Chronic obstructive pulmonary disease (COPD)

What is COPD?

COPD is the general term for lung conditions that make it difficult to breathe because the airways have become narrowed. It mainly affects middle-aged or older people and is often caused by smoking or long-term exposure to chemical irritants.

The two most common COPD conditions are:

• Emphysema – damage to the air sacs (alveoli) in the lungs

• Chronic (long-term) bronchitis – inflammation and narrowing of the airways

COPD symptoms

COPD makes it increasingly harder to breathe. It develops slowly over many years. Many people with the condition don't have any noticeable symptoms until they’re in their late 40s or 50s.

The main symptoms of COPD include:

• Increasing breathlessness

• Wheezing

• A persistent chesty cough with phlegm (mucus)

• Frequent chest infections

COPD symptoms usually worsen over time, making it increasingly difficult to do everyday activities. But treatment can help slow its development.

Other COPD Symptoms

Some less common symptoms, which tend to happen when COPD is at a more advanced stage, include:

• Tiredness/lack of energy

• Unintended weight loss

• Swelling of the ankles, feet and legs (oedema)

• Chest tightness or pain

COPD exacerbation
Sometimes COPD symptoms can suddenly get worse – this is known as a flare-up or exacerbation. Flare-ups are common and often happen during the winter months. They can last for several days or weeks and may require additional medical treatment or hospitalisation.

It's vital to get immediate medical attention if your symptoms become very severe. You may not be able to catch your breath, your lips or fingernails may go blue (cyanosis), or you may feel confused and struggle to concentrate.

What causes COPD?

COPD happens when the lungs and airways become damaged, inflamed, and narrowed. The leading cause of COPD is usually long-term exposure to cigarette smoke, but it can also affect people who have never smoked.

COPD main causes

Some of the critical things that can increase the risk of getting COPD include:

• Smoking – cigarettes are responsible for around 9 in every 10 cases of COPD because the harmful chemicals damage the lining of the lungs and airways.

• Chemicals – exposure to dust, certain chemicals, and fumes at work.

• Air pollution - some research suggests being exposed to air pollution over a prolonged period may cause COPD.

• Genetics – COPD appears to run in families. There is also a rare genetic condition called alpha-1-antitrypsin deficiency, making some people very susceptible to developing COPD at a young age.

What are the stages of COPD?

COPD has four stages ranging from mild to very severe:

Stage 1: mild
At this stage of the disease, people often do not realise they have a chronic lung condition. The symptoms are mild with an occasional cough and some shortness of breath.

Stage 2: moderate
As COPD progresses, the symptoms become more constant and start to affect daily life. In stage two, it can become increasingly difficult to breathe. Coughing may become more persistent with phlegm (mucus). Some people may experience wheezing and tightness in the chest. Tiredness and trouble sleeping may also be an issue.

Stage 3: severe
Stage three COPD has a significant impact on normal day-to-day activities. People in this stage of the disease experience more flare-ups (sometimes referred to as COPD exacerbations). Breathing and coughing get worse with more phlegm, and you may tire more easily. Other symptoms in the severe stage may include swelling in the ankles, feet, and legs (oedema), chest tightness, wheezing and more rapid breathing when doing basic tasks.

Stage 4: very severe (end-stage COPD)
At stage four of the disease (sometimes referred to as end-stage COPD), many of the symptoms experienced in the earlier stages, like shortness of breath, coughing with phlegm and fatigue (excessive tiredness) are significantly worse. Breathing can take a lot of effort, and people can feel out of breath, even while not doing anything. Flare-ups (exacerbations) may also become more frequent and severe.

When to see a GP

You should make an appointment with a GP if you’re having symptoms, such as:

• Shortness of breath

• Persistent chesty cough

• Increased phlegm when coughing

• Wheezing

• Frequent chest infections

A GP will listen to you, discuss your symptoms and may:

• Examine your chest and listen to your breathing using a stethoscope

• Ask about your lifestyle and if there is a family history of lung problems

• Arrange a spirometry test to find out how well your lungs are working

• Extra tests may be recommended such as a chest X-ray or blood test

Managing COPD

Effective treatment for COPD can help slow its development and control the symptoms.
Recommended treatments may include:

• Lifestyle advice, like stopping smoking

• Tablets or inhalers to improve breathing and help prevent any flare-ups.

• Pulmonary rehabilitation – an exercise and education programme

Living with COPD
It can sometimes feel challenging living with COPD but making some small changes can help:
Eat a healthy, well-balanced diet
Exercise regularly
Take prescribed medication
Get your annual flu vaccination
Learn to control breathing
Try to avoid things that will aggravate your condition (e.g., dust, smoke, traffic pollution, etc.)
Take things slowly and plan ahead
Talk to friends and family for support