Chronic obstructive pulmonary disease (COPD) is a disease that damages the lungs, making it difficult to breathe. It’s a progressive disease, meaning it gets worse over time. The disease decreases air flow in the lungs, causing breathing difficulty.
COPD is the fourth leading cause of the death in the United States. It is the third leading cause of death in the world.
What is COPD?
COPD is an umbrella term used to describe a series of progressive lung diseases characterized by difficulty breathing. The two primary COPD diseases are:
Emphysema results in damage to tiny air sacs in the lungs where oxygen transfers into the bloodstream. The air sacs lose their elastic quality and ability to stretch and shrink back. This damage can also destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, air may become trapped in the lungs and hard to breathe out.
Chronic bronchitis is a condition in which the bronchial tubes are regularly irritated or inflamed. This causes the lining of the bronchial tubes to thicken. Excess mucus develops, leading to coughing, wheezing and shortness of breath.
In addition, the bronchial tubes may lose their cilia. Cilia are tiny hairs that move mucus so it can be coughed out.
Who develops COPD?
It’s estimated 30 million Americans have COPD, according to the nonprofit COPD Foundation. Millions more may be undiagnosed or misdiagnosed with asthma – and not getting proper treatment.
Most COPD patients develop the condition after the age of 40 following years of exposure to something that irritates the lung. For most it’s tobacco smoke from cigarettes. Other risk factors for developing COPD include exposure to lung irritants. These may include long-term exposure to air pollution, workplace chemical fumes or secondhand smoke.
If you smoke, then it’s critical that you quit smoking. Cigarette smoking can not only cause lung damage but also put you at higher risk for heart disease. Not smoking is the single most important thing you can do to slow the rate of lung function decline, regardless of COPD disease severity. Ask your healthcare provider about cigarette smoking cessation programs.
Learn more on how to quit smoking or vaping
What are the symptoms of COPD?
- Increased shortness of breath
- Frequent coughing (with or without mucus) or chronic cough
- Increased breathlessness
- Chest tightness
- Frequent colds
- Nose and throat infections
- Fatigue or tiredness
Late stages of COPD may include worsening of current symptoms as well as weight loss, muscle loss or an increased risk for depression or anxiety.
How is COPD diagnosed?
A proper COPD diagnosis is key so people with the condition can get on a treatment plan right away. Doctors ask for your full health history, discuss your symptoms, and conduct a physical exam. Then they may conduct one of several lung function tests. These breathing tests may include:
A breathing test called spirometry gauges your body’s peak expiratory flow (PEF) rate. It measures how fast you can blow air out using maximum effort, your lung capacity and how well the lungs are working. Spirometry can also evaluate how well COPD treatment is working.
Chest computer tomography (CT) scan
A CT scan is a chest imaging test conducted in a medical imaging facility or hospital. It takes detailed pictures of your lungs and the inside of your chest. CT imaging tests can help figure out the cause of lung symptoms such as shortness of breath or chest pain. It can also tell your doctor if you have certain lung problems such as a tumor, excess fluid around the lungs that is known as pleural effusion, or pneumonia.
A chest X-ray is a fast and painless imaging test to look at structures in and around your chest. It can be done in the doctor’s office, clinic or hospital. The X-ray can help diagnose and check conditions such as pneumonia, lung cancer and lung tissue scarring, called fibrosis. Doctors may use chest X-rays to see how well certain treatments are working. They may also check for complications after procedures or surgeries.
Arterial blood gas test
This blood test measures the oxygen and carbon dioxide levels in your blood. The blood test is usually done in a doctor’s office or a hospital.
What are the treatments for COPD?
COPD disease control is essential. Several different types of medications are used for treating COPD. Some medications are delivered by metered-dose or dry powder inhalers, while others are delivered through a nebulizer. Nebulizers are electric or battery-operated devices that turn liquid medicine into a fine mist that can be inhaled via a mouthpiece or face mask. Other medications may be taken as oral medications.
Medications for COPD:
- Bronchodilators relax and open the airways to relieve COPD symptoms.
- Controller medications (anti-inflammatory) are used to reduce and prevent lung inflammation.
- Combination inhaler medications combine more than one type of COPD medication in one device.
- Phosphodiesterase-4 (PDE-4) inhibitors
In addition, antibiotics may be prescribed to respiratory infections that can worsen COPD.
Always use your COPD medication as prescribed. do not stop using the medication even when you are symptom-free and feeling well.
