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Mar 16, 2022
8 min read

Chronic obstructive pulmonary disease (COPD): causes, symptoms, and treatment

Chronic obstructive pulmonary disease (also known as COPD) is an inflammatory lung condition that makes it hard to breathe. COPD is usually caused by cigarette smoking. It’s most common after age 40 and typically gets worse over time. There are treatments that can improve COPD symptoms including medication, lifestyle changes, and in some cases, surgery.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

More than 16 million Americans have what’s called chronic obstructive pulmonary disease or COPD, which is a group of lung diseases. It’s suggested that many more people have COPD and don’t even know it (ALA, 2022).

Breathing with COPD has been compared to trying to breathe through a straw. It can affect people years after exposure and leads to an estimated 150,000 deaths each year in the United States (CDC, 2022)

COPD isn’t just one condition. While there is no cure for it, there are ways to treat symptoms and prevent flare-ups. 

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What is COPD?

Chronic obstructive pulmonary disease (COPD) is a common, yet irreversible set of lung conditions. COPD reduces airflow, making it harder to breathe. 

Examples of lung conditions that healthcare providers typically count under the COPD umbrella include chronic bronchitis, emphysema, and sometimes chronic asthma. Many people with COPD have multiple or all of these conditions. What type of COPD you have can be hard to identify as symptoms can overlap (Agarwal, 2021).

Many of the millions of people with COPD don’t realize they have it because symptoms can be gradual and take years to develop. People with COPD experience persistent difficulty breathing due to inflammation and damage caused by things like cigarette smoking and exposure to toxins. COPD causes the lungs to lose the ability to expand and shrink, which is essential for regular breathing (Agarwal, 2021). 

Symptoms of COPD

Most cases of COPD involve chronic bronchitis, emphysema, or both. Chronic bronchitis is inflammation of the lung tissue that creates mucus, leading to a phlegm-filled cough. A COPD cough can begin gradually and may start before or after difficulty breathing sets in (Han, 2022).

With emphysema, lung tissue is destroyed as the walls of air sacs break or stretch out. This creates large pockets of air space, reducing the surface area for oxygen exchange, and enabling carbon dioxide to build up in the lungs and blood. If the kidneys can’t balance these levels out, blood can become too acidic. This condition (hypercapnia) can cause a variety of symptoms including headaches, fatigue, dizziness, and seizures (Rawat, 2021). 

There are different stages of COPD ranging from mild to severe. Early signs of COPD can be missed or sometimes chalked up to a cold or allergies. Symptoms often begin with a lingering cough, phlegm in the throat or feeling like you need to clear your throat, and shortness of breath (especially after exercise) (Agarwal, 2021).

COPD symptoms can gradually worsen over months or years or cause flare-ups. As lung damage progresses, symptoms become more severe and constant. Signs of later stage COPD often seen are (Agarwal, 2021):

  • Wheezing due to difficulty exhaling
  • Trouble breathing
  • Chest tightness
  • Chronic cough
  • Increased mucus in the lungs
  • Frequent respiratory infections
  • Low energy, fatigue
  • Swelling in feet, ankles, or legs
  • Muscle wasting
  • Weight loss

The pressure in the lungs caused by COPD can also lead to pressure on the heart and is linked to heart disease. That’s why it’s critical to keep track of all symptoms and other potential medical problems and share them with your healthcare provider (Andre, 2019). 

COPD causes and risk factors

About 80% of COPD cases are linked to smoking cigarettes. It can also be caused by long-term exposure to second-hand smoke, air pollution, and pollutants like silica dust (Han, 2022). 

Other risk factors for COPD include (Han, 2022; Matteis, 2022):

  • Long-term exposure to pollutants like smog, silica, asbestos, or organic particles 
  • Being over the age of 40
  • Family history of COPD
  • A rare genetic condition called alpha-1-antitrypsin deficiency 

Diagnosing COPD

COPD is diagnosed based on your symptoms, test results, and medical history. It can be tricky to diagnose as it’s easily confused with other lung problems.

