Chronic Obstructive Pulmonary Disease (COPD)
Last Updated 11/02/2020
Author:Kevin M. O’Neil, MD, FCCP
About Chronic Obstructive Pulmonary Disease (COPD)
- COPD is a common disease that can be prevented.
- COPD causes loss of lung function over time.
- To diagnose COPD, your provider will give you breathing tests.
- You are at risk for COPD if you smoke; breathe indoor air pollution, including second-hand smoke; or are exposed to chemicals, fumes, or dust at work.
- COPD is one of the leading causes of death and disability worldwide.
Chronic swelling in your lungs damages your airways (the tubes that carry air to your lungs) by narrowing them and causing your lungs to fill will mucus. Also, swelling in the air sacs in your lungs, called alveoli, damages lung tissue. This process makes it hard to get oxygen into and remove carbon dioxide from your body.
As this disease—called chronic obstructive pulmonary disease, or COPD—gets worse, the swelling causes shortness of breath and can limit your ability to perform everyday tasks, like housework or climbing stairs. People with COPD also experience sudden worsening of symptoms, called flares, which are often triggered by infections. Severe flares can require emergency care.
COPD can also cause cough, chest tightness, wheezing, and increased mucus production. Severe COPD can lead to weight loss and fatigue. Depression, thin bones, lung cancer, heart disease, and muscle weakness are more common in people with COPD. COPD can also cause severe disability and even death
No one knows why some people get COPD and others do not. Many factors may lead to the lung tissue damage seen in COPD, including environmental exposure and genetics. Other factors are related to childhood illnesses and early lung development.
COPD costs the United States $50 billion a year in lost wages and medical bills and is the third most common cause of death. In the United States, 24 million people have COPD, and half don’t even know it.
Living Well with COPD
COPD Myths Busted
The Living Well with COPD patient guide will introduce you to COPD – its causes, symptoms and risk factors; how it is diagnosed; how it is treated; and how to manage the condition to minimize its impact.
This patient education guide, infographic, and other collateral pieces are generously supported by the Allergy and Asthma Network.
Symptoms of COPD
It’s easy to mistake COPD for other diseases, including asthma, chronic lung infections, and heart disease, especially in the early stages of COPD. Most people with COPD start having symptoms when they reach their 50s and 60s. A small number of people who have an inherited form of COPD called Alpha-1 can have symptoms at a much earlier age.
COPD typically develops slowly. Symptoms start out mild but get worse, especially if you continue to smoke or breathe in pollution or chemicals. The most common symptoms are:
- Shortness of breath
- Cough with mucus production
- Chest tightness
- Weight loss, poor appetite, weakness, and fatigue (with advanced disease)
What are the risk factors for COPD?
Smoking increases the risk of getting many diseases in addition to COPD, including lung cancer and heart disease. Not all smokers develop COPD. If you smoke, the risk of developing COPD increases about 20% to 25% depending on how much you smoke.
Other risk factors for developing COPD exist:
- Second-hand smoke exposure, which is the best known and most important risk factor
- Some dust and fumes in the workplace
- Indoor air pollution from burning wood and coal as fuel for heat and cooking
- Alpha-1 antitrypsin deficiency, an uncommon inherited condition that greatly increases the risk of developing COPD
- Having asthma, particularly if you smoking, as well
- Early lung infections and other conditions during childhood that limit normal lung development
Early diagnosis and management of COPD can help reduce its effect on your life.
How is COPD diagnosed?
To determine if you have COPD, your health care provider will ask you about your medical history and your symptoms. He or she will also give you a breathing test that shows how well you can breathe out. Your provider may recommend other tests, as well, including:
- A chest X-ray
- Measuring your oxygen level
- A blood test to check for an inherited (genetic) form of COPD
- Additional breathing tests
- Exercise testing
Get tested for COPD if you have ongoing problems with shortness of breath, a cough that produces mucus, wheezing, or chest tightness. Getting tested is especially important if you are a smoker or have a family history of COPD at an early age (before age 50).
If you already know that you have COPD, contact your health care provider if your symptoms get worse.
The most important step in treating COPD is to remove the cause of your lung inflammation. For most people, that’s cigarette smoke. There’s no good way to repair damaged lungs, but quitting smoking can slow the loss of lung function. It also helps prevent disease flares.
If you smoke, stop. If you don’t smoke, don’t start and try to avoid being around those who do smoke. If you need help quitting, ask your health care provider for resources to help you stop.