Bronchodilators relax tight muscles in the airways and relieve symptoms such as coughing, wheezing and shortness of breath. Bronchodilators can be both short-acting or long-acting.
What are the different types of bronchodilators for asthma?
- Short-acting beta-agonist bronchodilators (quick relief): You may sometimes hear these referred to as short-acting beta-agonists, or SABA. These include albuterol and levalbuterol. When using these quick-relief medication, COPD symptom relief starts almost immediately and lasts 3-6 hours. This is the medicine you should use if you are experiencing a sudden onset of COPD symptoms. You may also be advised to use it prior to activities that may expose you to COPD triggers.
- Long-acting beta-agonist bronchodilators: You may also hear these referred to as long-acting beta-agonists, or LABA. These include arformoterol, formoterol, olodaterol, salmeterol and vilanterol. Taken daily, LABA medications relieve symptoms for 12 to 24 hours. They are designed to prevent and reduce inflammation in the airways.
- Short-acting muscarinic antagonist (SAMA): These medications are also called anticholinergics. SAMA medications provides relief from symptoms for 6 to 8 hours. They are designed to relax and open the airways and clear mucus from the lungs. The primary SAMA medication is ipratropium bromide.
- Long-acting muscarinic antagonist (LAMA): Taken daily, these are longer lasting anticholinergics, providing relief for 12 to 24 hours. LAMA medications include aclidinium bromide, tiotropium and umeclidinium.
Controller medications are typically corticosteroids, which can be taken by inhaler or tablet. They are anti-inflammatory medications, meaning they help reduce airway inflammation and swelling. This helps prevent COPD flares before they can start. They can also help reduce mucus.
After using an anti-inflammatory medication, it takes time for airway swelling to subside and the mucus to clear out of the airways. Keep using the medication as directed, even if you don’t feel anything happening right away.
What are different types of controller medications for COPD?
- Inhaled corticosteroids can reduce and prevent airway inflammation and swelling. They are not typically prescribed just for COPD. Doctors usually prescribe them as part of a combination with a LABA and/or LAMA.
- Oral corticosteroids are pills used to treat acute COPD flares. They are usually prescribed only for short periods of time (5-7 days). Taken as prescribed, they gradually reduce COPD symptoms and open the airways. The dosage of oral corticosteroids is 10 times the dose of inhaled corticosteroids. As a result, there is an increased risk of side effects. These may include weight gain, insomnia, headaches, and easy bruising of the skin. Side effects may also include mental health problems, including moodiness and depression.If taking oral corticosteroids long-term, side effects can be even more problematic. These may include eye problems, onset of diabetes, increased risk of infections and thinning bones. Patients should talk with their doctor about the risks vs. benefits of long-term oral corticosteroid use.
Note: When you hear the term “steroids” in respiratory care, it refers to corticosteroids. These are NOT related in any way to the anabolic steroids used illegally in body building.
Combination medications combine two or even three medications into one inhaler. The devices may contain an anti-inflammatory inhaled corticosteroid, a SABA, LABA and/or LAMA.
What are different types of combination medications for COPD?
- Inhaled corticosteroids and LABA combinations: these are taken on a daily basis to reduce airway inflammation and relieve COPD symptoms. Most are taken once every 12 hours. One is taken once a day. These medication combos include budesonide/formoterol, fluticasone/salmeterol and fluticasone/vilanterol.
- Inhaled corticosteroid, LABA and LAMA combinations: these 3-in-1 inhalers treat COPD on multiple fronts. They are taken daily to relieve airway inflammation, open airways and relieve COPD symptoms. These inhalers include fluticasone/umeclidinium/vilanterol and budesonide/glycopyrrolate/formoterol.
- Inhaled LABA and LAMA combinations: these are taken daily to relax and open up breathing passages and relieve symptoms. These medication combos include umeclidinium/vilanterol, tiotropium/olodaterol, aclidinium bromide/formoterol, and glycopyrrolate/formoterol. The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report recommends LAMA and/or LAMA as an optimal first-line treatment option for most patients with COPD, regardless of exacerbation risk
- Inhaled SABA and SAMA: these medications relax and open up the airways and relieve symptoms within 15 minutes after a dose. It can be taken four times per day. The combination is ipratropium bromide and albuterol.
Phosphodiesterase-4 (PDE-4) inhibitors
PDE-4 inhibitors are approved for severe COPD and chronic bronchitis to reduce lung inflammation and ease flare-ups. This is an oral medication that comes in a tablet form called roflumilast.