To help figure out if your symptoms are related to COPD, your healthcare provider will ask if you smoke or have been exposed to secondhand smoke or other pollutants including fumes and dust. During a physical exam, a stethoscope is used to listen for wheezing in the lungs. Other tests for COPD may include (Agarwal, 2021):

  • Lung function tests: Also called pulmonary function tests, these can be done to determine how well your lungs are working. The main diagnostic test used is called spirometry. This involves breathing through a tube attached to a computer to measure how forcefully you can exhale. Measurements are taken before and after using an inhaled bronchodilator, which is a medication that helps loosen and expand the lungs.
  • Blood gas tests: A blood gas test that measures oxygen, nitric oxide, and other gas levels in the blood. These tests can help determine if you need oxygen therapy.
  • Chest X-rays or CT scans: These scans give your medical team a snapshot of the lungs. These images show changes in size and shape of your lungs, as well as any collapsed lung tissue or changes in the chest area. 
  • Lab tests: Other lab tests that look for infection, anemia, and genetic causes (like alpha-1 antitrypsin) may be ordered. 
  • 6-minute walk test: A timed walking test may be used to show how much oxygen you’re getting during physical activity. If you’re experiencing breathlessness, it can be a sign of a lung health problem.

How to treat COPD

There is no cure yet for COPD. How well you can live with the condition is based on how severe the condition is and how well breathing problems are managed. 

Infections, lung irritants, and not receiving proper long-term treatment can make lung disease worse and increase the chances of hospitalization. For this reason, healthcare providers suggest those with COPD get vaccinated for respiratory conditions like the flu, pneumococcal disease, and COVID-19

A recent study found that those with COPD were four times as likely to have severe disease from COVID (including hospitalization and ICU stay) than those without an existing lung condition (Agarwal, 2021; Gerayeli, 2021). 

Treating COPD combines lifestyle changes, medications, pulmonary rehabilitation, and sometimes surgery. The following approaches are tailored based on symptoms and how damaged the lungs are (Agarwal, 2021; Nici, 2020).

Lifestyle changes

There are things you can do on your own to prevent COPD from worsening. These lifestyle changes are also important more maintaining overall health as well:

  • Quit smoking 
  • Avoid secondhand smoke
  • Avoid lung irritants (like toxins, irritants, and fumes from common products like pesticides or incense) (Li, 2016; Guo, 2020)
  • Wear a mask to lower the risk of infections like COVID

Pulmonary rehabilitation

Also known as “respiratory rehab,” pulmonary rehabilitation aims to help people with COPD improve lung function, reduce symptoms, and have a better quality of life.

According to the American Lung Association, a comprehensive pulmonary rehabilitation plan involves (ALA, 2016):

Rehab often includes exercise, which helps strengthen the lungs and reduce symptoms like breathlessness and fatigue (Spruit, 2016). 

Overall, research shows a pulmonary rehab program improves both physical and psychological symptoms of those with COPD (McCarthy, 2015).

Medication

Bronchodilators are the primary drug treatment for COPD. These medications can be long or short-acting and are inhaled to relax muscles of the lungs. This helps open up your airways, making it easier to breathe. 

What type of medication you’re prescribed depends on the type of COPD you have. Treatments may include (Agarwal, 2021):

  • Inhaled bronchodilators: These are used to relax tight muscles in your airways, widening them and aiding air passage. Bronchodilators also help clear mucus from the lungs.
  • Inhaled corticosteroids: This treatment is used to reduce inflammation.
  • Oral medications: Certain drugs may be prescribed to reduce inflammation, such as corticosteroids (glucocorticoids). 
  • Antibiotics: A course of antibiotics is used to treat or prevent bacterial infections.  
  • Oxygen therapy: This is utilized if your blood oxygen levels are too low.

Surgery

Surgical procedures may be an option for some but are typically reserved for when other treatments have failed. Examples of these procedures include (Ashraf, 2021):

  • Bullectomy: The removal of a bulla (large air pocket)
  • Lung volume reduction surgery: The removal of a section of damaged lung
  • Lung valves: These devices can be placed in the lungs to prevent air from entering any damaged parts. This allows trapped air and fluids to escape and relieves pressure (FDA, 2018). 
  • Lung transplant

Preventing COPD

Most cases of COPD are linked to years of exposure to an irritant, like cigarette smoke. Everyone responds differently to their environment and genetics can factor in, so it’s hard to tell exactly who will get it. 

