Chronic Obstructive Pulmonary Disease (COPD)

Overview

Chronic obstructive pulmonary disease (COPD) is a long-term lung condition caused by damage to the airways and/or other parts of the lung. Long-term inflammation and airway remodeling can cause airflow limitation and make patient hard to breathe. COPD patients usually experience chronic long-lasting cough that may produce a slimy substance called mucus or sputum. COPD patients may also experience breathing problems, shortness of breath, wheezing, chest tightness, fatigue, frequent infections, and other symptoms.

COPD is a progressive disease, meaning symptoms develop slowly but worsen over time and can limit your ability to do routine activities. In severe cases, COPD can prevent people from doing even basic activities such as walking, cooking, or taking care of themselves.

The term COPD refers to two main conditions:

• Emphysema develops when there is damage to the walls between many of the air sacs in the lungs. When you breathe in, each air sac fills up with air, like a small balloon. In emphysema, the air sacs become bigger, fewer in number, and  irregular shape and this floppy pocket can no longer move air out efficiently, leading to air trapping.
• Chronic (long-term) bronchitis occurs when the lining of the airways is repeatedly or constantly irritated and inflamed, causing the lining to thicken and narrow. Large amounts of thick mucus form in the airways, making it hard to breathe.

Most people with COPD have a combination of emphysema and chronic bronchitis in different proportions. How serious each condition is varies from person to person.

COPD is a leading cause of death and disability in the United States. There is no cure, but treatments and lifestyle changes can help people feel better, stay more active, and slow the progress of the disease.

Signs and Symptoms

At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more serious.

Common symptoms of COPD include:

• Shortness of breath, especially during physical activity. It may feel like breathing takes more effort
• An ongoing cough or a cough that may produce a lot of mucus, sometimes called a “smoker’s cough.” This is often the first symptom of COPD
• Wheezing or a whistling or squeaky sound when breathing
• Chest tightness or heaviness, which may make it hard to take a deep breath or make it painful to breathe
• Fatigue or extreme tiredness
• Excess sputum production
• Feeling unable to breathe or take a deep breath

Not everyone with these symptoms has COPD, and not everyone with COPD has all these symptoms. A healthcare provider can diagnose this condition. You may also have additional conditions that need to be diagnosed and treated. It is very common for people with COPD to have other conditions, including heart disease.

If your symptoms are mild, you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. For more serious symptoms, such as becoming short of breath during physical work, your healthcare provider can provide treatments and other ways to help. Severe COPD can cause additional symptoms, such as lack of appetite, loss of weight and muscle, pulmonary hypertension, obstructive sleep apnea, osteoporosis, peripheral artery disease, anxiety, and depression.

Certain triggers, such as infections like the common cold or flu, poor air quality, cold air, smells, and/or a lung infection can lead to a sudden worsening of symptoms. When this happens, it is called a flare-up or an exacerbation.

During a flare-up, the person may experience:

• Chest tightness or a fever
• More coughing, or a change in cough (more mucus expelled)
• Coughing up yellow or green phlegm
• Unusually hard time catching one’s breath

The severity of the flare-up depends on the amount of lung damage the person has. Poor sleep or struggling to sleep can also increase increase the risk of a flare-up. Call a healthcare provider right away if symptoms worsen suddenly.

Related Health Effects

People with COPD face a higher risk of complications from other illnesses. People with COPD commonly have other conditions.

Heart

It is important for people with COPD to know about their heart health because heart and lung problems are often found together. During a COPD flare-up and in the weeks and months after, there is an increased risk of heart
attacks, strokes, and other cardiovascular events.

The most common condition among people with COPD is high blood pressure. Your healthcare provider can tell you your blood pressure numbers and talk to you about what they mean.

If you are at risk of another heart condition, such as heart failure, arrhythmia, heart disease, or peripheral artery disease, your provider will order additional heart tests. Learn more about heart treatments if you or a loved one has been diagnosed with a heart condition.

Frequent Colds

COPD increases frequency of colds or other respiratory infections, such as the flu, or influenza—and can increase serious problems related to infections. Flu also can cause serious problems for people with COPD.