Treating COPD with medication
Medication can help relieve many of the symptoms of COPD. It can also treat disease flares. Many COPD medications are taken using an inhaler, which helps drive more medication into the lungs. Often, several medications are combined in one inhaler. Health care providers may prescribe any of the following types of medication to treat COPD:
- Bronchodilators. Bronchodilators work by relaxing the muscles in the airways to make it easier to breathe out. There are 2 types of bronchodilators; which one a provider prescribes depends on how the drugs relax the muscles. The 2 type works differently, and they can be combined.
- Inhaled steroids. Inhaled steroids are medications that reduce swelling in the lungs.
- Phosphodiesterase-4 inhibiters. These medications help reduce swelling. They are often prescribed to patients who have more severe COPD.
- Antibiotics. Antibiotics are sometimes used to treat severe symptoms of COPD.
- Oxygen therapy. Oxygen can help patients who have low oxygen levels during exercise to exercise longer.
Treating COPD with surgery
Two types of surgery are used to treat severe symptoms of COPD:
- Lung volume reduction surgery. This surgery involves removing damaged lung tissue so that the remaining lung can work better. The procedure can help a small number of patients with COPD.
- Lung transplant. Lung transplant surgery can help some patients with very severe COPD.
Other treatments for COPD
- Vaccinations. Vaccinations can held decrease the risk for severe lung infections.
- Pulmonary rehabilitation programs. These programs combine education about COPD with a supervised exercise program that can improve patients’ ability to exercise and reduce shortness of breath.
Self-care and COPD
Patients with COPD face many challenges. COPD is a long-term disease and can affect many aspects of your life. But you can take steps to reduce the impact of COPD on your life:
- Stop smoking. And don’t allow others to smoke around you. Avoiding smoke helps slow the progression of COPD and reduce the risk of severe symptom flares.
- Stay active. Twenty minutes of moderate exercise 3 times a week helps reduce the risk of heart disease, decreases shortness of breath, and improves your well-being. If you can’t do 20 minutes of exercise or if you can’t do your normal activities because of shortness of breath, ask your health care provider to send you to pulmonary rehabilitation.
- Eat a healthy diet. A healthy body weight helps avoid shortness of breath.
- Educate yourself. Know about your disease and the treatment options. Know when you need to contact your provider. Have a plan for dealing with severe symptoms.
- Take your medications. Many of the medicines used to treat COPD are expensive, and not many generic substitutes are available. If you can’t afford your medicine, let your health care team know. There are programs that may help you cover the cost of your medication.
- Have a plan. If your COPD is moderate to severe, talk to your family and health care team about your wishes for end-of-life care. Knowing what’s important to you can help your provider and your family care for you as the disease progresses.
COPD progresses at a different rate for each person. For many people, COPD can eventually limit activity and reduce quality of life. Other diseases, like heart disease, depression, anxiety, and osteoporosis, are common among patients who have COPD and can also affect quality of life.
Get the facts about COPD: Myths BUSTED
Only smokers get COPD.
10% to 20% of people who get COPD have never smoked. Right now that number adds up to between 24,000 and 48,000 patients with COPD who never smoked.
COPD is a rare disease.
COPD is the third leading cause of death in the US, impacting roughly 24 million Americans.
I haven’t got COPD. This is just a smoker’s cough.
There is no such thing as a smoker’s cough. If you’re experiencing a recurrent and productive cough and/or sputum, you probably have an inflamed airway, which may be a sign of chronic bronchitis. If you have a persistent cough, see a qualified health-care provider.
I’ve smoked for more than 20 years. Stopping now won’t make any difference.
When you stop smoking you achieve two benefits to counter COPD. First, you dramatically reduce your risk for a heart attack (myocardial infarction). Secondly, you increase your life expectancy, literally adding years to your life. So it’s never too late to stop smiling to improve your health.
COPD only happens to old people.
COPD can occur at any age. While most people with COPD contract the disease in their 60s or later, it can occur as early as 40 and, in rare cases, even earlier.
There is no treatment for COPD.
COPD is a treatable condition and there are many options to help you manage the disease and feel better.
Getting started with oxygen therapy is a death sentence.
Many patients with COPD live more than 10 years while on oxygen therapy. With the latest, lightweight and portable oxygen concentrators, oxygen therapy no longer limits your mobility so you can continue activities outside of your home.
COPD Myths Busted
Think you might be at risk for COPD? Take this short screener.
