COPD (Chronic Obstructive Pulmonary Disease)
Progressive airflow obstruction, usually from smoking, causing breathlessness and cough.
Overview
COPD encompasses chronic bronchitis and emphysema. Smoking is the dominant cause. Symptoms progress slowly and exacerbations drive hospital admission. Treatment focuses on smoking cessation, inhalers, pulmonary rehabilitation and vaccination.
Symptoms
- • Breathlessness on exertion
- • Chronic cough with sputum
- • Wheeze
- • Frequent chest infections
- • Fatigue
Risk factors
- • Smoking (current or past)
- • Occupational dust/fume exposure
- • Indoor biomass smoke
- • Alpha-1 antitrypsin deficiency
- • Age >40
Causes
- • Tobacco smoke
- • Air pollution
- • Genetic alpha-1 antitrypsin deficiency
🚨 Red flags — seek urgent care
- • Severe breathlessness at rest
- • Blue lips or fingertips
- • Confusion or drowsiness
- • Coughing blood
When to seek care
- • Increased breathlessness or sputum change
- • Fever with worsening cough
- • Reduced exercise tolerance
Diagnosis
- • Post-bronchodilator spirometry showing FEV1/FVC <0.70 in a symptomatic patient with risk factors
- • GOLD grade by FEV1 % predicted (1 mild → 4 very severe)
- • Assess symptoms (mMRC / CAT) and exacerbation history to assign A/B/E group
- • Chest X-ray to exclude other pathology; consider HRCT and alpha-1 antitrypsin
Treatment
- • Smoking cessation — the single most effective intervention
- • Inhaled therapy stepwise: SABA/SAMA as needed → LABA + LAMA → triple ICS+LABA+LAMA if eosinophilic or exacerbating
- • Pulmonary rehabilitation for all symptomatic patients
- • Long-term oxygen therapy if PaO2 ≤7.3 kPa (or ≤8.0 kPa with cor pulmonale)
- • Exacerbations: prednisolone 30 mg 5 days, antibiotics if purulent sputum, controlled oxygen targeting SpO2 88–92%
Prevention
- • Avoid tobacco smoke (first- and second-hand)
- • Reduce occupational exposure to dusts and fumes
- • Annual influenza vaccination; pneumococcal and COVID-19 vaccines
- • Maintain physical activity
Complications
- • Acute exacerbations and hospitalisation
- • Respiratory failure (type 1 and type 2)
- • Pulmonary hypertension and cor pulmonale
- • Pneumothorax (from bullous disease)
- • Comorbid cardiovascular disease, osteoporosis, depression, lung cancer
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Does stopping smoking help once I have COPD?
Yes — stopping smoking is the single most effective treatment and slows progression at any stage.
Will stopping smoking now still help?
Yes — quitting at any stage slows further lung-function decline to near-normal rates, reduces exacerbations and is the single most effective treatment for COPD.
Do I need long-term oxygen?
Long-term oxygen is offered when resting oxygen saturation is persistently low (PaO₂ ≤7.3 kPa) and is used for at least 15 hours a day. It improves survival but only when used as prescribed.
What is pulmonary rehabilitation?
A structured 6–8 week programme of supervised exercise and education. It improves breathlessness, exercise capacity and quality of life as much as many inhaled treatments.