COVID-19 has a higher risk of getting very sick in people with COPD. COVID-19 can affect the respiratory tract (including the nose, throat, and lungs), and possibly lead to pneumonia and acute respiratory disease.

Other Health Problems

Other health problems, such as obesity or peripheral artery disease, that are caused by similar risk factors (smoking or not getting enough physical activity), may also be present. These other health problems may, in turn, make COPD worse.

Smoking Prior to COPD

If you smoked before getting COPD, you may be at risk of developing lung cancer. Your provider may suggest yearly computed tomography (CT) scans to check.

Causes and Risk Factors

COPD most often occurs in people age 40 and over. Major risk factors include:

• Smoking: Cigarette smoking is the leading cause of COPD in the United States. E-cigarettes and vaping also increase risk. 
• Long-term exposure to lung irritants: These include secondhand smoke, air pollution, chemical fumes, dust from the environment or workplace, smoke from home cooking, and heating fuels used without ventilation.
• Changes to lung growth and development: Conditions affecting the lungs when a baby is still in the uterus or during childhood can increase the risk. Examples include smoking in pregnancy or childhood asthma. Air pollution can also limit the growth of a child’s lungs and increase their risk of developing COPD.
• Infections: Conditions such as HIV and tuberculosis can raise COPD risk.
• Genetic conditions: A genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause COPD. Other potential genetic risk factors include vitamin D deficiency, and mutations in CHRNA genes.

How Does COPD Affect Men and Women Differently?

COPD affects both men and women. However, COPD may affect men and women differently. Rates of COPD in all age groups under 75 are higher among women than men.

The reason for the differences in COPD between men and women is not known. Researchers think the cause may be related to hormones or other physiological differences, or differences in biology. Women also have smaller lungs than men do, which may make their airways more prone to narrowing when exposed to irritants.

Women may be more likely to be diagnosed with severe COPD that develops relatively early, before 55 years old. Most people with COPD who never smoked are women.

Disease Burden

• Compared with older men, older women may be more likely to experience serious symptoms of COPD, such as severe shortness of breath, even if they smoke less during their lifetime than men.
• More women than men are hospitalized for COPD.
• Women who have COPD tend to have more flare-ups.
• Women with COPD are also more likely than men with COPD to struggle with anxiety and depression.

Prevention Guidance

COPD often can be prevented, mainly by not smoking. Here are five key steps everyone at risk can take:

• Quit smoking. Quitting is the best way to prevent more damage to the lungs. Ask a healthcare provider about programs and products to help quit smoking. Call the CDC Quitline at 1-800-QUIT-NOW or visit smokefree.gov for resources.
• Avoid other lung irritants. Stay away from things that could irritate the lungs, like dust, strong fumes, secondhand smoke, and air pollution. Stay indoors when outdoor air quality is poor.
• Visit a healthcare provider regularly. Make a list of breathing symptoms to share with the provider. Talk about getting a spirometry test.
• Stay up to date on vaccines. Get a flu shot every year. Get vaccinated against pneumococcal disease. Talk to a doctor about COVID-19 vaccination.
• Talk to your employer. If exposed to lung irritants at work, ask about ways to limit exposure.

Diagnosis

The sooner COPD is diagnosed and treated, the better the person will breathe. Physicians report one of the biggest barriers to diagnosing COPD is that patients do not fully report their symptoms or smoking history.

Ask for a Lung Function Test If You:

• Are over age 40
• Are or were a smoker
• Feel out of breath often
• Bring up a lot of mucus when coughing
• Have already been diagnosed with a lung disease
• Have alpha-1 antitrypsin (AAT) deficiency
• Are concerned about lung health

COPD diagnosis is based on:

• Signs and symptoms: Chronic cough, excess sputum
• Personal and medical history: Smoking history or exposure to lung irritants such as secondhand smoke, air pollution, chemical fumes, or dust
• Lung function tests: Especially spirometry

Spirometry

The main test for COPD is spirometry. It is a quick, simple, and noninvasive breathing test that measures how much air a person can blow out of their lungs (volume) and how fast they can blow it out (flow).

