Overview

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that obstructs airflow, making it difficult to breathe. It includes two primary types: chronic bronchitis and emphysema. COPD often results from long-term exposure to lung irritants such as cigarette smoke, air pollution, chemical fumes, and dust.

Although it is incurable, effective treatment can help manage symptoms, slow disease progression, and improve quality of life.

Types

Chronic bronchitis involves inflammation and narrowing of the bronchial tubes. This condition causes excess mucus production, resulting in a persistent cough and breathing difficulty.

Emphysema damages the alveoli (air sacs) in the lungs. Over time, the sacs lose elasticity, making it harder for oxygen to enter the bloodstream and carbon dioxide to be expelled.

Symptoms

COPD symptoms typically develop gradually and worsen over time. Early signs may be subtle, leading to delayed diagnosis. Common symptoms include:

  • Chronic cough (with or without mucus)

  • Chest tightness

  • Shortness of breath, especially during activity

  • Frequent respiratory infections

  • Fatigue

  • Wheezing

  • Difficulty taking deep breaths

Exacerbations

COPD exacerbations refer to sudden worsening of symptoms. Triggers can include infections, air pollution, or changes in weather. Symptoms may include:

  • Change in mucus color (yellow, green, or brown)

  • Increased mucus volume

  • Heightened breathlessness, even during mild activity

  • Severe fatigue

  • Trouble sleeping

  • Morning headaches

Exacerbations can lead to hospitalization and long-term lung damage if not treated promptly.

Advanced stage signs

End-stage COPD is marked by severe respiratory impairment. Symptoms may include:

  • Significant weight loss or gain

  • Pursed-lip breathing

  • Hypercapnia (elevated carbon dioxide levels)

  • Hypoxemia (low oxygen levels)

  • Inability to perform daily activities

  • Reduced lung sounds on examination

Causes

COPD arises when airways and alveoli become inflamed, narrowed, and less flexible. This limits airflow and leads to mucus accumulation. Primary causes include:

  • Long-term smoking (primary risk factor)

  • Secondhand smoke exposure

  • Occupational exposure to dust, fumes, or chemicals

  • Indoor/outdoor air pollution

  • Frequent childhood respiratory infections

  • Genetic disorder: alpha-1 antitrypsin deficiency

Risk factors

You may be at greater risk of developing COPD if you:

  • Smoke or have smoked in the past

  • Have a family history of COPD

  • Were exposed to air pollutants at home or work

  • Had chronic asthma in childhood

  • Have low birth weight or lung growth issues in childhood

  • Are over 40 years of age

Diagnosis

To diagnose COPD, healthcare providers conduct a medical history review, physical examination, and diagnostic tests. These may include:

  • Spirometry: Measures lung function and airflow limitation

  • Chest X-ray or CT scan: Detects lung damage and rules out other conditions

  • Arterial blood gas test: Assesses oxygen and carbon dioxide levels in the blood

  • Complete blood count (CBC): Detects infection or anemia

  • Alpha-1 antitrypsin (AAT) test: Screens for hereditary AAT deficiency

  • 6-minute walk test: Monitors oxygen saturation and endurance during physical activity

Stages

COPD is classified into stages based on spirometry results and symptom severity:

  • Stage 1: Mild

  • Stage 2: Moderate

  • Stage 3: Severe

  • Stage 4: Very Severe

Patients are also grouped by exacerbation risk:

  • Group A: Fewer symptoms, low exacerbation risk

  • Group B: More symptoms, low exacerbation risk

  • Group E: Any symptom level, high exacerbation risk

Treatment

Treatment aims to improve breathing, reduce symptoms, and prevent complications.

Lifestyle changes

  • Quit smoking and avoid secondhand smoke

  • Eat a balanced, nutritious diet

  • Exercise regularly to strengthen lungs and muscles

  • Stay up to date with vaccinations (flu, COVID-19, pneumonia)

  • Avoid environmental irritants and allergens

Medications

  • Bronchodilators: Relax airway muscles for easier breathing

  • Inhaled corticosteroids: Reduce inflammation in the lungs

  • Combination inhalers: Include bronchodilators and steroids

  • Oral medications: Such as theophylline or leukotriene modifiers

  • Antibiotics or antivirals: To treat respiratory infections

  • Oxygen therapy: For those with low oxygen levels

Pulmonary rehabilitation

Pulmonary rehab programs combine exercise, education, and emotional support. Benefits include:

  • Improved exercise tolerance

  • Better understanding of COPD

  • Reduced anxiety and depression

  • Enhanced quality of life

Programs are usually conducted in groups and supervised by respiratory therapists.

Surgical options

For advanced COPD, surgery may be necessary:

  • Bullectomy: Removal of large air pockets (bullae) that interfere with breathing

  • Lung volume reduction surgery (LVRS): Removal of damaged lung tissue to enhance function of remaining lung

  • Lung transplant: For eligible patients with end-stage COPD

Prevention

While not all COPD cases are preventable, risk can be greatly reduced by:

  • Never smoking or quitting smoking early

  • Minimizing exposure to harmful fumes or pollutants

  • Using protective equipment at work

  • Managing asthma and other respiratory conditions

  • Vaccinating against respiratory infections

Related conditions

COPD increases the risk of developing other health issues:

  • Asthma: Often coexists with COPD (asthma-COPD overlap)

  • Lung cancer: COPD patients have higher cancer risk

  • Heart disease: Especially right-sided heart failure

  • Diabetes: Shared inflammatory pathways

  • Depression and anxiety: Due to lifestyle limitations

  • GERD (acid reflux): Can exacerbate lung symptoms

Living with COPD

COPD impacts many aspects of daily life, but proactive management can improve well-being. Tips for living better with COPD:

  • Follow a personalized COPD action plan

  • Take medications consistently

  • Monitor and track symptoms

  • Stay physically active within limits

  • Join support groups for emotional encouragement

With proper care and support, many individuals with COPD live long, meaningful lives.