chest X-ray - to look for problems in the lungs
Blood-oxygen test – to measure the level of oxygen in your blood
Peak flow test – a breathing test that can help rule out asthma
Phlegm test – your phlegm (sputum) may be tested for signs of a chest infection
ECG, or electrocardiogram – to measure your heart’s electrical activity
Echocardiogram – a heart scan using ultrasound
Computerised tomography (CT) scan – a scan that can help identify lung problems
Causes of COPD
There is overwhelming evidence that chronic obstructive pulmonary disease is mainly a disease of smokers. Most people with COPD are or have been long-term smokers, and smoking cigarettes hugely increases the risk of getting COPD. In the UK, it is thought that 85-90 per cent of COPD is caused by smoking.
Stopping smoking cuts the risk of getting COPD and helps prevent it getting worse if you already have it.
“I was upset, but I accepted it as I had smoked cigarettes for years, I brought it onto myself, I can't blame someone else for my bad habit.”HealthUnlocked COPD survey response, 2018
Other possible causes of COPD include:
Long-term exposure to industrial dust and fumes – read about work-related COPD on the Health and Safety Executive website
Genetic factors, including alpha-1 antitrypsin deficiency, a rare condition in which your body doesn’t make enough of a protein called alpha-1 antitrypsin that protects the lungs from damage. Read about alpha-1-antitrypsin deficiency on the British Lung Foundation website.
- Premature birth that leads to lung damage, known as neonatal chronic lung disease.
- Some research has found that passive smoking – breathing other people’s smoke – may increase your risk of COPD.
- Some studies have suggested air pollution may cause COPD. High levels of air pollution can certainly increase breathing difficulties.
Effects of COPD
Once the symptoms of COPD have started, they usually worsen gradually over the years, especially if you continue to smoke. Treatment can mean COPD doesn't severely limit daily activities for many people. But even with treatment and stopping smoking, the disease often continues to worsen – treatment can slow the progression but can’t reverse damage already done.
As the condition worsens, breathlessness increases and breathing difficulties start to limit your mobility and prevent you doing everyday things like walking, shopping and so on.
Being unable to play with grandchildren or not being well enough to babysit for them was among the top impacts of the disease mentioned in our 2017 online survey of people with COPD.
“I get breathless and tired playing with young children so I have not been as involved with my grandchildren as I could have been”HealthUnlocked COPD survey response, 2018
Though many people are diagnosed in retirement, COPD forces a good many people to stop working – in our survey, a third said it had caused them to stop work.
This forced unemployment can bring money worries and loss of self-esteem, adding to the risk of mental health problems. About 60 per cent of people with COPD are affected by anxiety or depression at some point.
As time goes on, chest infections often become more frequent and flare-ups (exacerbations) of symptoms occur more often, typically when you have a chest infection. Serious flare-ups may require hospital treatment.
“I retired early through ill health.”HealthUnlocked COPD survey response, 2018
In severe COPD, heart failure – when the heart becomes unable to pump blood efficiently – is common. The changes COPD bring can cause a lower level of oxygen in the blood and a rise in pressure in the blood vessels in the lungs. These changes can strain the heart, causing heart failure and leading to even greater breathlessness and other symptoms, including fluid retention.
The final stage of COPD is respiratory failure, when the lungs are so damaged that the level of oxygen in the blood becomes very low and carbon dioxide – the waste gas you breathe out – builds up in the bloodstream. At this point people need palliative care, including end-of-life care. Read about palliative care in long-term progressive conditions on the Marie Curie website.
Stages of COPD
COPD is divided into four stages or grades depending on the severity of the condition. Working out how much your airflow is restricted is central to which category you would be in, though other aspects of the condition will also be considered.
To assess your airflow, a spirometry test is used to calculate how much you breathe out in one second.
This value is called FEV1 – forced expiratory volume in 1 second. Your results are then compared with the average expected from someone of your age, height, weight and sex.
COPD is classed as mild, moderate, severe or very severe, depending on the FEV1 figure:
Stage 1 – Mild - is where FEV1 is at least 80% of the expected value
Stage 2 – Moderate - is an FEV1 between 50% and 79%
Stage 3 – Severe - is an FEV1 between 30% and 49%
Stage 4 - Very severe - is an FEV1 below 30%
Treatment of COPD
As there’s no cure for chronic obstructive pulmonary disease (COPD) treatment aims to slow its progression and control the symptoms so that you can live as normally as possible.
If you smoke, first on the list of treatments is to quit. COPD is caused mainly by smoking and stopping can improve your breathing and limit further lung damage.
Inhalers of different types may be prescribed to help you breathe more easily. Inhalers deliver medicine straight to the lungs as you breathe in (inhale). There are various inhalers for COPD, some short-acting, some longer lasting, some with a single medication and others with a combination of drugs – your prescription will depend on your individual needs.
Your doctor might also prescribe tablets or capsules to ‘open’ your airways or help clear mucus. People who have recurrent flare-ups (exacerbations), where symptoms become suddenly much worse, may be given drugs such as antibiotics and steroids to keep at home in case of a flare-up.
Top 3 medications people with COPD are taking
3 most popular responses from the HealthUnlocked COPD user survey question "Which medication do you take to manage your COPD?"
