COPD: Causes, Symptoms & Treatment

Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases that cause airflow obstruction and breathing difficulties. The two main conditions that make up COPD are emphysema (destruction of the air sacs/alveoli) and chronic bronchitis (inflammation and narrowing of the bronchial tubes with excess mucus production). Most people with COPD have features of both.

COPD is the third leading cause of death worldwide. In the United States, approximately 16 million people have been diagnosed with COPD, and millions more may be undiagnosed.

• Cigarette smoking: The primary cause (85-90% of cases)
• Secondhand smoke exposure
• Occupational exposure: Dust, chemicals, and fumes
• Air pollution: Indoor (biomass fuel for cooking/heating) and outdoor
• Alpha-1 antitrypsin deficiency: A genetic condition (rare, accounts for ~1-2% of cases)
• History of childhood respiratory infections
• Asthma: Long-standing asthma can contribute to fixed airflow obstruction

Symptoms typically develop slowly and worsen over time:

• Progressive shortness of breath, especially during physical activity
• Chronic cough (often called "smoker's cough")
• Sputum (mucus) production
• Wheezing
• Chest tightness
• Frequent respiratory infections
• Fatigue and decreased exercise tolerance
• In advanced disease: weight loss, ankle swelling, cyanosis (bluish lips/fingertips)

Exacerbations (flare-ups): Acute worsening of symptoms often triggered by infections or air pollution; can be life-threatening

• Spirometry: The essential diagnostic test -- measures how much air you can forcefully exhale and how quickly. An FEV1/FVC ratio below 0.70 after bronchodilator use confirms airflow obstruction
• Chest X-ray: May show hyperinflation but is not diagnostic
• CT scan: Shows emphysema, can identify other conditions (lung cancer screening)
• Pulse oximetry and arterial blood gases: Assess oxygen levels
• Alpha-1 antitrypsin testing: Recommended for all newly diagnosed COPD patients

Smoking cessation -- the single most effective intervention:

• The only measure proven to slow the rate of lung function decline
• Nicotine replacement, varenicline, bupropion, and behavioral counseling

Medications:

• Short-acting bronchodilators (albuterol, ipratropium): For quick relief
• Long-acting bronchodilators (LABA: formoterol, salmeterol; LAMA: tiotropium, umeclidinium): Mainstay of maintenance therapy
• Inhaled corticosteroids (ICS): Added for patients with frequent exacerbations and eosinophilic inflammation
• Combination inhalers: LABA/LAMA, or LABA/LAMA/ICS triple therapy
• Phosphodiesterase-4 inhibitor (roflumilast): For severe COPD with chronic bronchitis phenotype
• Prophylactic antibiotics (azithromycin): For select patients with frequent exacerbations

Non-pharmacological:

• Pulmonary rehabilitation (exercise training, education, nutritional counseling)
• Supplemental oxygen therapy (for patients with resting hypoxemia)
• Vaccinations: Annual influenza, pneumococcal, COVID-19, RSV
• Lung volume reduction surgery or endobronchial valves (selected patients)
• Lung transplantation (end-stage disease)

See a doctor if you experience persistent cough, progressive shortness of breath, or if you are a current or former smoker over age 40 with any respiratory symptoms. Early diagnosis allows for interventions that can slow disease progression.