Here is what to expect during a spirometry test:

• The patient is seated. A technician will place a clip on their nose so they can breathe only through the mouth.
• A mouthpiece connected to a machine measures how well the person breathes.
• The technician asks the patient to take a deep breath, then blow all air out as fast as possible. This gets repeated a few times. It is painless, but it does take some effort.

Spirometry can detect COPD before symptoms become severe. It can also help determine whether other conditions, such as asthma or heart failure, are causing the symptoms.

Other Diagnostic Tests

Other tests that may be used include:

• Chest X-ray or chest computed tomography (CT) scan
• Arterial blood gas test
• Lung diffusion capacity test

Treatment and Management

There is currently no cure for COPD. However, lifestyle changes and treatments can greatly improve quality of life, help people stay more active, and slow the progression of the disease.

Medicines

Two of the most common medicines to treat COPD are bronchodilators and inhaled steroids:

• Bronchodilators usually come in an inhaler and work to relax and open the muscles around the airways, making it easier to breathe.
• Inhaled steroids help prevent the airways from getting inflamed.
• Targeted biologics approved by FDA include dupilumab and mepolizumab.
• Antibiotics can help if there is a bacterial infection.

The healthcare provider may also recommend other types of medicines, including anti-inflammatory agents.

Pulmonary Rehabilitation

Pulmonary rehabilitation is a personalized treatment program that includes exercise training, COPD management education, and breathing techniques. Sometimes psychological or nutritional counseling is included. It can help those with COPD breathe easier and improve quality of life by staying active and carry out day-to-day tasks. Two out of three people who participate in pulmonary rehabilitation report positive outcomes.

A pulmonary rehabilitation team may include:

• Doctors and nurses
• Respiratory therapists who teach breathing strategies
• Exercise specialists who help improve endurance and muscle strength
• Physical therapists who teach energy-conserving techniques
• Dieticians who offer nutritional counseling
• Psychologists who help manage depression, anxiety, and overall mental health

Physical Activity Training

A healthcare provider or a pulmonary therapist may teach activities to strengthen arms and legs, as well as breathing exercises that strengthen the muscles needed for breathing.

Oxygen Therapy

Oxygen therapy is a treatment that delivers oxygen for you to breathe, typically from tubes resting in your nose or from a face mask. You may need oxygen therapy if you have a condition that causes your blood oxygen levels to be too low.

Oxygen therapy can be given for a short or long period of time in the hospital, in another medical setting, or at home. Oxygen poses a fire risk, so you should never smoke or use flammable materials when using oxygen. You may experience side effects from this treatment, such as a dry or bloody nose, tiredness, and morning headaches. Oxygen therapy is generally safe.

Surgery

Surgery may benefit some people who have COPD. It usually is an option only when serious symptoms have not improved with medicines.

• 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.
• Stents, or small mesh tubes, can help release air trapped in the lungs or keep airways open.
• 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 reenter.
• Lung volume reduction surgery removes damaged tissue from the lungs and helps the lungs work better.

Lung Transplant

A lung transplant is surgery to remove a diseased lung and replace it with a healthy lung. Lung transplants are used to improve quality of life and extend the lifespan for people who have severe or advanced chronic lung conditions that do not respond to other treatments.

During a lung transplant, you will be given general anesthesia and will not be awake for the surgery. A surgeon will open your chest, cut the main airway and blood vessels, and remove your diseased lung. The surgeon will connect the healthy donor lung, reconnect the blood vessels, and close your chest. After the surgery, you will recover in the hospital for 1 to 3 weeks. After leaving the hospital, you will visit your healthcare provider often to make sure that you are recovering well.

To help prevent your body from rejecting the new lung, you will need to take medicines that suppress your immune system for the rest of your life. Practicing good hygiene, getting annual vaccines, and adopting healthy lifestyle choices such as heart-healthy eating and not smoking are also very important.

Healthy Lifestyle Choices

Lifestyle changes can also slow the progression of the disease:

• Don’t smoke.
• Drink plenty of fluids, include high-fiber foods in the diet, and avoid foods high in sodium.
• Stay physically active. Physical activity can strengthen the muscles that help us breathe.
• Take care of mental health.