Antibiotics are used to treat a respiratory infection (such as acute bronchitis or pneumonia) that can make COPD worse. People with COPD tend to have more respiratory infections.
Important: Be sure to talk with your doctor about the potential for side effects with COPD medications, particularly oral corticosteroids and PDE-4 inhibitors.
Additional treatments for COPD:
Oxygen therapy may be used if a person’s oxygen level is too low.
Pulmonary rehabilitation is a whole-body approach treatment of COPD.
Surgical interventions are usually a last resort for people who have severe COPD symptoms that have not improved with taking medicines.
Are biologics available for COPD? Not yet. But there are multiple ongoing studies evaluating biologics for COPD.
Some people with COPD may need extra oxygen to help improve their daily breathing. Many different types of devices are available, including portable units.
Oxygen therapy is a treatment that delivers oxygen for people to breathe. Oxygen therapy can be delivered from tubes resting in the nose, a face mask, or a tube placed in the trachea (windpipe). People may need oxygen therapy if the blood oxygen levels become too low.
Some people with COPD on extra oxygen will only need it while sleeping or during certain activities. Others may need it all the time.
Oxygen therapy is generally safe. Side effects may include a dry or bloody nose, tiredness and morning headaches. Oxygen poses a fire risk, so you should never smoke or use flammable materials when using it.
Pulmonary rehabilitation (or pulmonary rehab) is a supervised whole-body approach to COPD care. It includes COPD education, exercise training, nutrition counseling, health education, breathing techniques, and more. Pulmonary rehab is also used for other chronic obstructive lung disease conditions.
Benefits of pulmonary rehab include:
reduce risk of COPD flares and shorten hospital stays
make it easier to manage routine activities, work, and outings or social activities
reduce symptoms of anxiety or depression
improve quality of life
Bullectomy removes one or more very large bullae from the lungs. Bullae are larger air spaces that form when the walls of the air sacs are destroyed. These air spaces can become so large that they interfere with breathing.
One-way endobronchial valves can be implanted in one of your bronchial tubes. These valves allow air to exit the damaged or diseased parts of the lung, but not re-enter.
Lung volume reduction surgery removes damaged tissue from the lungs and helps the lungs work better.
A lung transplant is surgery to remove a diseased lung and replace it with a healthy lung. Lung transplants are used to extend the lifespan for people who have severe or advanced chronic lung conditions that do not respond to other treatments.
Does asthma lead to COPD?
Asthma by itself does not lead to COPD. But a person whose lungs are damaged by poorly controlled asthma and continued exposure to irritants such as tobacco smoke is at increased risk of developing COPD.
It’s possible for people to have both diseases – this is called Asthma-COPD Overlap, or ACO. Delayed diagnosis is common with ACO.
ACO treatment involves aggressive medication – usually inhaled corticosteroids and a combination of medications that include a long-acting beta-agonist and a muscarinic antagonist. If asthma or COPD symptoms worsen or persist, request a lung function test from your doctor.
Pulmonary Rehabilitation Infographic Transcript
Pulmonary Rehabilitation — Live Better and Live Longer
Pulmonary Rehabilitation and Mortality
- COPD is the 3rd leading cause of death worldwide
- More than 16 million people diagnosed with COPD in the US
Pulmonary Rehabilitation Improves Outcomes
- Increase in exercise capacity
- Increase in your quality of life
- Decrease in the number of exacerbations
Pulmonary Rehabilitation Saves Lives
- But only 3-4% of Medicare beneficiaries with COPD receive Pulmonary Rehabilitation
- 60% of COPD cases go undiagnosed
There is a 37% decrease in mortality for Medicare beneficiaries who received pulmonary rehabilitation within 3 months of hospital discharge
(Lindenauer et al., Association Between Initiation of Pulmonary Rehabilitation After Hospitalization for COPD and 1-year Survival Among Medicare Beneficiaries. JAMA 2020 May 12;323(18):1813-1823.)
There is a 33% decrease in lower risk of death in those with fibrotic interstitial lung disease who participated in 8-% or more of planned pulmonary rehabilitation sessions
(Guler S, et al. Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study. Thorax 2021. Aug 30; throaxjbl-2021-217361.)
Pulmonary rehabilitation helps patients feel better and live longer but is underutilized
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William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as Medical Director and a member of the Board of Directors with Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).