COPD

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What Is COPD?

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition that causes persistent airflow limitation and breathing symptoms. It includes varying degrees of emphysema, small-airway disease, and chronic bronchitis.

COPD generally progresses over time, but the rate of decline can be slowed. Exacerbations—periods of sudden symptom worsening—can accelerate lung-function loss and may require urgent treatment or hospitalization.

What Causes COPD?

The most common cause is long-term exposure to tobacco smoke. Other causes include occupational dusts and chemicals, indoor biomass smoke, outdoor air pollution, and abnormal lung development.

A small proportion of cases are related to alpha-1 antitrypsin deficiency, an inherited condition that can lead to early emphysema. Asthma and repeated childhood respiratory insults may also contribute to persistent airflow limitation.

Diagnosis

Diagnosis requires spirometry showing airflow obstruction after use of a bronchodilator, interpreted together with symptoms and exposure history. Chest imaging, oxygen measurement, blood tests, and alpha-1 antitrypsin testing may be used to characterize disease or exclude alternatives.

Treatment Options

Treatment includes smoking cessation, inhaled bronchodilators, selected inhaled corticosteroid combinations, vaccination, pulmonary rehabilitation, physical activity, and an action plan for exacerbations. Correct inhaler technique is essential.

Oxygen therapy, noninvasive ventilation, lung-volume reduction procedures, or transplantation may be appropriate for selected advanced cases. Exacerbations are treated according to severity with intensified bronchodilators, corticosteroids, antibiotics when indicated, and respiratory support.

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Living With COPD

Smoking cessation is the most effective step for slowing progression. Patients should use inhalers exactly as prescribed, check technique regularly, remain active, and follow vaccination and pulmonary rehabilitation recommendations.

A written exacerbation plan can help patients respond early to increased breathlessness, sputum volume, or sputum color change. Nutrition, anxiety, sleep, and coexisting heart disease should also be addressed.

When to Seek Emergency Care

Seek emergency care for severe or rapidly worsening breathlessness, inability to speak in full sentences, blue or gray lips, new confusion or drowsiness, chest pain, coughing blood, very low oxygen readings, or failure of rescue medication to provide relief.

Prognosis

COPD is chronic and not fully reversible, but symptoms, exercise capacity, and quality of life can improve substantially with treatment. Prognosis depends on lung function, exacerbation frequency, smoking status, oxygen levels, nutrition, activity, and other diseases.

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Risks

Risk factors include cigarette, cigar, pipe, or secondhand smoke exposure; occupational dusts, fumes, and chemicals; indoor biomass fuel smoke; air pollution; older age; impaired lung growth; recurrent childhood respiratory disease; asthma; and alpha-1 antitrypsin deficiency. Complications include respiratory infections, pulmonary hypertension, heart disease, weight loss, anxiety, depression, and respiratory failure.

Symptoms

Common symptoms include progressive shortness of breath, chronic cough, sputum production, wheezing, chest tightness, reduced exercise tolerance, frequent respiratory infections, fatigue, and unintended weight loss in advanced disease. Exacerbations cause an acute increase in breathlessness, cough, or sputum beyond normal day-to-day variation.

Diagnosis

A clinician reviews respiratory symptoms, smoking and occupational exposure, previous infections, asthma history, and exacerbations. Spirometry before and after a bronchodilator is the key test and demonstrates persistent expiratory airflow obstruction.

Pulse oximetry, chest X-ray or CT, blood counts, arterial blood gas analysis, exercise testing, and cardiac evaluation may be added depending on severity. Alpha-1 antitrypsin deficiency testing is recommended at least once for people diagnosed with COPD, particularly with early or unusual disease.