In severe cases of COPD where inhalers haven't worked, you may be given nebulised medication, where a machine turns liquid medicine into a fine mist that you breathe in. If you need this, you’ll usually be given a nebuliser machine to use at home.
If your blood’s oxygen level drops to a very low level, you may need oxygen at home which you breathe through a nasal tube or mask. Called long-term oxygen therapy, you’d need to use it for 16 hours daily. It can help stop the level of oxygen in your blood becoming dangerously low, but it won’t help with symptoms such as breathlessness.
If your oxygen level is OK while you're resting but drops when you exert yourself, you may be able to have ‘ambulatory oxygen therapy’ which you can use just during activities.
Pulmonary rehabilitation is a programme of exercise and education to help people with lung problems. It can help you increase the amount of exercise you can do before getting out of breath, improve your symptoms and help with problems around self-confidence and mood. In our online survey, a third of respondents said pulmonary rehabilitation was one of the best treatments.
“Pulmonary rehab changed my life and attitude.”HealthUnlocked COPD survey response, 2018
The programmes usually involve group sessions two or three times a week for about six weeks and typically cover physical exercise training, learning about your condition, advice on diet, and emotional and psychological issues.
Read about pulmonary rehabilitation on The British Lung Foundation website.
Surgery is not usually an option for most people with severe COPD. There are several possible major operations, but they carry high risks for people with COPD.
The three main possible operations are:
- lung volume reduction – removal of a damaged area of lung. This might allow the healthier lung parts to work more effectively and make breathing easier
- bullectomy – removal of a pocket of air from a lung to help the lungs work better and ease breathing
- lung transplant – replacing a damaged lung with a healthy lung from a donor
Living with COPD
Chronic obstructive pulmonary disease can affect all areas of your life but there’s a lot you can do to ensure you keep as well as you can and continue to enjoy the things you like.
First, if you have COPD and you smoke, quit. Of all the things you can do, this is among the most important. You can get help to quit from your GP, pharmacist, or NHS Stop Smoking services.
“Stop smoking and keep as active as possible.”HealthUnlocked COPD survey response, 2018
Exercise and diet
Regular exercise can help ease your symptoms and improve your general fitness, which in turn can help fend off infections and flare-ups. How much exercise you do will depend on your circumstances and you might want to discuss this with your GP. If you go on a pulmonary rehabilitation programme, it will include a structured exercise plan that meets your needs and ability.
Along with exercise, it’s important to maintain a healthy weight and ensure you eat a well-balanced diet.
“I’m more active. I use a Fitbit and walk every day. I avoid people with colds, take a healthy lifestyle more seriously and enjoy myself too”HealthUnlocked COPD survey response, 2018
Medicines and vaccines
Make sure you take any prescribed medication as directed and check you use your inhaler properly – some people don’t get the full benefit of an inhaler because they use them incorrectly. If you take over-the-counter medicines alongside your prescription drugs, check the leaflets – some medicines interfere with one another. If you are concerned about your medicines, talk to your GP.
Because of the likelihood of chest infections in COPD, you should get the annual flu jab and the single-shot pneumococcal vaccination that prevents infections such as pneumonia.
Watch the weather
Cold snaps, heatwaves and very humid conditions can all increase breathing problems in COPD so knowing what’s on the way can help you prepare and plan round unfavourable conditions.
Any long-term condition such as COPD can strain close relationships, interfere with your sex life, limit your social activities and generally leave you feeling ‘down’. Your partner or others close to you may also have worries about your health. It’s generally a good idea to be honest about how you feel and discuss any issues openly. This can help reduce anxiety and stress, which can in turn help with your symptoms.
It’s also a good idea to explain the condition to people you socialise with. As one online survey participant explained:
“People do not understand why you get very tired. I no longer dance or play bowls, cannot keep up with a group of people, and often have to cancel arrangements at the last minute.”HealthUnlocked COPD survey response, 2018
Maintaining your social life is important for your health and wellbeing, and talking with family and friends so they understand your situation is a big part of that.
Support and apps
Support groups and forums
Some people find it helps to talk to others with COPD. There are usually local support groups where you can meet people face-to-face and there are plenty of online forums and communities where you can ask questions and join discussions.
- Find a UK Breathe Easy local group
- Find a Better Breathers club with the American Lung Association
The value of online support
Responses from HealthUnlocked user survey 2017
There’s a range of smartphone and computer apps to help you manage your COPD. Some are free and some paid-for. In the UK, some paid apps might be available free through the NHS.
One of the most recommended is myCOPD. It offers many functions, can reduce the number of appointments you need with a doctor or hospital and can help you get to grips with inhaler techniques, which make a vast difference to how effective inhalers are. It also helps with breathing exercises and provides a medication diary and symptom tracker along with other tools.
The app, which has NHS approval, can also be used by clinicians to check in with you remotely and help them track your condition and improve your care.
COPD Navigator is another app that provides similar functions.
Find more COPD information
- American Lung Association
- British Lung Foundation
- COPD on NHS Choices
- COPD Foundation (US)
- Healthline - COPD
- World Health Organization - COPD