However, there are basic ways to prevent the most common causes of COPD (Agarwal, 2021):

  • Avoid smoking, vaping, and inhaling other toxins or lung irritants. Tobacco smoke is not the only commonly inhaled irritant.
  • If you’re dealing with particles in the air at work, wear a proper mask to reduce what you inhale. 
  • Avoid heavily polluted areas when possible
  • Limit the inhalation of harsh chemicals, pesticides, or other airborne fumes
  • Avoid respiratory infections 

When to see a healthcare professional

If you notice a persistent cough or difficulty breathing, contact a healthcare provider. A cough is usually a temporary condition but it’s best to have it checked out if it hasn’t gone away or you’re concerned. 

Lung inflammation and COPD are also linked to a higher risk of lung cancer, so your healthcare provider may discuss cancer screening with you. If you have COPD, it’s important to work with a medical professional to control flare-ups and other conditions to improve overall health and quality of life (Durham, 2015).

References

  1. Agarwal, A. K. (2021). Chronic obstructive pulmonary disease. StatPearls. Retrieved Feb. 24, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK559281/ 
  2. American Lung Association (ALA). (2016). How pulmonary rehab helps you breathe. Retrieved Feb. 24, 2022 from https://www.lung.org/blog/pulmonary-rehab-helps-breathe 
  3. American Lung Association (ALA). (2022). COPD prevalence. Retrieved Feb. 24, 2022 from https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-prevalence 
  4. André, S., Conde, B., Fragoso, E., Boléo-Tomé, J. P., Areias, V., & Cardoso, J. (2019). COPD and cardiovascular disease. Pulmonology, 25(3), 168–176. doi:10.1016/j.pulmoe.2018.09.006. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30527374/#:~:text=COPD%20is%20one%20of%20the,cardiac%20comorbidities%20are%20frequently%20associated 
  5. Ashraf, O., Disilvio, B., Young, M., Ghosh, S., & Cheema, T. (2021). Surgical interventions for COPD. Critical Care Nursing Quarterly, 44(1), 49–60. doi:10.1097/cnq.0000000000000339. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33234859/ 
  6. Centers for Disease Control and Prevention (CDC). (2022). Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema. Retrieved from https://www.cdc.gov/nchs/fastats/copd.htm
  7. De Matteis, S., Jarvis, D., Darnton, L., Consonni, D., Kromhout, H., et al. (2022). Lifetime Occupational Exposures and Chronic Obstructive Pulmonary Disease Risk in the UK biobank cohort. Thorax. doi:10.1136/thoraxjnl-2020-216523. Retrieved from https://pubmed.ncbi.nlm.nih.gov/35082144/ 
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  9. Gerayeli, F. V., Milne, S., Cheung, C., Li, X., Yang, C. W., Tam, A., et al. (2021). COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine, 33, 100789. doi:10.1016/j.eclinm.2021.100789. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971471/ 
  10. Guo, S. E., Chi, M. C., Lin, C. M., & Yang, T. M. (2020). Contributions of burning incense on indoor air pollution levels and on the health status of patients with chronic obstructive pulmonary disease. PeerJ, 8. doi:10.7717/peerj.9768. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469933/ 
  11. Han, M. (2022). Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging. UpToDate. Retrieved from https://www.uptodate.com/contents/chronic-obstructive-pulmonary-disease-definition-clinical-manifestations-diagnosis-and-staging 
  12. Li, J., Sun, S., Tang, R., Qiu, H., Huang, Q., Mason, T., & Tian, L. (2016). Major Air Pollutants and risk of COPD exacerbations: A systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 11, 3079–3091. doi:10.2147/copd.s122282. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161337/ 
  13. McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003793.pub3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25705944/ 
  14. Nici, L., Mammen, M. J., Charbek, E., Alexander, P. E., Au, D. H., et al. (2020). Pharmacologic management of chronic obstructive pulmonary disease. an official American Thoracic Society Clinical Practice guideline. American Journal of Respiratory and Critical Care Medicine, 201(9). doi:10.1164/rccm.202003-0625st. Retrieved from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193862/ 
  15. Rawat, D. (2021). Hypercapnea. StatPearl. Retrieved March 14, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK500012/  
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  17. U.S. Food and Drug Administration (FDA). (2018). FDA approves novel device for treating breathing difficulty from severe emphysema. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-novel-device-treating-breathing-difficulty-severe-emphysema