Chronic obstructive pulmonary disease (COPD)

What is COPD?

Chronic obstructive pulmonary disease, or COPD, is an umbrella term for a group of long-term lung conditions that make breathing progressively harder. It includes emphysema and chronic bronchitis, and many people with COPD have a mix of both.

What are the symptoms of COPD?

The most common symptoms are:

• breathlessness, especially when you're active
• a lasting cough that brings up phlegm, sometimes written off as nothing more than a smoker's habit
• wheezing
• getting chest infections often.

Symptoms tend to worsen gradually over months and years, and you may also have sudden spells where things get noticeably worse for a few days, called an exacerbation. In more advanced COPD, you might also notice a barrel-shaped chest or a bluish tinge to your skin or lips, both signs that your body isn't getting enough oxygen.

What are the causes of COPD and who is at risk?

By far the biggest cause is smoking: the more you've smoked, and for longer, the greater your chances of developing COPD. Exposure to secondhand smoke can also cause COPD. Occasionally, COPD can affect people who've never smoked. Extended exposure to harmful dust, fumes or chemicals, whether at work or elsewhere, can also lead to it, as can prolonged exposure to indoor air pollution from solid fuels used for cooking or heating.

A small number of cases stem from a rare inherited condition known as alpha-1 antitrypsin deficiency, leaving the lungs less able to withstand damage. You're also somewhat more likely to develop COPD as you get older, or if respiratory infections or asthma affected you as a child.

Are there different types of COPD?

The two most common conditions of COPD are chronic bronchitis and emphysema. Emphysema involves the tiny air sacs in your lungs becoming damaged and enlarged, and its main symptom is breathlessness. Chronic bronchitis, by contrast, is ongoing inflammation and narrowing in your larger airways, with a persistent cough as the main symptom.

Most people diagnosed with COPD have some degree of both, rather than a pure case of one or the other.

How is COPD diagnosed?

COPD is diagnosed based on your symptoms, whether you smoke or have smoked in the past and other risk factors and a breathing test (Spirometry).

The key test is spirometry, a simple breathing test that measures how much air you can blow out and how quickly, which helps confirm COPD and rule out conditions with similar symptoms, such as asthma. Other investigations include chest x ray and blood tests.

How is COPD treated?

COPD can't be cured, and any damage already done to your lungs can't be reversed, but treatment can ease symptoms and slow further decline.

If you smoke, quitting is the single most valuable thing you can do, at any stage of the condition. Beyond that, treatment usually includes:

• inhalers, starting with a short-acting one used as needed, moving to a longer-acting version, and sometimes a steroid inhaler too, if flare-ups keep happening
• pulmonary rehabilitation, a structured programme that combines exercise with education and can improve your fitness, confidence and quality of life
• tablets or capsules for some people, such as those that thin mucus or reduce airway inflammation, alongside short courses of steroids or antibiotics during a bad flare-up
• oxygen therapy at home, for people whose blood oxygen has dropped to a low level.

Surgery, including removing damaged lung tissue or, rarely, a lung transplant, is reserved for a small proportion of people whose COPD is severe.

When should I see a doctor?

Book an appointment with your GP if you have ongoing breathlessness or a cough that brings up phlegm, especially if you're in your late 30s or older and currently smoke, or once did. Don't put it off: starting treatment early, before your lungs are significantly damaged, makes a real difference.

If you've already been diagnosed, get in touch with your care team if your breathlessness is worsening, or your phlegm looks or smells different from usual. The same goes for a persistent fever, or swelling in your ankles or legs that doesn't settle overnight.

Call 999 or get to A&E straight away if your breathing suddenly becomes severely difficult, or your temperature spikes very high.

The same applies if:

• your speech becomes slurred
• you seem confused, restless or drowsier than usual
• Chest pain
• Racing heartbeat
• Recommended treatment is not working
• Lips, tongue or nail beds turning blue, grey or pale.