What is Chronic Obstructive Pulmonary Disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is where air cannot get out of the lungs easily (the airflow is obstructed). COPD is a common condition that mainly affects middle-aged or older adults who smoke or have smoked. Jobs where people are exposed to dust fumes and chemicals also increase the risk of COPD, as well as having chest trouble or asthma in childhood.

COPD includes long-term (chronic) bronchitis and emphysema:

• Bronchitis means the airways are inflamed and narrowed. People with bronchitis often cough up phlegm. Bronchitis can be a short-term (acute) infection, but for people with COPD, bronchitis is long-term (chronic). You can read more about acute bronchitis on the NHS website.
• Emphysema affects the tiny air sacs at the end of the airways in your lungs, where oxygen is taken up into your bloodstream. These air sacs break down and the lungs become baggy and full of bigger holes which trap air, making it harder to breathe.

These conditions can often occur together. In both conditions the airways become narrowed. This makes it harder to move air in and out as you breathe, and your lungs are less able to take in oxygen and get rid of carbon dioxide.

Your airways are lined by muscle and elastic tissue. In a healthy lung, the springy tissue between the airways pulls on the airways to keep them open. In a lung with COPD, the airways are narrowed because:

• the lung tissue is damaged so there is less pull on the airways
• mucus blocks part of the airway
• the airway lining becomes inflamed and swollen.

COPD is a long-term condition with no current cure. However, there are treatments and medications to help you breathe more easily and help keep you active. There are also things you can do to self-manage your condition at home.

COPD affects people in different ways. Some people with the condition have only mild lung damage and few symptoms. Other people have very damaged lungs and can feel very breathless and limited in what they’re able to do – these people would be considered to have a severe case of COPD.

COPD usually develops because of long-term damage to your lungs from breathing in a harmful substance. This is usually cigarette smoke.

But COPD can also be caused from exposure to smoke from other sources and air pollution. Jobs where people are exposed to dust, fumes and chemicals can also contribute to developing COPD.

You’re most likely to develop COPD if:

• you’re over 35
• you are, or have been, a smoker, or
• you had chest problems as a child.

Some people are more affected than others by breathing in harmful substances. COPD does seem to run in families, so if your parents had chest problems then your own risk is higher. A rare genetic condition called alpha-1-antitrypsin deficiency makes people much more likely to develop COPD at a young age.

Symptoms include:

• getting short of breath easily when you do everyday things such as going for a walk or doing housework
• having a cough that lasts a long time
• wheezing
• coughing up more phlegm (mucus) than usual.

You might get these symptoms all the time. Or they might appear or get worse when you have an infection, or when you breathe in smoke or fumes.

If you have COPD that makes breathing very difficult, you could lose your appetite and notice you’ve lost weight. You may also find that your ankles swell because of a build-up of fluid (oedema). These are both symptoms of advanced COPD.

With COPD, you might experience flare-ups of your condition (these are also called acute exacerbations). This is where breathing and other symptoms get worse suddenly over a short period of time. As the underlying COPD gets more severe, some people may not be able to cope with this at home and may need to go to hospital for treatment. Sadly, despite treatment, a severe flare-up can be fatal. It’s thought that around 4% of people admitted to hospital with an acute COPD exacerbation will die.

In the UK there are 1.3 million people with a diagnosis of COPD. And each year, around 30,000 people die in the UK from COPD. It’s important to talk to your doctor or nurse about longer-term treatments and advance care planning. This means thinking about what you would like to happen if your condition gets worse, or you experience more severe flare-ups, to help your family and your doctor to understand your wishes. Read more information on advance care planning and taking control of your choices.

With COPD, your airways have become narrowed permanently – inhaled medication can help to open them up, but only to some extent.

With asthma, the narrowing of your airways comes and goes. It often happens when you’re exposed to a trigger – something that irritates your airways – such as dust, pollen or tobacco smoke. Inhaled medication can open your airways fully and relieve symptoms by relaxing your airways.

So, if you have symptoms like feeling breathless, cough, wheeze or a tight chest and these are much better on some days than others, or if you often wake up in the night with symptoms, it could be that you have asthma.

Because the symptoms are similar and because people who have asthma can go on to develop COPD in later life, it is sometimes difficult to distinguish the two conditions.

Additionally, some people have both COPD and asthma.