- COPD Education and inhaler training videos, provided by the COPD Foundation
- Respiratory Inhalers at a Glance
- Respiratory Inhalers at a Glance (en español)
- COPD Glossary and Medications by Brand
- COPD Glossary and Medications by Brand (en español)
- Living Well With COPD Guide
- Conviviendo con la EPOC
Online and phone support
There are many places to get support for COPD. Local and online groups can help you find answers to your questions and provide assistance. Your health care provider will likely know the support groups in your area. Online resources are listed below:
- The Better Breathers Clubs and American Lung Association Lung Helpline
- The COPD foundation
- COPD Support
- The Mayo Clinic website
- The National Health Lung and Blood Institute
- National Jewish Hospital
- Animated COPD patient
- COPD Foundation Information Line: (866) 316-COPD (2673)
Call to learn more about COPD and talk to people who understand the effect COPD has on your life.
- American Lung Association
- Better Breathers Club. Find a support group in your area to connect with others living with COPD and to learn from educational presentations and discussions.
- National Heart, Lung, and Blood Institute
- COPD-Alert Support and Advocacy Group. Provides information and advice for patients with COPD.
Information about COPD
- COPD Foundation
- Centers for Disease Control and Prevention
- Global Initiative for COPD
- US COPD Coalition
- How To Use Inhalers
For health-care providers
- WipeCOPD. WipeCOPD is an acronym for Web-based Interactive Professional Education in Chronic Obstructive Pulmonary Disease. This program was developed with the help of an educational grant entitled the “GlaxoSmithKline Distinguished Scholar Award in Respiratory Health” from the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.
Frequently asked questions about COPD
Do I have COPD?
This sounds like a simple question, but many diseases can be confused with COPD, especially asthma. Some patients have features of both asthma and COPD, called asthma-COPD overlap syndrome. Patients with this syndrome should see a lung specialist because they tend to have more problems than patients with either asthma or COPD alone.
How severe is my COPD?
Health care providers use breathing tests and the GOLD classification system to grade COPD severity. The scoring system can be helpful, but it’s not always accurate. The more important question to ask yourself and to discuss with your provider is, “How does COPD keep me from doing what I want to do?”
Am I up to date on my immunizations?
Preventing infection is important for patients with COPD. Patients should be up to date on all immunizations but pay particular attention to influenza (flu) and pneumonia vaccinations. Current recommendations say that patients with COPD should receive yearly flu shots and both pneumococcal (pneumonia) vaccinations.
What are the side effects of my medications?
This is an important question. Your health care provider should review with you how to take all new medications and their possible side effects. Ask if there are any interactions with your other medications and how to tell if the side effects are serious enough for you to stop the medication.
What should I do if my breathing gets worse?
Ask your health care provider what you should do when your provider’s office isn’t open when you need help.
What should I do if I’m traveling? Do I need oxygen for an airplane flight?
Traveling can create challenges. If you are traveling, make sure that you have enough medication for the trip in your carry-on bag (if you’re flying). If you use oxygen, you will need it when flying. Some people who don’t typically use oxygen will also need it on an airplane. Your health care provider can tell if you will need oxygen based on some simple office tests. You will also need to notify the airline. If you need oxygen at your destination, your oxygen supplier will need to arrange this in advance.
I can exercise by myself. Why do I need to go to pulmonary rehabilitation?
Pulmonary rehabilitation is more than just exercise. These programs offer education that can help patients with COPD. Exercise in pulmonary rehabilitation is monitored by medical professionals, and you are less likely to stop exercising if you do it with a group.
Do I need a nebulizer?
Nebulizers convert liquid medicine into a mist that can be inhaled. Most patients with COPD don’t need nebulizers, but these devices can help some patients who have difficulty using inhalers. There are several disadvantages to using nebulizers, too. For example:
- It takes extra time to deliver medication through a nebulizer.
- Nebulizers are less portable and require cleaning.
- Not all medications can be given with a nebulizer.
- Nebulizer medication doses are much larger than those in inhalers, so the risk of side effects is higher
Talk to your provider about a nebulizer if you’re having problems using an inhaler.
Oral steroids help my breathing when I have a flare. Why can’t I take them all the time?
Oral steroids can help with flares, but they have many side effects that get worse when you use them over time. Also, oral steroids have not been shown to help most patients with stable COPD, and they are not recommended for long-term use.
Should I have a lung transplant?
COPD is the most common reason for a lung transplant. Lung transplants can improve survival and quality of life in some patients with end-stage COPD, but they can have complications, as well. After a lung transplant, you need to take medication to keep from rejecting the transplant. The supply of lungs for transplant is limited, and not everyone with COPD is healthy enough for the surgery. Transplants are typically done when a person has less than 2 years to live, but it can be difficult to predict how quickly COPD will get worse. If you think you may be interested in a lung transplant, ask your provider to send you to a transplant center for testing.