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Chronic obstructive pulmonary disease (COPD)

Published by Bupa's health information team, November 2009.

This factsheet is for people who have chronic obstructive pulmonary disease (COPD), or who would like information about it.

COPD describes a number of long-term lung conditions that cause breathing difficulties. COPD tends to get progressively worse and is most commonly caused by smoking.

Animation - How chronic obstructive pulmonary disease develops
About COPD
Symptoms of COPD
Causes of COPD
Diagnosis of COPD
Treatment of COPD
Prevention of COPD
Questions and answers
Related topics
Further information
Sources

How chronic obstructive pulmonary disease develops

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About COPD

COPD is common - it affects 900,000 people in the UK. It more commonly affects older men although the number of women with COPD is increasing as a direct result of more women smoking.

The term COPD has replaced the previously separate conditions of chronic bronchitis and emphysema.

Bronchitis affects the lining of your bronchi - the main airways that lead from your windpipe (trachea) to your lungs. The lining becomes irritated and inflamed if you have chronic bronchitis and produces excess mucus that blocks the airways.
Emphysema affects your alveoli - the tiny air sacs where oxygen passes into the blood. Emphysema damages the structure of the alveoli causing the walls to break down.

The effects of COPD mean less oxygen passes into your blood.

Illustration showing the changes to the bronchioles and alveoli in COPD
The changes to the bronchioles and alveoli in COPD

Symptoms of COPD

At first, you may not notice any symptoms of COPD. The condition progresses gradually, starting with either a 'phlegmy' cough or breathlessness. Many people developing COPD don't see their GP at this stage, but the earlier you get treatment the better.

As the disease progresses symptoms can vary but they include:

chronic cough (often the first symptom)
a gradual increase in breathlessness with physical exertion
regularly coughing up phlegm
wheezing
weight loss
waking up at night as a result of breathlessness caused by lying flat
feeling tired

It's rare to get chest pains or cough up blood if you have COPD - if this happens you may either have a different disease or another disease as well as COPD.

You may find that your symptoms are worse in winter. It's common to have two or more 'flare-ups' a year. This is when your symptoms are particularly severe.

Causes of COPD

The biggest single cause of COPD is smoking. Between 10 and 20 in 100 of all smokers develop COPD.

If you stop smoking, your chances of developing COPD begin to fall. If you already have COPD, stopping smoking can lead to an improvement in your symptoms and mean it progresses more slowly.

You're also more likely to get COPD:

if your job exposes you to certain dusts or fumes
from environmental factors, such as air pollution
from inherited problems - an inherited shortage of a protein called alpha antitrypsin that helps protect your lungs from the effects of smoking may increase your risk, but fewer than one in 100 people with COPD have this

Allergies and asthma have also been suggested to increase your chances of getting COPD, but the evidence isn't conclusive.

Diagnosis of COPD

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If your GP thinks you have COPD, he or she will ask you about the problems you have had with your chest and how long you have had them. He or she will usually examine your chest with a stethoscope, listening for noises such as wheezing or crackles.

Your GP may also perform a lung test called a spirometry test. You will be asked to blow into a device that measures how much and how fast you can force air out from your lungs. Different lung problems produce different results so this test helps to separate COPD from other chest conditions such as asthma.

Other tests you might have include:

a blood test to look for anaemia or signs of infection
a chest X-ray to see if your lungs show signs of COPD, and to exclude other lung diseases
a CT scan to build up a three-dimensional picture of your lungs to rule out other diseases
an electrocardiogram (ECG) to measure the electrical impulses from your heart to check if you have heart and/or lung disease
an echocardiogram to see if your heart is working as it should
a pulse oximeter to monitor the oxygen concentration in your bloodstream to see if you need oxygen therapy
an antitrypsin deficiency test - you may need this if your COPD developed when you were 40 or younger or if you don't smoke

Treatment of COPD

There isn't a cure or a way to reverse the damage to your lungs but there are things you can do to stop COPD from getting worse. The most important treatment is to stop smoking. Giving up smoking can relieve your symptoms and slow down the progression of COPD, even if you've had it for a long time. If you have mild COPD, stopping smoking may get rid of your symptoms completely.

Self-help

There are other steps you can take to stop COPD getting worse and to ease your symptoms, including:

keeping up your fluid levels by drinking enough water and using steam or a humidifier to help keep your airways moist - this can help reduce the thickness of mucus and phlegm that are produced
exercising to keep moving and eating a healthy diet to help your heart and lungs
having a flu vaccination each year, as COPD makes you particularly vulnerable to the complications of flu, such as pneumonia (bacterial infection of the lungs)
having a vaccination for the Streptococcus pneumoniae bacterium that causes pneumonia

Pulmonary rehabilitation

Ask your GP about pulmonary rehabilitation. These are programmes consisting of exercise, education about COPD, advice on nutrition and psychological support. Pulmonary rehabilitation has been shown to help people with COPD.

Medicines

There are various medicines that may help to ease your symptoms. Some help to control flare-ups. Discuss with your GP which treatment is best for you.

Bronchodilators

These treatments, commonly used for asthma, may help to relieve wheezing and breathlessness by relaxing your lungs (bronchodilation) so that air flows into them more easily. They are available as short-acting or long-acting inhalers or as tablets.

Steroids

Steroid treatments may help if you have more severe COPD. They are usually used if bronchodilators aren't effective and are available as inhalers or as tablets.

Steroid tablets may be prescribed as a short course for one or two weeks if you have a bad flare-up. They work best if you take them as soon as possible after the flare-up starts.

Mucolytics

Mucolytics break down the phlegm in your lungs, making it easier for you to cough it up. Your GP may prescribe you a mucolytic if you have a chronic, phlegm-producing cough. Mucolytics may also reduce the number of flare-ups you have although more research is needed to prove this.

Oxygen therapy

If your COPD becomes severe, you may develop low blood oxygen levels. Oxygen therapy can help relieve this. You inhale the oxygen through a mask or small tubes (nasal cannulae) that sit beneath your nostrils.

The oxygen is provided in large tanks for home use, or in smaller, portable versions for outside the home. An oxygen concentrator - a machine that uses air to produce a supply of oxygen-rich gas - is an alternative to tanks.

It's particularly important to give up smoking if you have oxygen therapy for COPD because there is a serious fire risk. Oxygen therapy can either be short-term, long-term - where you use it all the time at home - or ambulatory - when it's used for exercise or when outdoors.

Surgery

If you have severe COPD, your GP may recommend surgery to remove diseased areas of your lung. This can help your lungs to function more effectively. However, this is only carried out in certain circumstances - ask your GP for more advice.

Rarely, having a lung transplant may be an option. This is usually only if your life expectancy is under two years.

Prevention of COPD

You have the best chance of preventing COPD if you don't smoke.

If your job exposes you to dusts or fumes, it's important to take care at work and use any relevant personal protective equipment, such as face masks, to help prevent you from inhaling any harmful substances.