Living With COPD

Managing COPD is an ongoing process.

Manage COPD at Home

• Join a COPD self-management program. Ask your healthcare provider for a program that will help you learn about COPD and interventions that can make it easier to manage the disease and have a better quality of life. This might help you deal with fatigue, for example.
• Talk to your provider about following an eating plan that will meet your nutritional needs. If you have trouble eating enough because of symptoms such as shortness of breath and fatigue, you may not get all the calories and nutrients you need. This can make your symptoms worse and raise your risk for infections. Your doctor may suggest eating smaller meals more often throughout the day, resting before eating, and taking vitamins or nutritional supplements. Eating a healthy diet with fresh fruits and vegetables, whole grains, and fish may also help protect your lungs.
• Ask your provider what types of activities you can safely do. You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness.
• Put items you use often in one easy-to-reach place. Find simple ways to cook, clean, and do other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things.
• Ask for help in making things more accessible in your house so that you will not need to climb stairs as often.
• Keep your clothes loose-fitting and wear clothes and shoes that are easy to put on and take off.
• Use your medicines as recommended. Make sure you are using the inhaler correctly. It is normal for patients to have problems with their inhaler, so do not worry about asking your healthcare team multiple times how to use it. There are many different inhaler types, and the best type for you might change over time. Take your inhaler when you visit your healthcare provider so they can give you advice or see if you need a change.
• Stay indoors when air quality is poor and consider using an air filter. Air pollution can make it harder to breathe and worsen other symptoms of COPD. It can also lead to more flare-ups and make them worse. These threats to the health of people with COPD may grow as climate change increases the frequency of wildfires and periods of extreme heat.
• See a dentist regularly and brush your teeth often to maintain good oral health.
• If you experience heartburn, ask your provider to recommend ways to reduce it. Reflux can increase your risk of a flare-up.

Work with a Doctor

• See a healthcare provider on a regular basis.
• Bring a list of all current medicines to each office visit.
• Tell the doctor if symptoms worsen or if new ones developed.
• Ask questions about the disease, symptoms, and treatment options.
• Ask about breathing techniques.
• Ask how to use an inhaler correctly.

Prepare for Medical Emergencies

Keep vital information in an easy-to-find place:

• A list of all medicines taken for COPD and other conditions
• Contact information for the doctor, including office and emergency phone numbers
• Directions to the doctor’s office and the nearest hospital
• Contact information for people to reach if unable to speak or drive
• Health insurance card or information

Get the Most Out of the Provider Visits

• Log symptoms for the days or weeks before the appointment and bring the log to the doctor.
• Write down questions before the visit to remember to ask them.
• Bring a family member or friend if possible. Two sets of ears are always better than one.
• Learn about COPD before the visit to be prepared.

Avoid Flare-Up Triggers

Certain triggers may cause a sudden worsening of COPD symptoms.

• Avoid lung irritants like fumes, dust, and smoke.
• Stay inside with windows closed when air quality is at unhealthy levels.
• Avoid cold temperatures.
• Try to avoid being around sick people. Consider wearing a mask in public indoor places.

Support for Mental Health

Living with COPD may cause fear, anxiety, depression, and stress. Talking to your healthcare provider or a professional counselor may help. If you are depressed, your provider may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with COPD. You can see how other people with similar symptoms have coped. Talk with your provider about local support groups or check with an area medical center.

Caregivers, friends, and family provide an important support network that can help stay on track with treatment and identify symptoms. Support from family and friends can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on COPD.

Find Treatment

• COPD Foundation
• American Lung Association
• Quit Smoking Resources on smokefree.gov
• American Thoracic Society

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

As part of its broader commitment to research on lung diseases, the NIH leads and supports research and programs on COPD in the United States and around the world. Research supported by the NIH has shown that certain treatments and lifestyle changes, such as quitting smoking, can help people with COPD stay more active and slow the progression of the disease. Current studies look at the potential benefits of treating COPD in its earliest stages.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  

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